Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure

Li, Na; Zhu, Yan; Zeng, Jianping

doi:10.1002/clc.23738

Cited by 11 publications

(9 citation statements)

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“…Pulmonary congestion (PC) is one of the major characteristics of HF [ 6 , 7 , 8 ]. The importance of PC in the disease course of HF has been confirmed by numerous clinical trials, and the presence of PC is shown to be associated with a significantly increased risk of mortality and rehospitalization in HF patients [ 6 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Pérez-Herrero

Lorenzo-Villalba

Urbano

et al. 2022

JCM

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Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139–0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.

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Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Pérez-Herrero

Lorenzo-Villalba

Urbano

et al. 2022

JCM

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“…Eksempelvis er hjerteinfarktpasienter en utsatt gruppe til å få postinfarkt hjertesvikt med utvikling av lungeødem. Tidlig ultralyd og faste rutiner ved hjelp av fokusert ultra lyd kan guide og bedre pasientbehandlingen (44,45). Pleuravaeske og lungestuvning er således et tegn på hjertesviktforverring, men kan vaere utfordrende å oppdage uten bruk av ultralyd, grunnet lite fremtredende symptomer (45)(46)(47)(48).…”

Section: Diskusjonunclassified

Fokusert ultralyd utført av sykepleiere for å kartlegge hjertesykdom. En systematisk litteraturstudie

Rødseth,

Steindal,

Hofsø

2024

inspira

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Bakgrunn: Hjertesykdom medfører symptomer som kan være vanskelig å oppdage basert på kliniske undersøkelser, for både erfarne sykepleiere og leger. Fokusert ultralyd er en standardisert, men forenklet ultralydundersøkelse som raskt kan kartlegge viktige parametere knyttet til hjertesykdom. Bruk av ultralyd utført av sykepleiere blir stadig mer vanlig innen akutt- og intensivmedisin, men det mangler en systematisk litteraturstudie som undersøker sykepleieres presisjon til å utføre og tolke ultralyd for kartlegging av og behandling av hjertesykdom. Hensikt: Hensikten med denne systematiske litteraturstudien var å sammenstille forskning som undersøkte sykepleieres evne til å utføre og tolke fokusert ultralyd knyttet til primære og sekundære tilstander av hjertesykdom. Metode: Denne systematiske litteraturstudien ble gjennomført etter det metodiske rammeverket beskrevet av Booth og kollegaer, og ble rapportert i henhold til sjekklisten PRISMA 2020. Systematiske søk ble gjennomført 21. desember 2021 i Cinahl, Embase og Medline. Studier ble inkludert hvis de møtte følgende kriterier: 1) kvantitativ design; 2) inkluderte sykehuspasienter med alder over 18 år; 3) sykepleiere utførte eller tolket ultralyd (inkludert fokusert ekkokardiografi) i hjerteregionen; 4) data med sammenlikningsgrunnlag mellom sykepleier og ekspert; og 5) artikkel publisert på engelsk, norsk, svensk eller dansk i fagfellevurderte tidsskrift. Studieseleksjon og dataekstraksjon ble utført individuelt av par av forfattere. Kvalitetsvurdering av primærstudier ble utført etter sjekklister fra Joanna Briggs Institute. Resultatene ble sammenfattet i et beskrivende format. Resultat: Totalt 12 studier ble inkludert. Presisjon av utføring av undersøkelsen blant sykepleierne var i 57,4–98,8 prosent mot ekspert. Presisjon av tolkning viste r = 0,59–0,96, sensitivitet 64–98 prosent, spesifisitet 51–98 prosent, positiv prediktiv verdi 74–100 prosent, og negativ prediktiv verdi 82–98 prosent mot ekspert. Konklusjon: Sykepleiere kan tilegne seg kunnskaper til å utføre og tolke fokusert ultralyd i hjerteregionen. Samtidig beskriver primærstudiene sprikende resultater. Sykepleieres presisjon til å utføre og tolke ultralyd avhenger av opplæring, mengdetrening, klinisk setting, omfanget av ultralydundersøkelsene og det anatomiske område i hjerteregionen som ble skannet. ENGLISH ABSTRACT Use of focused cardiac ultrasound by nurses. A systematic review Background: Heart disease causes a number of symptoms that are difficult for both experienced nurses and physicians to detect based on physical examination. Focused ultrasound is a standardized but simplified ultrasound examination that quickly can discover and provide valuable information related to heart disease. The use of ultrasound is increasing in emergency and intensive care medicine, but there is a lack of a systematic review that examines nurses’ precision in performing and interpreting ultrasound, related to screening and treatment of heart disease. Aim: The aim of this systematic review was to describe nurses’ precision in performing and interpreting ultrasound related to primary and secondary conditions of heart disease. Methods: The systematic review utilized Booth and colleagues’ methodological approach and was reported according to the PRISMA 2020 checklist. Systematic searches in the databases Cinahl, Embase and Medline were conducted on 21. December, 2021. Studies were included if they had a 1) quantitative design; 2) included hospitalized patients aged 18 years or older; 3) nurses performed and/or interpreted ultrasound (and focused echocardiography) related to primary and secondary conditions of heart disease; 4) nurses performance and/or interpretation of ultrasound were compared against expert; and 5) articles written in English, Norwegian, Swedish, or Danish in peerreviewed journals. Pairs of authors independently assessed eligibility and extracted data. Quality appraisal and risk of bias was conducted using checklists from Joanna Briggs Institute. Results were summarized in a narrative format. Result: Twelve studies met inclusion criteria. Precision in feasibility resulted in 57.4–98.8 per cent against expert. Results of interpretation precision was r = 0.59–0.96, sensitivity 64–98 per cent, specificity 51–98 per cent, positive predictive value 74–100 per cent, and negative predictive value 82–98 per cent against expert. Conclusion: Nurses can obtain knowledge to perform and interpret focused ultrasound in the cardiac region. Primary studies described varying results. Precision appears to depend on training, clinical setting, the extent of the ultrasound examinations and the anatomical area of the cardiac region.

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“…The number of A lines and gray zones need not be taken into account while changing medication because there was no causal link between pulmonary congestion and the lung's ultrasonography B-Lines and A-Lines. The B-lines, a marker of lung congestion, might be semi-quantitatively quantified by lung ultrasonography (11). (Figure 1) illustrates the thoracic ultrasonography points method for the detection of pulmonary congestion.…”

Section: Clinical Applications and Significance; Reflection From Lite...mentioning

confidence: 99%

Utilization and Clinical Significance of Thoracic Ultrasonography

Kaabi¹,

Alattas²,

AlRshood³

et al. 2022

JOHS

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Imaging has made significant contributions to the understanding of lung diseases in critically ill patients in recent times. Thoracic ultrasonography is a real-time imaging technique that is easy to use, non-invasive, potentially widespread, and radiation-free. Its rising use in critical care and accompanying study findings, support its status as a new approach for bedside chest imaging. Imaging is now used to diagnose lung pathology, track its progression, and direct therapeutic strategy. It can be used repeatedly over time as a part of a dynamic clinical evaluation and is a useful tool for determining the etiology of a patient's shock or respiratory failure. The purpose of this research is to review the available information about utilization and clinical significance of thoracic ultrasonography. When it comes to diagnosing pneumothorax, pneumonia, pleural effusion, and pulmonary edema, thoracic ultrasonography is more reliable than a chest radiograph. The placement and confirmation of subclavian central lines is one of the crucial functions of thoracic ultrasonography. Following the insertion of a chest tube, lung ultrasonography may be beneficial for monitoring and assessing the pneumothorax's resolution. To determine the size and location of a mass on the chest wall and to assist with the mass lesion's biopsy, a thoracic ultrasonography may be efficient, practical, and affordable. In cases of pulmonary effusion, ultrasonography can be used to estimate the quantity of effusion. Additionally, thoracic ultrasonography was efficiently used in coronavirus disease- 2019 infection patients since it posed less of a threat to break airborne isolation and spread infection to others also showed significant findings.

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Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure

Cited by 11 publications

References 53 publications

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Fokusert ultralyd utført av sykepleiere for å kartlegge hjertesykdom. En systematisk litteraturstudie

Utilization and Clinical Significance of Thoracic Ultrasonography

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