Effect of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Randomized, Multicenter Trial (EPICC Study)

Bailón, Manuel Méndez; Rodrigo, J.M. Cepeda; Lorenzo-Villalba, Noël; González, J.M. Cerqueiro; Curbelo, José; Manuel, Elpidio Calvo; Martín‐Sánchez, Francisco Javier; Freire, Ramón Bover; Romano, P. Cubo; Espinosa, Luís; Arévalo-Lorido, José Carlos; Casas-Rojo, José Manuel; Macho, J. Torres

doi:10.1007/s10557-019-06891-z

Cited by 10 publications

(12 citation statements)

References 25 publications

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“…Similarly, wrongful interpretation of ultrasound accompanied by unwarranted change of management may have undesired effects. Currently, several trials are either underway or recently published that may potentially provide higher quality evidence [ 36 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

et al. 2022

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Background Lung ultrasound has established itself as an accurate diagnostic tool in different clinical settings. However, its effects on clinical-decision making are insufficiently described. This systematic review aims to investigate the impact of lung ultrasound, exclusively or as part of an integrated thoracic ultrasound examination, on clinical-decision making in different departments, especially the emergency department (ED), intensive care unit (ICU), and general ward (GW). Methods This systematic review was registered at PROSPERO (CRD42021242977). PubMed, EMBASE, and Web of Science were searched for original studies reporting changes in clinical-decision making (e.g. diagnosis, management, or therapy) after using lung ultrasound. Inclusion criteria were a recorded change of management (in percentage of cases) and with a clinical presentation to the ED, ICU, or GW. Studies were excluded if examinations were beyond the scope of thoracic ultrasound or to guide procedures. Mean changes with range (%) in clinical-decision making were reported. Methodological data on lung ultrasound were also collected. Study quality was scored using the Newcastle–Ottawa scale. Results A total of 13 studies were included: five studies on the ED (546 patients), five studies on the ICU (504 patients), two studies on the GW (1150 patients), and one study across all three wards (41 patients). Lung ultrasound changed the diagnosis in mean 33% (15–44%) and 44% (34–58%) of patients in the ED and ICU, respectively. Lung ultrasound changed the management in mean 48% (20–80%), 42% (30–68%) and 48% (48–48%) of patients in the ED, in the ICU and in the GW, respectively. Changes in management were non-invasive in 92% and 51% of patients in the ED and ICU, respectively. Lung ultrasound methodology was heterogeneous across studies. Risk of bias was moderate to high in all studies. Conclusions Lung ultrasound, exclusively or as a part of thoracic ultrasound, has substantial impact on clinical-decision making by changing diagnosis and management in the EDs, ICUs, and GWs. The current evidence level and methodological heterogeneity underline the necessity for well-designed trials and standardization of methodology.

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Section: Discussionmentioning

confidence: 99%

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

et al. 2022

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“…A study (28) evaluated the left heart function of patients admitted to the cardiovascular department through the application of echocardiography and pulmonary ultrasound, the results have showed that the number of B-lines is related to the patients' New York heart function classification and left ventricular radiography, and LVEF is closely related to the degree of diastolic insufficiency. Besides, it's been reported that lung ultrasound examination can have a better predictive effect on the right heart pressure and PVR of patients with HF (29).…”

Section: Discussionmentioning

confidence: 99%

Combined use of cardiopulmonary ultrasound in the diagnosis of pulmonary edema in patients with heart failure: a retrospective analysis

Shen¹,

Chen²,

Yu³

2020

Cardiovasc Diagn Ther

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Background: Heart failure (HF) is generally complicated with pulmonary edema (PE), the early diagnosis and treatment is essential. We aimed to evaluate the effects of combined use of cardiopulmonary ultrasound in the diagnosis of PE in HF patients, to provide reference for the management of HF.Methods: HF patients treated in our hospital from January 1, 2019 to June 30, 2020 were included. All patients underwent echocardiography and lung ultrasonography, and analyzed the characteristics of patients and related detected results. Logistic regression analyses were conducted to identify the potential risk factors. And the receiver operating characteristic (ROC) curve was conducted to compare the predictive value of factors.Results: A total of 183 HF patients were included, the incidence of PE in HF patients was 62.84%.

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“…Considering the pathophysiologic rationale behind normalizing interstitial fluid and circulating volume, and lung ultrasonography's ability to affect these parameters, we believe that larger, well-designed trials might be able to identify important effects on clinical outcomes. There are currently several ongoing trials on lung ultrasonography-guided management that may provide further and higher quality of evidence (Bail on et al 2019;Russell et al 2019;Rusu et al 2019).…”

Section: Very Low ◌◌◌mentioning

confidence: 99%

Effects of Lung Ultrasonography-Guided Management on Cumulative Fluid Balance and Other Clinical Outcomes: A Systematic Review

Heldeweg

Jagesar

Haaksma

et al. 2021

Ultrasound in Medicine & Biology

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Lung ultrasonography is accurate in detecting pulmonary edema and overcomes most limitations of traditional diagnostic modalities. Whether use of lung ultrasonography-guided management has an effect on cumulative fluid balances and other clinical outcomes remains unclear. In this systematic review, we included 12 studies using ultrasonography guided-management with a total of 2290 patients. Four in-patient studies found a reduced cumulative fluid balance (ranging from À0.3 L to À2.4 L), whereas three out-patient studies found reduction in dialysis dry weight (ranging from À2.6 kg to À0.2 kg) compared with conventionally managed patients. None of the studies found adverse effects related to hypoperfusion. The use of lung ultrasonographyguided management was not associated with other clinical outcomes. This systematic review shows that lung ultrasonography-guided management, exclusively or in concert with other diagnostic modalities, is associated with a reduced cumulative fluid balance. Studies thus far have not shown a consistent effect on clinical outcomes.

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Effect of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Randomized, Multicenter Trial (EPICC Study)

Cited by 10 publications

References 25 publications

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

Combined use of cardiopulmonary ultrasound in the diagnosis of pulmonary edema in patients with heart failure: a retrospective analysis

Effects of Lung Ultrasonography-Guided Management on Cumulative Fluid Balance and Other Clinical Outcomes: A Systematic Review

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