Lung ultrasound for monitoring cardiogenic pulmonary edema

Abstract

Several studies address the accuracy of lung ultrasound (LUS) in the diagnosis of cardiogenic pulmonary edema (CPE) evaluating the interstitial syndrome, which is characterized by multiple and diffuse vertical artifacts (B-lines), and correlates with extravascular lung water. We studied the potential role of LUS in monitoring CPE response to therapy, by evaluating the clearance of interstitial syndrome within the first 24 h after Emergency Department (ED) admission. LUS was performed at arrival (T0), after 3 (T3) and 24 (T24) hours. Eleven regions were evaluated in the antero-lateral chest; the B-lines burden was estimated in each region (0 = no B-lines, 1 = multiple B-lines, 2 = confluent B-lines/white lung) and a mean score (B-Score, range 0-2) was calculated. Patients received conventional CPE treatment. Blood chemistry, vital signs, blood gas analysis, diuresis at T0, T3, T24 were also recorded. A complete echocardiography was obtained during hospitalization. Forty-one patients were enrolled. Respiratory and hemodynamic parameters improved in all patients between T0 and T3 and between T3 and T24. Mean B-score significantly decreased at T3 (from 1.59 ± 0.40 to 0.73 ± 0.44, P < 0.001) and between T3 and T 24 (from 0.73 ± 0.44 to 0.38 ± 0.33, P < 0.001). B-score was higher in the lower pulmonary regions at any time. At final evaluation (T24) 75 % of apical and only 38 % of basal regions were cleared. LUS allows one to assess the clearance of interstitial syndrome and its distribution in the early hours of treatment of CPE, thus representing a possible tool to guide therapy titration.

Serial Sonographic Assessment of Pulmonary Edema in Patients With Hypertensive Acute Heart Failure

“…The rate of improvement in sonographic pulmonary edema in our study was more rapid than that observed by Cortellaro et al, likely because of differences in our studied populations. Although our study was not designed to evaluate the rate of sonographic pulmonary edema improvement, it is notable that the median time for an 80% or greater reduction in sonographic pulmonary edema (in the 10 patients who attained this degree of improvement in the ED), was 86 minutes (IQR, 69–149 minutes).…”

“…In a heterogeneous cohort of patients with AHF, Cortellaro et al evaluated the dynamics of pulmonary decongestion over the initial 24 hours of treatment using a simplified scoring system that incorporated B‐line coalescence (0, no B‐lines; 1, multiple B‐lines; and 2, confluent B‐lines) across 11 lung zones. At 3 hours from admission, hemodynamic and respiratory vital signs improved significantly, and the B‐line score improved by 54%.…”

Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review

“…Results of the search and study selection are summarized in Figure . We identified six studies in emergency department (ED) or hospitalized patients with dyspnoea or AHF ( n = 25–152) ( Table ) . One investigation assessed the impact of the change from a sitting to a supine position in ED patients with prior HF .…”

“…Two AHF studies, which used the same 28‐zone quantification method, reported mean changes of 22 B‐lines [from a mean ± standard deviation (SD) of 53.4 ± 17.2 to 31.7 ± 13.5; P < 0.01] after 24 h of treatment and 28 B‐lines (from a mean ± SD of 48 ± 48 to 20 ± 23; P < 0.0001) between admission and discharge . Two other AHF studies examined B‐lines in 11 zones and found a significant reduction in ‘positive’ LUS zones (based on a score) in 3 h of HF therapy, and between admission and discharge . Only one of the publications reviewed reported temporal blinding of the ultrasound readers (supplementary material online, Table S2).…”

“…25,26 Two other AHF studies examined B-lines in 11 zones and found a significant reduction in 'positive' LUS zones (based on a score) in 3 h of HF therapy, and between admission and discharge. 23,27 Only one of the publications reviewed reported temporal blinding of the ultrasound readers 13 (supplementary material online, Table S2).…”