Lung ultrasound in internal medicine efficiently drives the management of patients with heart failure and speeds up the discharge time

Abstract

Lung ultrasound (LUS) is a valid tool for the assessment of heart failure (HF) through the quantification of the B-lines. This study in HF patients aims to evaluate if LUS: (1) can accelerate the discharge time; (2) can efficiently drive diuretic therapy dosage; and (3) may have better performance compared to the amino-terminal portion of B type natriuretic peptide (NT-proBNP) levels in monitoring HF recovery. A consecutive sample of 120 HF patients was admitted from the Emergency Department (ED) to the Internal Medicine Department (Verona University Hospital). The Chest X-ray (CXR) group underwent standard CXR examination on admission and discharge. The LUS group underwent LUS on admission, 24, 48 and 72 h later, and on discharge. The Inferior Cava Vein Collapsibility Index, ICVCI, and the NT-proBNP were assessed. LUS discharge time was significantly shorter if compared to CXR group (p < 0.01). During hospitalization, the LUS group underwent an increased number of diuretic dosage modulations compared to the CXR group (p < 0.001). There was a stronger association between partial pressure of oxygen in arterial blood (PaO2) and B-lines compared to the association between PaO2 and NT-proBNP both on admission and on discharge (p < 0.001). The B-lines numbers were significantly higher on admission in patients with more severe HF, and the ICVCI was inversely associated with B-lines number (p < 0.001). The potential of LUS in tailoring diuretic therapy and accelerating the discharge time in HF patients is confirmed. Until the technique comes into common use in different departments, it is plausible that LUS will evolve with different facets

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

“…The novelty of this study is that it is the first randomized trial assessing the impact on LOS of a multi-organ focused ultrasound in internal medicine. Last year, Mozzini et al [51] described a positive impact of repetitive lung ultrasounds on the LOS in patients with heart failure admitted to the internal medicine ward. Based on their results, we are optimistic about finding a positive effect this time assessing a multi-organ focused ultrasound which not only evaluate lung but also heart and DVT.…”

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission. – Study protocol of a randomized controlled trial: the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

“…The novelty of this study is that it is the first randomized trial assessing the impact on length of stay of a multi-organ focused ultrasound in internal medicine. Last year, Mozzini et al (50) have described a positive impact of repetitive lung ultrasounds on the length of hospital stay in heart failure patients admitted to the internal medicine ward. Based on their results, we are optimistic about finding a positive effect this time assessing a multi-organ focused ultrasound which not only evaluate lung but also heart and deep venous thrombosis.…”

B‐lines by lung ultrasound predict heart failure in hospitalized patients with acute anterior wall STEMI

“…B-lines have been confirmed to be positively correlated with EVLW assessed by golden criteria such as post-autopsy gravimetry and trans-pulmonary thermodilution 7,20,23. With increasing EVLW, LUS images change from normal black lung without ultrasound signal or visible A-line (Figure 1) to black-white lung with multiple B-lines ,7 and the B Line decreases with decreasing EVLW after the application of diuretics 24.…”