Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review

Arvig, Michael Dan; Laursen, Christian B.; Jacobsen, Niels; Gæde, Peter; Lassen, Annmarie Touborg

doi:10.1007/s40477-021-00622-7

Cited by 10 publications

(10 citation statements)

References 51 publications

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“…It was showed that incorporating LUS results may enhance the predictive capability of contemporary HF risk scores [54]. However, the impact of repeated ultrasound scans on prognostic outcomes remains uncertain [58].…”

Section: Resultsmentioning

confidence: 99%

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Prognostic significance of Lung ultrasound for Heart Failure Patient Management in Primary Care. A Systematic Review

Panisello-Tafalla,

Montoya,

Caballol-Angelats

et al. 2024

Preprint

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Heart failure (HF) affects about 60 million people worldwide, making it one of the chronic conditions with the greatest health and economic impact. The primary objective was to assess the efficacy of lung ultrasound (LUS) in the management of HF in order to intervene early and reduce the rate of hospital readmissions. A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, including clinical trials, meta-analysis, systematic reviews, and original articles from 2019/1/1-2023/12/31, about LUS for the assessment of HF, on an outpatient basis, for HF diagnosis or/and decompensation. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 873 articles were identified of which 33 articles were selected: [n=19] focused on prognostic assessment of HF, [n=11] centred on multimodal diagnostic assessments, and [n=2] addressing therapeutic guidance for HF diagnosis. LUS exhibits advantages in the detection of sub-clinical congestion linked to prognostic significance in re-admission and mortality during out-patient follow-up, after hospital discharge, and in complex scenarios as the patients' homes or institutional long-term care facilities. However, there are considerable uncertainties in their interpretation and monitoring changes due to its lack of standardization. The need for an updated international consensus on the use of LUS seems obvious.

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Section: Resultsmentioning

confidence: 99%

“…3/ LUS-Guided Treatment: LUS-guided treatment was linked to a 45% reduction in the risk of hospitalization and a decrease in urgent visits [46,47,54,55,58] with follow-up since three months, six months up to one year. However, no significant differences in death rates were observed [46,47,55].…”

Section: Resultsmentioning

confidence: 99%

Prognostic significance of Lung ultrasound for Heart Failure Patient Management in Primary Care. A Systematic Review

Panisello-Tafalla,

Montoya,

Caballol-Angelats

et al. 2024

Preprint

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“…In particular, B-lines, which can be seen in the loss of peripheral lung aeration, for example, in cardiogenic and non-cardiogenic pulmonary oedema, and pneumonia, can resolve with treatment, especially in patients with heart failure. 6 7 However, in our systematic review leading to this trial, no studies reported an effect of treatment guided by serial PoCUS on the severity of dyspnoea. 6 …”

Section: Introductionmentioning

confidence: 88%

“… 6 7 However, in our systematic review leading to this trial, no studies reported an effect of treatment guided by serial PoCUS on the severity of dyspnoea. 6 …”

Section: Introductionmentioning

confidence: 88%

Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomised, controlled trial

Arvig,

Lassen,

Gæde

et al. 2023

Emerg Med J

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BackgroundSerial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. The objective was to investigate if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS and usual care could reduce the severity of dyspnoea compared with usual care alone.MethodsThis was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021. Patients aged ≥18 years admitted with a primary complaint of dyspnoea were allocated 1:1 with block randomisation to usual care, which included a single cardiopulmonary PoCUS within 1 hour of arrival (control group) or usual care (including a PoCUS within 1 hour of arrival) plus two additional PoCUS performed at 2 hours interval from the initial PoCUS (serial ultrasound group). The primary outcome was a reduction of dyspnoea measured on a verbal dyspnoea scale (VDS) from 0 to 10 recorded at inclusion and after 2, 4 and 5 hours.ResultsThere were 206 patients recruited, 102 in the serial ultrasound group and 104 in the control group, all of whom had complete follow-up. The mean difference in VDS between patients in the serial ultrasound and the control group was −1.09 (95% CI −1.51 to −0.66) and −1.66 (95% CI −2.09 to −1.23) after 4 and 5 hours, respectively. The effect was more pronounced in patients with a presumptive diagnosis of acute heart failure (AHF). A larger proportion of patients received diuretics in the serial ultrasound group.ConclusionTherapy guided by serial cardiopulmonary PoCUS may, together with usual care, facilitate greater improvement in the severity of dyspnoea, especially in patients with AHF compared with usual care with a single PoCUS in the ED. Serial PoCUS should therefore be considered for routine use to aid the physician in stabilising the patient faster.Trial registration numberNCT04091334.

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“…In a systematic review of 24 studies with 1900 hospitalized ADHF patients [ 66 ], a smaller IVC CI was associated with a 2.5-fold higher risk of readmission and higher mortality, and more B-lines correlated with a 1.5-fold increased risk of mortality and readmission.…”

Section: Comparison Of Techniques To Assess Intravascular Volume or R...mentioning

confidence: 99%

Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update

Kaptein

2023

Clinical Kidney Journal

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Goals of volume management are to accurately assess intravascular and extravascular volume and predict response to volume administration, vasopressor support, or volume removal. Data are reviewed that support the following: 1) Dynamic parameters reliably guide volume administration and may improve clinical outcomes compared to static parameters, but some are invasive or only validated with mechanical ventilation without spontaneous breathing. 2) Ultrasound visualization of inferior vena cava (IVC) diameter variations with respiration reliably assesses intravascular volume and predicts volume responsiveness. 3) Although physiology of IVC respiratory variations differs with mechanical ventilation and spontaneous breathing, IVC collapsibility index (CI) and distensibility index are interconvertible. 4) Prediction of volume responsiveness by IVC CI is comparable for mechanical ventilation and spontaneous breathing patients. 5) Respiratory variations of subclavian/proximal axillary and internal jugular veins by ultrasound are alternative sites, with comparable reliability. 6) Data support clinical applicability of IVC CI to predict hypotension with anesthesia, guide ultrafiltration goals, predict dry weight, predict intra-dialytic hypotension, and assess acute decompensated heart failure. 7) IVC ultrasound may complement ultrasound of heart, lungs, and abdominal organs for venous congestion, for assessing and managing volume overload and deresuscitation, renal failure, and shock. 8) IVC ultrasound has limitations including inadequate visualization. Ultrasound data should always be interpreted in clinical context. Additional studies are required to further assess and validate the role of bedside ultrasonography in clinical care.

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Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review

Cited by 10 publications

References 51 publications

Prognostic significance of Lung ultrasound for Heart Failure Patient Management in Primary Care. A Systematic Review

Prognostic significance of Lung ultrasound for Heart Failure Patient Management in Primary Care. A Systematic Review

Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomised, controlled trial

Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update

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