Nurse-Provided Lung and Inferior Vena Cava Assessment in Patients With Heart Failure

Zisis, Georgios; Yang, Yang; Huynh, Quan; Whitmore, Kristyn; Lay, Maria; Wright, Leah; Carrington, M.; Marwick, Thomas H.

doi:10.1016/j.jacc.2022.04.064

Cited by 20 publications

(10 citation statements)

References 42 publications

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“…Additionally, LUS-guided treatment was associated with a lower risk of Major Adverse Cardiac Events (MACEs) [59,60]. Nonetheless, while LUS improved fluid status with a significantly greater reduction in the number of B-lines during the first 48 hours, it did not reduce heart failure readmission [53,55,62].…”

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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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%

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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“…27 Furthermore, IVC assessment in patients with HF was not performed in ≈40% if a nurse with limited scanner experience performed the exam. 28…”

Section: Discussionmentioning

confidence: 99%

Estimation of Right Atrial Pressure by Ultrasound-Assessed Jugular Vein Distensibility in Patients With Heart Failure

Ammirati,

Marchetti,

Colombo

et al. 2024

Circ: Heart Failure

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BACKGROUND: Clinical evaluation of central venous pressure is difficult, depends on experience, and is often inaccurate in patients with chronic advanced heart failure. We assessed the ultrasound-assessed internal jugular vein (JV) distensibility by ultrasound as a noninvasive tool to identify patients with normal right atrial pressure (RAP ≤7 mm Hg) in this population. METHODS: We measured JV distensibility as the Valsalva-to-rest ratio of the vein diameter in a calibration cohort (N=100) and a validation cohort (N=101) of consecutive patients with chronic heart failure with reduced ejection fraction who underwent pulmonary artery catheterization for advanced heart failure therapies workup. RESULTS: A JV distensibility threshold of 1.6 was identified as the most accurate to discriminate between patients with RAP ≤7 versus >7 mm Hg (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.64–0.84]) and confirmed in the validation cohort (receiver operating characteristic, 0.82 [95% CI, 0.73–0.92]). A JV distensibility ratio >1.6 had predictive positive values of 0.86 and 0.94, respectively, to identify patients with RAP ≤7 mm Hg in the calibration and validation cohorts. Compared with patients from the calibration cohort with a high JV distensibility ratio (>1.6; n=42; median RAP, 4 mm Hg; pulmonary capillary wedge pressure, 11 mm Hg), those with a low JV distensibility ratio (≤1.6; n=58; median RAP, 8 mm Hg; pulmonary capillary wedge pressure, 22 mm Hg; P <0.0001 for both) were more likely to die or undergo a left ventricular assist device implant or heart transplantation (event rate at 2 years: 42.7% versus 18.2%; log-rank P =0.034). CONCLUSIONS: Ultrasound-assessed JV distensibility identifies patients with chronic advanced heart failure with normal RAP and better outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03874312.

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“…While the literature demonstrating that RNs can safely operate POCUS continues to evolve, there are reports that nurses, physiotherapists, and respiratory therapists with appropriate training can safely operate POCUS with beneficial patient outcomes (See et al, 2016;Tulleken et al, 2019;Whittaker et al, 2007;Zisis et al, 2022). One hospital system in California has trained nurses to identify features of pulmonary edema, roughly estimate ejection fraction, and detect pathological features of cardiac physiology with POCUS (Lai & Paquin, 2020).…”

Section: Can Emergency Nurses Be Certified To Operate Pocus?mentioning

confidence: 99%

Clinician’s Corner: An introduction to point-of-care ultrasound

Lai¹,

Mclaughlin²,

McLean³

2023

CJEN

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A 67-year-old is brought to your resuscitation room in your emergency department. She is in acute distress and has a blood pressure of 211/120, a heart rate of 130 per minute, a respiratory rate of 31 breaths per minute, and an oxygen saturation of 88% on room air. You are about to call for a portable chest radiograph, but the emergency nurse practitioner reaches for the point-of-care ultrasound machine, puts the probe on the patient’s chest, and in under a minute, states: “I see B-lines and weak cardiac contractility; there is normal lung sliding.”

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Nurse-Provided Lung and Inferior Vena Cava Assessment in Patients With Heart Failure

Cited by 20 publications

References 42 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

Estimation of Right Atrial Pressure by Ultrasound-Assessed Jugular Vein Distensibility in Patients With Heart Failure

Clinician’s Corner: An introduction to point-of-care ultrasound

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