Prognostic Value of Extravascular Lung Water Assessed With Ultrasound Lung Comets by Chest Sonography in Patients With Dyspnea and/or Chest Pain

Frassi, Francesca; Gargani, Luna; Tesorio, Paola; Raciti, Mauro; Mottola, Gaetano; Picaño, Eugenio

doi:10.1016/j.cardfail.2007.07.003

Cited by 169 publications

(112 citation statements)

References 26 publications

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“…In case of pulmonary overload, in a supine patient, fluids tends to be distributed in lateral and posterior zones [34,35] thus allowing detection of interstitial syndrome on medium and posterior axillary regions rather than on paraclavear region. In our study, the sensitivity of single LUS examination, with 12 B-Lines as diagnostic cut-off, shows a lower value than those previously reported in other studies [14], however this could be explained considering that many patients with AHF received diuretic therapy in pre-hospital setting. We selected a cut-off value higher than 12 B-Lines to reach the highest possible specificity …”

Section: Discussioncontrasting

confidence: 90%

“…This is an easy technique to perform and interpret, readily available and repeatable over time. Moreover it can be carried out at the bedside even in emergency situations [14,15]. The execution of this investigative technique in the ED and also in pre-hospital setting would provide additional and reliable information to patients with dyspnea favoring rapid identification of the etiology [16].…”

Section: Journal Of Intensive and Critical Care Issn 2471-8505mentioning

confidence: 99%

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Bedside Evaluation of Critical Dyspnea. Proposal of a Diagnostic Score for Acute Heart Failure in Emergency Setting

Pastorelli¹,

Capecchi²,

Gialli³

et al. 2017

J Intensive Crit Care

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Section: Discussioncontrasting

confidence: 90%

Section: Journal Of Intensive and Critical Care Issn 2471-8505mentioning

confidence: 99%

Bedside Evaluation of Critical Dyspnea. Proposal of a Diagnostic Score for Acute Heart Failure in Emergency Setting

Pastorelli¹,

Capecchi²,

Gialli³

et al. 2017

J Intensive Crit Care

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“…The demonstrated drop in sensitivity was expected, as prior studies have shown that the absolute number of B lines correlates strongly with the volume of extravascular lung water 5 20 , 27 , 28 Subclinical disease might be expected to manifest fewer B lines. Using alternative strategies, groups report mixed success using fewer B lines or pleural effusions to identify pulmonary oedema 2 …”

Section: Resultsmentioning

confidence: 76%

Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol

Baker

Mitchell

Thompson

et al. 2013

Australas J Ultrason Med

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Introduction: Emergency department differentiation of pulmonary oedema from chronic obstructive airways disease causing acute breathlessness is inaccurate 25% of the time despite clinical acumen, clinician‐reported chest x‐ray and ECG. This research investigates whether a basic lung ultrasound protocol (LUS) could improve identification of pulmonary oedema in breathless elderly patients. Method: Researchers prospectively sampled patients over 60 years, describing any breathlessness on presentation to a suburban emergency department. LUS studies were acquired by experienced or novice sonologists, interpreted by a blinded reviewer and compared with cardiologist chart audit for diagnosis at admission (gold standard). The admitting doctor's diagnosis, blinded to LUS, was compared with the chart audit result. Results: 204 LUS were collected, 145 by experienced sonologist and 59 by inexperienced. Diagnostic accuracy compared to cardiologist audit was 86.2% (95% CI 80.9 to 90.3), significantly higher than 70.2%, diagnostic accuracy for admission diagnosis, difference in proportion of 16% (95%CI 7.7 to 24.4%). Conclusion: A simple lung scanning protocol can help exclude pulmonary oedema in any breathless elderly patient.

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“…The amount of EVLW has been suggested as a prognostically important factor towards understanding decompensated HF 27, 28. Additionally, the time course for changes in both EVLW and functional values may be important.…”

Section: Discussionmentioning

confidence: 99%

The effect of diuresis on extravascular lung water and pulmonary function in acute decompensated heart failure

et al. 2018

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AimsThe effect of extravascular lung water (EVLW) and relationship to functional status as a result of acute decompensated heart failure (ADHF) are not well understood. We sought to quantify changes in clinical variables, EVLW, airway anatomy, spirometry, and diffusing capacity for carbon monoxide before and after treatment for ADHF.Methods and resultsFifteen patients were recruited within 24 h of hospital admission. Spirometry, diffusing capacity for carbon monoxide, and surrogates of EVLW by computed tomography were measured and were then repeated within 24 h of discharge. From the computed tomography (CT) scan, surrogates of EVLW were calculated from the distribution of CT attenuation of the lung tissue. Airways were segmented using the vida apollo software. Patients were hospitalized for 4.6 ± 2.1 days, had 10 ± 4.8 L of fluid removed (7.0 ± 4.2 L between study visits), and lost 7.1 ± 4.9 kg. Patients had significant clearance of fluid from the lungs (per cent change: mean, 4.2 ± 6.1%; skew, 17.5 ± 27.0%; kurtosis, 37.6 ± 56.7%; full‐width half‐maximum, 10.2 ± 13.5%). Static lung volumes and maximal flows improved significantly (per cent change: forced vital capacity, 14.5 ± 13.6%; forced expiratory volume in 1 s, 15.9 ± 14.0%; forced expiratory flow at 25–75% of forced vital capacity, 27.2 ± 42.9%). The ratio of membrane conductance to capillary blood volume improved significantly (per cent change: alveolar–capillary membrane conductance/capillary blood volume, 23.4 ± 22.8%). Weight loss during hospitalization was significantly correlated with improved spirometry and diffusing capacity.ConclusionsExtravascular lung water contributes to the pulmonary congestive syndrome in ADHF patients, and its clearance is an important component of the improvement in pulmonary function as a result of inpatient treatment.

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Prognostic Value of Extravascular Lung Water Assessed With Ultrasound Lung Comets by Chest Sonography in Patients With Dyspnea and/or Chest Pain

Cited by 169 publications

References 26 publications

Bedside Evaluation of Critical Dyspnea. Proposal of a Diagnostic Score for Acute Heart Failure in Emergency Setting

Bedside Evaluation of Critical Dyspnea. Proposal of a Diagnostic Score for Acute Heart Failure in Emergency Setting

Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol

The effect of diuresis on extravascular lung water and pulmonary function in acute decompensated heart failure

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