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.
Similar content being viewed by others
References
Hugli O, Braun JE, Kim S, Pelletier AJ, Camargo CA Jr (2005) United States emergency department visits for acute decompensated heart failure, 1992 to 2001. Am J Cardiol 96(11):1537–1542. doi:10.1016/j.amjcard.2005.07.064
Fonarow GC, Scientific Advisory Committee ADHERE (2003) The Acute Decompensated Heart Failure National Registry (ADHERE): opportunities to improve care of patients hospitalized with acute decompensated heart failure. Rev Cardiovasc Med 4(Suppl 7):21–30
Ray P, Birolleau S, Riou B (2002) Acute dyspnoea in elderly patients. Rev Mal Respir 19(4):491–503
Singer AJ, Emerman C, Kellerman L, Peacock WF et al (2008) Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Ann Emerg Med 51:25–34. doi:10.1016/j.annemergmed.2007.04.005
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA et al (2012) International evidence-based recommendations for point-of-care lung ultrasound. Int Care Med 38(4):577–591. doi:10.1007/s00134-012-2513-4
Pivetta E, Goffi A, Cibinel GA, SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont et al (2015) Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU Multicenter Study. Chest 148(1):202–210. doi:10.1378/chest.14-260
Gargani L, Frassi F, Gheorghiade M, Picano E et al (2008) Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Failure 10:70–77. doi:10.1016/j.ejheart.2007.10.009
Frassi F, Gargani L, Mottola G, Picano E et al (2007) Prognostic value of extravascular lung water assessed with ultrasound lung comets by chest sonography in patients with dyspnea and/or chest pain. J Cardiac Fail 13:830–835
Mueller C et al (2015) European Society of Cardiology-Acute Cardiovascular Care Association Position paper on acute heart failure: a call for interdisciplinary care. Eur Heart J Acute Cardiovasc Care. doi:10.1177/2048872615593279
Felker GM, O’Connor CM, Braunwald E, Heart Failure Clinical Research Network Investigator (2009) Loop diuretics in acute decompensated heart failure: necessary? Evil? A necessary evil? Circ Heart Fail 2:56–62. doi:10.1161/CIRCHEARTFAILURE.108.821785
Gheorghiade M, Follath F, European Society of Cardiology, European Society of Intensive Care Medicine et al (2010) Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 12:423–433. doi:10.1093/eurjhf/hfq045
Metry G, Wegenius G, Hedenstrom H, Danielson BG et al (1997) Lung density for assessment of hydration status in hemodialysis patients using the computed tomographic densitometry technique. Kidney Int 52(6):1635–1644
Noble VE, Murray AF, Steele DJ, Liteplo A et al (2009) Ultrasound assessment for extravascular lung water in patients undergoing haemodialysis. Chest 135:1433–1439. doi:10.1378/chest.08-1811 (Epub 2009 Feb 2)
Mallamaci F, Benedetto FA, Picano E, Zoccali C et al (2010) Detection of pulmonary congestion by chest ultrasound in dialysis patients. JACC 3:585–594. doi:10.1016/j.jcmg.2010.02.005
Yancy CW, Jessup M et al (2013) 2013 ACCF/AHA guideline for the management of heart failure. Circulation 128:240–327. doi:10.1161/CIR.0b013e31829c8776
Mc Murray JJV et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 33:1787–1847. doi:10.1093/eurheartj/ehs104
Volpicelli G, Caramello V, Bar F, Frascisco MF et al (2008) Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure. Am J Emerg Med 26(5):585–591. doi:10.1016/j.ajem.2007.09.014
Mebazaa A, Yilmaz MB, Anker SD, Filippatos G et al (2015) Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine—short version. Eur Heart J 36:1958–1966. doi:10.1093/eurheartj/ehv066 (Epub 2015 May 21)
Fagenholz PJ, Gutman JA, Thomas SH, Harris NS et al (2007) Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest 131(4):1013–1018
Strained M, Prosen G, Borovnik Lesjak V (2016) Bedside lung ultrasound for monitoring the effectiveness of prehospital treatment with continuous positive airway pressure in acute decompensated heart failure. Eur J Emerg Med 23(1):50–55. doi:10.1097/MEJ.0000000000000205
Di Somma S, De Berardinis B, Bongiovanni C, Marino R et al (2010) Use of BNP and bioimpedance to drive therapy in heart failure patients. Congest Heart Fail 16(Suppl 1):S56–S61. doi:10.1111/j.1751-7133.2010.00162
Yancy CW, Lepton M, Fonarow GC, ADHERE Scientific Advisory Committee and Investigator et al (2006) Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) database. J Am Coll Cardiol 47(1):76–84
Wu MY, Chang NC, WU CH, Tam KW et al (2014) Loop diuretic strategies in patients with acute decompensated heart failure: a meta-analysis of randomized controlled trials. J Crit Care 29(1):2–9. doi:10.1016/j.jcrc.2013.10.009 (Epub 2013 Oct 29)
Volz EM, Felker GM (2009) How to use diuretics in heart failure. Curt Treat Options Cardiovasc Med 11(6):426–432
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Cortellaro, F., Ceriani, E., Spinelli, M. et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Intern Emerg Med 12, 1011–1017 (2017). https://doi.org/10.1007/s11739-016-1510-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-016-1510-y