Lung Ultrasound-Guided Emergency Department Management of Acute Heart Failure (BLUSHED-AHF): A Randomized Controlled Pilot Trial.
Lung Ultrasound-Guided Emergency Department Management of Acute Heart Failure (BLUSHED-AHF): A Randomized Controlled Pilot Trial.
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DOI：
10.1016/j.jchf.2021.05.008
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Collins SP
中科院分区：
文献类型：
--
作者：
Pang PS;Russell FM;Ehrman R;Ferre R;Gargani L;Levy PD;Noble V;Lane KA;Li X;Collins SP
针对急性心力衰竭（AHF）的肺充血仍然是护理的关键目标。肺部超声（LUS）B线是肺充血的半定量评估。AHF患者的B线是否通过靶向治疗而减少尚不清楚。确定6小时LUS指导的护理策略是否优于急诊科（艾德）的常规管理。其次，我们探讨了早期有针对性的干预是否会改善结果。一项多中心、单盲、基于ED的初步试验，将130例患者随机分配至：1）6小时LUS指导的治疗策略vs 2）结构化常规护理。在整个住院期间和出院后90天对患者进行随访。6小时时B线≤ 15是主要结局。30天时的存活和出院天数（DAOOH）是主要的探索性结局。两组间6小时B线≤ 15的患者比例（25% LUS vs 27.5%常规治疗; p = 0.83）或6小时B线数量（35.4 ± 26.8 LUS vs 34.3 ± 26.2常规治疗，p = 0.82）无显著差异。DAOOH也无差异（LUS组21.3 ± 6.6 vs常规治疗组21.3 ±7.1，（p = 0.99））。然而，在最初的48小时内，LUS指导的患者中观察到的B线数量减少幅度显著大于常规结构化护理（p = 0.04）。在这项初步试验中，与常规治疗相比，艾德使用LUS靶向肺充血在减少6小时或30天DAOOH时的B线数量方面没有获益。然而，LUS引导的患者在最初的48小时内更快地解决了充血问题。
Targeting pulmonary congestion in acute heart failure (AHF) remains a key goal of care. Lung ultrasound (LUS) B-lines are a semi-quantitative assessment of pulmonary congestion. Whether B-lines decrease in patients with AHF by targeting therapy is not well known. To determine whether a 6-hour LUS guided strategy-of-care improves pulmonary congestion over usual management in the emergency department (ED) setting. Secondarily, we explored whether early targeted intervention leads to improved outcomes. A multi-center, single-blind, ED-based, pilot trial, randomizing 130 patients to: 1) a 6-hour LUS-guided treatment strategy vs 2) structured usual care. Patients were followed throughout hospitalization and 90-days post-discharge. B-lines ≤ 15 at 6 hours was the primary outcome. Days alive and out of hospital (DAOOH) at 30-days was the main exploratory outcome. No significant difference in the proportion of patients with B-lines ≤ 15 at 6 hours (25% LUS vs 27.5% usual care; p = 0.83) or the number of B-lines at 6 hours (35.4 ± 26.8 LUS vs 34.3 ± 26.2 usual care, p = 0.82) was observed between groups. There were also no differences in DAOOH (21.3 ± 6.6 LUS arm vs 21.3 ±7.1 usual care, (p = 0.99)). However, a significantly greater reduction in the number B-lines was observed in LUS guided patients compared to usual structured care during the first 48 hours (p = 0.04). In this pilot trial, ED use of LUS to target pulmonary congestion conferred no benefit compared to usual care in reducing the number of B-lines at 6 hours or in 30-days DAOOH. However, LUS-guided patients had faster resolution of congestion during the initial 48 hours.
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影响因子：
1.9
作者：
Gargani L
通讯作者：
Gargani L
影响因子：
1.9
作者：
Gargani, Luna;Volpicelli, Giovanni
通讯作者：
Volpicelli, Giovanni
影响因子：
4.6
作者：
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通讯作者：
Goffi, Alberto
影响因子：
24
作者：
Collins, Sean P.;Liu, Dandan;Butler, Javed
通讯作者：
Butler, Javed
DOI：
10.1002/j.2205-0140.2015.tb00221.x
发表时间：
2015-11-01
影响因子：
--
作者：
Baker, Kylie;Soong, Luke;Brierley, Stephen
通讯作者：
Brierley, Stephen