Lung ultrasound for monitoring cardiogenic pulmonary edema
Lung ultrasound for monitoring cardiogenic pulmonary edema
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DOI：
10.1007/s11739-016-1510-y
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发表时间：
2017-10-01
影响因子：
4.6
通讯作者：
Cogliati, Chiara
中科院分区：
文献类型：
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作者：
Cortellaro, Francesca;Ceriani, Elisa;Cogliati, Chiara
几项研究探讨了肺超声（LUS）诊断心源性肺水肿（CPE）的准确性，评价了间质性综合征，其特征为多发性和弥漫性垂直伪影（B线），并与血管外肺水相关。我们研究了LUS在监测CPE对治疗的反应中的潜在作用，通过评估急诊科（艾德）入院后前24小时内间质综合征的清除率。在到达时（T0）、3小时（T3）和24小时（T24）后进行LUS。在前外侧胸部评价了11个区域;估计每个区域的B线负荷（0 =无B线，1 =多条B线，2 =融合B线/白色肺），并计算平均评分（B评分，范围0-2）。患者接受常规CPE治疗。记录T0、T3、T24时的血生化、生命体征、血气分析、利尿情况。住院期间获得完整的超声心动图。入组了41例患者。在T0和T3之间以及T3和T24之间，所有患者的呼吸和血流动力学参数均有所改善。平均B评分在T3时显著降低（从1.59 +/- 0.40降至0.73 +/- 0.44，P < 0.001），在T3和T24之间显著降低（从0.73 +/- 0.44降至0.38 +/- 0.33，P < 0.001）。在任何时间，下肺区域的B评分均较高。在最终评价（T24）时，75%的顶侧区域和仅38%的基底侧区域被清除。LUS允许评估CPE治疗早期间质性综合征的清除及其分布，因此代表了指导治疗滴定的可能工具。
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.