Skip to main content
SpringerLink
Log in

Lung ultrasound for monitoring cardiogenic pulmonary edema

  • EM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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

    Article  PubMed  Google Scholar 

  2. 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

    Google Scholar 

  3. Ray P, Birolleau S, Riou B (2002) Acute dyspnoea in elderly patients. Rev Mal Respir 19(4):491–503

    CAS  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  CAS  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. 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

    Google Scholar 

  10. 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

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  CAS  PubMed  Google Scholar 

  13. 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)

    Article  PubMed  Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    Article  Google Scholar 

  16. 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

    Article  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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)

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  Google Scholar 

  21. 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

  22. 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

    Article  PubMed  Google Scholar 

  23. 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)

    Article  PubMed  Google Scholar 

  24. Volz EM, Felker GM (2009) How to use diuretics in heart failure. Curt Treat Options Cardiovasc Med 11(6):426–432

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emergency Medicine Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Francesca Cortellaro, Monica Spinelli & Daniele Coen

  2. Internal Medicine Department, Ca Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Via F.Sforza 35, Milan, Italy

    Elisa Ceriani

  3. Emergency Medicine Department, L. Sacco Hospital, University of Milan, Milan, Italy

    Carlo Campanella & Ilaria Bossi

  4. Biomedical and Clinical Sciences Department, University of Milan, Milan, Italy

    Giovanni Casazza

  5. Internal Medicine Department, L. Sacco Hospital, University of Milan, Milan, Italy

    Chiara Cogliati

Authors
  1. Francesca Cortellaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisa Ceriani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monica Spinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlo Campanella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ilaria Bossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniele Coen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giovanni Casazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chiara Cogliati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisa Ceriani.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-016-1510-y

Keywords

Search

Navigation