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Internal and Emergency Medicine

, Volume 12, Issue 7, pp 1011–1017 | Cite as

Lung ultrasound for monitoring cardiogenic pulmonary edema

  • Francesca Cortellaro
  • Elisa CerianiEmail author
  • Monica Spinelli
  • Carlo Campanella
  • Ilaria Bossi
  • Daniele Coen
  • Giovanni Casazza
  • Chiara Cogliati
EM - ORIGINAL

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.

Keywords

Acute cardiogenic pulmonary edema Lung ultrasound Interstitial syndrome 

Notes

Compliance with ethical standards

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.

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Copyright information

© SIMI 2016

Authors and Affiliations

  • Francesca Cortellaro
    • 1
  • Elisa Ceriani
    • 2
    Email author
  • Monica Spinelli
    • 1
  • Carlo Campanella
    • 3
  • Ilaria Bossi
    • 3
  • Daniele Coen
    • 1
  • Giovanni Casazza
    • 4
  • Chiara Cogliati
    • 5
  1. 1.Emergency Medicine DepartmentASST Grande Ospedale Metropolitano NiguardaMilanItaly
  2. 2.Internal Medicine Department, Ca Granda Foundation IRCCS, Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
  3. 3.Emergency Medicine Department, L. Sacco HospitalUniversity of MilanMilanItaly
  4. 4.Biomedical and Clinical Sciences DepartmentUniversity of MilanMilanItaly
  5. 5.Internal Medicine Department, L. Sacco HospitalUniversity of MilanMilanItaly

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