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Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review

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Abstract

Purpose

The primary aim was to investigate if treatment guided by serial ultrasound of the inferior vena cava-collapsibility index (IVC-CI) and B-lines on lung ultrasound (LUS) could reduce mortality, readmissions, and length of stay (LOS) in acutely dyspneic patients admitted to a hospital, compared to standard monitoring. The secondary aim was to determine how the changes of B-lines and IVC-CI are correlated to vitals and symptoms.

Methods

A systematic search was conducted on PubMed, Embase, Cochrane, Google Scholar, Web of Science, Scopus, OpenGrey, ProQuest, and databases for ongoing trials. The risk of bias was assessed according to study design.

Results

Of the 8258 studies identified, 50 were selected for full-text screening, and 24 studies were chosen for data extraction (19 pre–post-, two non-randomized controlled-, two randomized controlled-, and one retrospective cohort study), covering 2040 patients. Most studies were single-center and had small study populations with only heart failure patients. The risk of bias was high. No studies evaluated how the difference between two ultrasound measurements correlated with the primary outcomes. Seven studies reported that a decline in either B-lines or IVC size, or an increased IVC-CI reduced mortality, readmissions, and LOS when correlated to a single ultrasound measurement. All studies showed changes in the IVC-CI and B-lines, but these were not related to vitals or symptoms.

Conclusion

B-lines and IVC-CI are dynamic variables that change over time and with treatment. A single ultrasound measurement can influence prognostic outcomes, but it remains uncertain if repeated scans can have the same impact.

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Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code availability

Coding is available upon request.

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Acknowledgements

The authors acknowledge Anne Faber Hansen, research librarian, MSci, PhD, from the University Library of Southern Denmark, who contributed to designing the search strategy. We thank Claire Gudex, MD, PhD, from the University of Southern Denmark, for editing the manuscript.

Funding

The study is supported by the Department of Emergency Medicine at Slagelse Hospital and grants from the Naestved, Slagelse, and Ringsted Hospitals’ Research Fund (Grant Number 111.2219) and by a 1-year scholarship from the University of Southern Denmark. The funders have no role in the study’s design, in the collection, analysis, or interpretation of data, in the writing of manuscripts, or in decisions to publish results.

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Authors and Affiliations

  1. Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark

    Michael Dan Arvig

  2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Michael Dan Arvig

  3. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Michael Dan Arvig, Christian B. Laursen, Niels Jacobsen, Peter Haulund Gæde & Annmarie Touborg Lassen

  4. Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark

    Christian B. Laursen & Niels Jacobsen

  5. Regional Center for Technical Simulation, TechSim, Odense, Denmark

    Niels Jacobsen

  6. Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark

    Peter Haulund Gæde

  7. Department of Emergency Medicine, Odense University Hospital, Odense, Denmark

    Annmarie Touborg Lassen

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Contributions

MDA has conceived the study and received inputs and feedback from ATL, NJ, PHG, and CBL. MDA developed the search strategy in cooperation with AFH. MDA and NJ screened the included studies and independently assessed the quality and extracted the data. MDA drafted the manuscript. All co-authors read and approved the final manuscript.

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Correspondence to Michael Dan Arvig.

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Arvig, M.D., Laursen, C.B., Jacobsen, N. et al. Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review. J Ultrasound 25, 547–561 (2022). https://doi.org/10.1007/s40477-021-00622-7

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