title: Integrated cardiopulmonary sonography: a useful tool for assessment of acute pulmonary edema in the intensive care unit.
abstract: OBJECTIVE
  Bedside sonography has become a popular method of assessment of critically ill patients with shock and dyspnea. This study evaluated the usefulness of integrated cardiopulmonary sonography for assessment of acute pulmonary edema.
  
  
  METHODS
  A total of 128 intensive care unit (ICU) patients with acute pulmonary edema were randomly divided into 2 groups: a sonography group, which received standard treatment as well as cardiopulmonary sonography, and a control group, which received standard treatment only. All patients were treated according to the same therapeutic strategies and underwent chest radiography and central venous catheter placement. Serum myocardial injury marker levels and central venous/arterial blood gas parameters were measured 0, 24, and 72 hours after enrollment. The cumulative fluid infusion volume at 6, 12, 24, and 72 hours, the time to diagnosis of the pulmonary edema etiology by the attending physician, the lengths of ICU and hospital stays, and ICU mortality were recorded.
  
  
  RESULTS
  The sonography group had a shorter time to diagnosis and received a smaller fluid infusion volume than the control group. There were no significant differences in ICU mortality and lengths of ICU and hospital stays between the sonography and control groups. In patients with cardiogenic pulmonary edema, the sonography group had a significantly shorter ICU stay and a faster return to normal myocardial injury marker levels and perfusion parameters than the control group (P < .05).
  
  
  CONCLUSIONS
  Integrated cardiopulmonary sonography resulted in faster and better-informed clinical decision making, shortened the time to diagnosis of the pulmonary edema etiology, and decreased fluid use. However, the impact of this examination on prognoses requires further study. We propose that integrated cardiopulmonary sonography may be a useful bedside tool for treatment of ICU patients with acute pulmonary edema.
authors: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors: Xiao-Ting
authors: XT
authors: Wang
authors: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. daweiliupumch@163.com.
authors: Da-Wei
authors: DW
authors: Liu
authors: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors: Hong-Min
authors: HM
authors: Zhang
authors: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors: Wen-Zhao
authors: WZ
authors: Chai
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D002405:Catheterization, Central Venous; D016638:Critical Illness; D004452:Echocardiography; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D007902:Length of Stay; D008168:Lung / Q000000981:diagnostic imaging; D009200:Myocardial Contraction; D010100:Oxygen / Q000097:blood; D019095:Point-of-Care Systems; D011654:Pulmonary Edema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D019344:Lactic Acid; D010100:Oxygen
keywords: acute pulmonary edema; critical care; etiology; point-of-care ultrasound; prognosis; sonography