title: Impact of patient positioning on lung ultrasound findings in acute heart failure.
abstract: OBJECTIVE
  The purpose of this study was to compare lung ultrasound findings in both the supine and upright positions in heart failure patients presenting with dyspnea or chest pain.
  
  
  RESULTS
  We performed lung ultrasonography on 50 heart failure patients in the emergency department. Each subject underwent eight-zone lung sonography in the seated upright position, followed by a repeat ultrasound in the supine position. Each ultrasound video clip was later assigned a score (0-2 B-lines=0 points, 3-7 B-lines=1 point, >7 B-lines=2 points) by a physician who was blinded to patient position, chest zone, and clinical information. The median B-line score on eight-zone lung ultrasound was significantly higher in the supine (6, interquartile range (IQR) 2-10) vs the sitting position (5, IQR 1-8; p<0.001). Subjects with vascular congestion or pulmonary edema on chest x-ray (CXR) (n=29) also had higher median eight-zone B-line scores in the supine position (6, IQR 4-10) compared to the sitting position (5, IQR 2-8; p=0.002). Subjects without any acute pulmonary findings on CXR (n=19) had similar median eight-zone B-line scores in sitting (4, IQR 1-7) and supine positions (4, IQR 1-9, p=0.093).
  
  
  CONCLUSIONS
  Our findings suggest that patient positioning may impact the number of B-lines on lung ultrasound in a heart failure population. A consistent approach to patient positioning during lung ultrasonography may be necessary in order to monitor dynamic changes in heart failure.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, USA sfrasure@partners.org.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Frasure
authors.affiliation: Department of Emergency Medicine, Mount Sinai St Luke's and Mount Sinai Roosevelt Hospitals, USA.
authors.forename: Danielle K
authors.initials: DK
authors.lastname: Matilsky
authors.affiliation: Department of Emergency Medicine, Mount Sinai St Luke's and Mount Sinai Roosevelt Hospitals, USA.
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Siadecki
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, USA.
authors.forename: Elke
authors.initials: E
authors.lastname: Platz
authors.affiliation: Department of Emergency Medicine, Mount Sinai St Luke's and Mount Sinai Roosevelt Hospitals, USA.
authors.forename: Turandot
authors.initials: T
authors.lastname: Saul
authors.affiliation: Department of Emergency Medicine, Mount Sinai St Luke's and Mount Sinai Roosevelt Hospitals, USA.
authors.forename: Resa E
authors.initials: RE
authors.lastname: Lewiss
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D014463:Ultrasonography
keywords: B-lines; B-type natriuretic peptide levels; Heart failure; dyspnea; lung ultrasound