title: Lung ultrasound for monitoring cardiogenic pulmonary edema.
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.
authors.affiliation: Emergency Medicine Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cortellaro
authors.affiliation: Internal Medicine Department, Ca Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Via F.Sforza 35, Milan, Italy. ceriani.elisa@live.com.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ceriani
authors.affiliation: Emergency Medicine Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Spinelli
authors.affiliation: Emergency Medicine Department, L. Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Campanella
authors.affiliation: Emergency Medicine Department, L. Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Bossi
authors.affiliation: Emergency Medicine Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Coen
authors.affiliation: Biomedical and Clinical Sciences Department, University of Milan, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casazza
authors.affiliation: Internal Medicine Department, L. Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cogliati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D015633:Extravascular Lung Water / Q000000981:diagnostic imaging; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000145:classification / Q000175:diagnosis*; D014463:Ultrasonography / Q000379:methods* / Q000592:standards*
keywords: Acute cardiogenic pulmonary edema; Interstitial syndrome; Lung ultrasound