An inpatient PC model for patients with acute HF is associated with short-term improvement in symptom burden, QOL, and depressive symptoms.

Purpose: Pulmonary ultrasound (PU) examination at the point-of-care can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of PU abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, PU scoring system that would allow for standardized documentation, have high interprovider agreement, and correlate with clinical metrics. Methods:In this prospective study of 250 adults intubated for ARF, a PU examination was performed at intubation, 48-hours later, and at extubation. A total lung score (TLS) was calculated.Clinical metrics and final diagnosis were extracted from the medical record.Results: TLS correlated positively with mortality (P 5 .03), ventilator hours (P 5 .003), intensive care unit, and hospital length of stay (P 5 .003, P 5 .008), and decreasing PaO 2 /FiO 2 (P < .001).Agreement of PU findings was very good (kappa 5 0.83). Baseline TLS and subscores differed significantly between ARF categories (nonpulmonary, obstructive, and parenchymal disease).Conclusions: A quick, scored, PU examination was associated with clinical metrics, including mortality among a diverse population of patients intubated for ARF. In addition to diagnostic and prognostic information at the bedside, a standardized and quantifiable approach to PU provides objectivity in serial assessment and may enhance communication of findings between providers. K E Y W O R D Sintubation, point-of-care ultrasound, pulmonary ultrasonography, respiratory insufficiency | I N TR ODU C TI ONPulmonary ultrasound (PU) has become an essential tool for rapidly identifying the etiology of acute respiratory failure (ARF), following treatment progress, and clarifying nonspecific chest radiograph (CXR) abnormalities among critically ill patients, 1-5 and with test characteristics better than the clinical examination and CXR. 6,7 When used in combination with cardiac and vascular ultrasound, it can enhance the understanding of etiology 3 and may reduce the need for CXR or chest CT. [8][9][10] Acquisition, interpretation, and integration of PU findings at an isolated point in time are essential to prompt and accurate diagnosis.Tracking PU changes over time is equally important in confirming a diagnosis and adjusting treatment. To do so requires a standardized approach to PU such that providers can document and agree not only with themselves but also with each other over time. [11][12][13][14] PU scoring models have been developed to meet the need for standardization and have been shown to correlate with various metrics in specific patient populations. 5,11,[15][16][17] Scoring systems correlate with mortality in patients with acute respiratory distress syndrome

In a recent randomized trial, inpatient palliative care (PC) visits were associated with improved quality of life and symptom burden for patients with heart failure. To better understand what actions by PC providers may have led to those outcomes, we conducted chart reviews of 101 patients in the intervention group (who received PC). Palliative care actions are described for all patients and for those with higher symptoms. Orders were written for 24% of patients, most frequently for pain. Recommendations to change current care were made for 40% of patients. At least 1 element of future care planning was documented for 99% of patients. Palliative care for inpatients with HF led to additive actions beyond standard care, especially for pain, and promoted HF-specific goals of care discussions.

No abstract

No abstract