Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications

Picaño, Eugenio; Gargani, Luna; Gheorghiade, Mihai

doi:10.1007/s10741-009-9148-8

Cited by 96 publications

(70 citation statements)

References 42 publications

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“…Pulmonary congestion may be semiquantified using lung ultrasound [22,25,27,[51][52][53][54][55]. In the clinical arena, lung ultrasound can therefore be employed as a bedside, easy-to-use, alternative tool for monitoring pulmonary congestion changes in heart failure patients, as they disappear or clear upon adequate medical treatment [27,[56][57][58][59][60]. More generally, any significant change in lung aeration resulting from any therapy aimed at reversing aeration loss might be detected by corresponding changes in lung ultrasound patterns [61,62].…”

Section: P-d3-s2 (Strong: Level A)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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Background: The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. Methods: A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Results: Seventythree proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/ conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. Conclusions: This document reflects the overall results of the first consensus conference on ''point-of-care'' lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.

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Section: P-d3-s2 (Strong: Level A)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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“…9 Lung ultrasound (US) is a novel, validated technique that has been increasingly applied to estimate lung water in patients with heart disease 10 and patients with acute respiratory failure treated in intensive care units. 11 The rationale of this technique is that, in the presence of lung congestion, the US beam is reflected by thickened interlobular septa, a phenomenon generating hyperechoic reverberation artifacts between edematous septa and the overlying pleura (i.e., US bundles at narrow basis going from the US transducer to the limit of the screen, the so-called lung comets, 12 which can be considered as a US equivalent of B lines [BL-US] detected in chest x-rays).…”

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confidence: 99%

Pulmonary Congestion Predicts Cardiac Events and Mortality in ESRD

Zoccali

Torino

Tripepi

et al. 2013

Journal of the American Society of Nephrology

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Pulmonary congestion is highly prevalent and often asymptomatic among patients with ESRD treated with hemodialysis, but whether its presence predicts clinical outcomes is unknown. Here, we tested the prognostic value of extravascular lung water measured by a simple, well validated ultrasound B-lines score (BL-US) in a multicenter study that enrolled 392 hemodialysis patients. We detected moderate-to-severe lung congestion in 45% and very severe congestion in 14% of the patients. Among those patients with moderate-to-severe lung congestion, 71% were asymptomatic or presented slight symptoms of heart failure. Compared with those patients having mild or no congestion, patients with very severe congestion had a 4.2-fold risk of death (HR=4.20, 95% CI=2.45-7.23) and a 3.2-fold risk of cardiac events (HR=3.20, 95% CI=1.75-5.88) adjusted for NYHA class and other risk factors. Including the degree of pulmonary congestion in the model significantly improved the risk reclassification for cardiac events by 10% (P,0.015). In summary, lung ultrasound can detect asymptomatic pulmonary congestion in hemodialysis patients, and the resulting BL-US score is a strong, independent predictor of death and cardiac events in this population.

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“…2 It is now recognised that not only is fluid accumulation and retention, a mechanism for acute pulmonary oedema, but so too is fluid redistribution from the systemic circulation to the pulmonary circulation due to venoconstriction or vasoconstriction in a person who is euvolaemic. 3,4 Therapies for the treatment of acute pulmonary oedema reverse one or more of these factors, with re-absorption of pulmonary oedema both a passive and an active process. 5 Frequently, more than one risk factor is present, with iatrogenic fluid administration a major preventable factor.…”

Section: Discussionmentioning

confidence: 99%