The prognostic and clinical value of monitoring patients with acute dyspnea with serial focused ultrasound of the lungs (FLUS) and inferior vena cava (IVC): a systematic review

Michael Dan Arvig*, Christian Borbjerg Laursen, Niels Jacobsen, Peter Gæde, Annmarie Touborg Lassen

*Corresponding author for this work

Research output: Contribution to conference without publisher/journalConference abstract for conferenceCommunication

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Abstract

Background
Acute dyspnea is one of the most common complaints in the emergency department with high in-hospital mortality. The current methods of monitoring the patients lack both sensitivity and specificity. The aims were to investigate if monitoring patients with focused ultrasound of the lungs (FLUS) and/or ultrasound of inferior vena cava (IVC) has a 1) prognostic value, 2) clinical value, and 3) if ultrasound findings correlate over time with other parameters.

Methods
A systematic search was conducted on 12th of June 2018 on PubMed, Embase, Cochrane, Google Scholar, sWeb of Science, and Scopus. The grey literature was sought in OpenGrey and ProQuest. We included trials with adult patients with acute dyspnea admitted to a hospital who underwent repeated FLUS and/or IVC scans. In the 1837 studies identified, first titles and abstracts were screened. 23 studies were selected for full-text screening, and of those, 7 were chosen for data extraction. Additional 5 papers were identified through systematic snowballing. Risk of bias was accessed according to the study design.

Results
Twelve studies were included (11 prospective cohort studies, 1 RCT) with a total of 824 patients. In 5 studies the patients only received ultrasound scanning of ICV; in 4 studies only with FLUS, and in 3 studies with both modalities. Generally, the studies had small study populations, and no sample size calculations were made. Only patients suspected of heart failure were investigated, and the studies were methodological heterogeneous. Four studies reported that patients with a reduction in either B-lines, IVC size and/or an increased IVC collapsibility index (IVCCI) had fewer readmissions and deaths. Three studies reported on optimized treatment in relation to the same findings. All studies reported either a reduction of B-lines, IVC size and an increase in IVCCI as a sign of possible decreased congestion/redistribution of fluid but few studies related the findings to other parameters.

Conclusions
The overall bias in the studies was high. Repeated FLUS and IVC scans showed promising results as a monitoring tool, but further investigations with larger study populations and with patients with undifferentiated dyspnea are needed to generalize the findings.
Translated title of the contributionDen prognostiske og kliniske værdi af at monitorere patienter med akut åndenød med gentagne ultralydsskanninger af lunger og vena cava inferior: et systemtisk review
Original languageEnglish
Publication date25. Oct 2018
Publication statusPublished - 25. Oct 2018
EventDanish emergency medicine conference - Radisson Blu Scandinavia Hotel, Århus, Denmark
Duration: 25. Oct 201826. Oct 2018
Conference number: 8
http://www.meetingplanners.dk/subsites/demc/index.html

Conference

ConferenceDanish emergency medicine conference
Number8
LocationRadisson Blu Scandinavia Hotel
Country/TerritoryDenmark
CityÅrhus
Period25/10/201826/10/2018
Internet address

Keywords

  • Ultrasound
  • Lung ultrasound
  • Point-of-care ultrasound
  • Monitoring
  • Inferior vena cava
  • Focused cardiac ultrasound
  • Dyspnea

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