Clinical Study Of Objective Evaluation Of Bedside Ultrasound In The Treatment Of Patients With Acute Cardiiogenic Pulmonary Edema

Objective:Through observing the distribution and clearance of lung water in patients with acute cardiogenic pulmonary edema(ACPE)before and after treatment by bedside ultrasound,this study explores the role of this technique in the objective evaluation of the treatment of acute pulmonary edema at an early stage.Methods:During May 2018 and July 2019,72 patients diagnosed with acute cardiogenic pulmonary edema at the emergency rooms of the Affiliated Second Hospital of Suzhou University and the First People's Hospital of Kunshan City were included in the study(6 cases from the former,66 cases from the latter).Inclusion criteria:all clinical criteria(acute respiratory distress,orthopnoea,physical examination,respiratory failure);at least two auxiliary examination results(clear signs of pulmonary congestion on chest X-ray or CT image;more visible B lines integral on pulmonary ultrasound;echocardiography showing increased filling pressure;increased pulmonary water through PICCO;significantly increased NT-proBNP).Exclusion criteria:people under 18;pregnant women;those with history of heart transplantation,pneumothorax,interstitial lung disease,ARDS,pulmonary fibrosis,Severe pneumonia;nasal and facial deformities;patients with large airway secretions;patients with coma and ST segment elevation myocardial infarction.All patients with acute dyspnea were given venous access,oxygen and multifunctional vital signs monitoring immediately after entering the emergency room.Besides,we collected laboratory tests like NT-proBNP?hs-CRP?cTnI?CKMB?renal functions,completed the examination of the arterial blood gas analysis,and then performed ultrasound in half lying position and chest imaging examination.Patients with ACPE who met the inclusion criteria weretreated with cardiac,diuretic,vasodilator and non-invasive positive pressure ventilation.Hourly blood pressure,heart rate,respiratory rate,pulse oxygen before and after treatment were recorded,and heart rhythms,heart sounds,and lung rale were also checked.After the patient's dyspnea was improved(effectively),the bedside lung ultrasound in the same position as well as blood gas analysis were performed again.Through comparing basic vital signs,blood gas index changes,pulmonary water distributionand clearance before and after treatment to determine the role of bedside ultrasound in the objective evaluation of the treatment of acute pulmonary edema at an early stage.Results:Finally,we gained complete data from 64 patients,including 34 males and 30 females.The average age was 74.6 years,and 84.4% of patients were 65 years or older.The patients with de novo AHF accounted for 25.0%and acute decompensated chronic heart failure 75.0%.The underlying causes of heart failure are mainly ischemic heart disease,followed by hypertension,heart valve disease,arrhythmia,and noncardiac diseases.NT-proBNP increased significantly in ACPE patients,hs-CRP increased in most patients,CKMB increased in about half the patients,and cTnI and SCr increased in about 1/3 patients.64 patients with ACPE experienced significant improvement in dyspnea symptoms after the median of 2.35hoursof treatment.Except for the diastolic blood pressure(p>0.05),the other basic vital signs and blood gas indicators were significantly improved(pvalues were all less than 0.05),and the number of B lineintegral in the lung was significantly reduced(43.0±2.3vs30.4±2.3,p<0.001).Comparison of pulmonary water distribution in eight chestareas of both lungs:the lower right chest area(R4)is the most obvious,and the upper left anterior chest area(L1)is relatively small;the B line integral of each chest area are significantly reduced after treatment(p<0.001),The B line clearance rate of the upper right chest area(R3)was faster than that of other chest area(p<0.05).At admission,the lower chest area(R2+R4+L2+L4)had the most commonly distributed lung water,followed by the lateral chest area(R3+R4+L3+L4).After treatment,the B line clearance rate of the upper chest area(R1+R3+L1+L3)was faster than that of other chest area(p<0.001).Correlation analysis between B line integral and biomarkers such as heart failure before treatment shows that B line integral wasin significantly positive correlationwithNT-proBNP(r=0.716,p<0.001),positively correlated with hs-CRP in a low level(r=0.370,p<0.05)and no correlation with cTnI?SCr?CKMB.Conclusion:For patients with acute cardiogenic pulmonary edema,it is feasible to monitor pulmonary water and its clearance in the emergency room with bedside ultrasound.There is a significant correlation between B line integral and NT-proBNP levels in patients with acute cardiogenic pulmonary edema.Following effective treatment of pulmonary edema,B line integral in different chest areas are significantly reduced,,indicating that B line integral can be used as an objective indicator to evaluate the treatment effect of acute cardiogenic pulmonary edema.