Maw Anna, Ortiz-Lopez Carolina, Morris Megan, Jones Christine D, Gee Elaine, Tchernodrinski Stefan, Kramer Henry R, Galen Benjamin, Dempsey Amanda, Soni Nilam J
Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA.
Medicine, University of Colorado, Denver, USA.
Cureus. 2020 Jun 26;12(6):e8844. doi: 10.7759/cureus.8844.
Acute decompensated heart failure is the leading admitting diagnosis in patients 65 years and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in five geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.
急性失代偿性心力衰竭是65岁及以上患者的主要入院诊断原因，仅在美国每年就有超过100万例住院病例。已知用于评估和监测心力衰竭患者容量状态的传统工具，包括症状和体格检查结果，准确性有限。相比之下，床旁肺部超声是一种实用且有循证依据的工具，可用于监测心力衰竭患者的容量状态。然而，目前很少有住院医生使用该工具来监测利尿情况。我们对在美国五个地理位置不同的学术机构执业的23名住院医生进行了半结构化访谈，以更好地了解住院医生目前如何评估和监测心力衰竭住院患者的容量状态。我们还探讨了他们对采用肺部超声的看法和态度。参与访谈的住院医生报告称，传统利尿监测工具的可靠性和准确性较差，并表示有兴趣学习或已经在使用肺部超声进行此项监测。受访者认为培训所需时间以及获取不影响工作流程的设备是采用肺部超声的重要障碍。
