Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
JACC Heart Fail. 2021 Sep;9(9):638-648. doi: 10.1016/j.jchf.2021.05.008. Epub 2021 Jul 7.
The goal of this study was to determine whether a 6-hour lung ultrasound (LUS)-guided strategy-of-care improves pulmonary congestion over usual management in the emergency department (ED) setting. A secondary goal was to explore whether early targeted intervention leads to improved outcomes.
Targeting pulmonary congestion in acute heart failure remains a key goal of care. LUS B-lines are a semi-quantitative assessment of pulmonary congestion. Whether B-lines decrease in patients with acute heart failure by targeting therapy is not well known.
A multicenter, single-blind, ED-based, pilot trial randomized 130 patients to receive a 6-hour LUS-guided treatment strategy versus structured usual care. Patients were followed up throughout hospitalization and 90 days' postdischarge. B-lines ≤15 at 6 h was the primary outcome, and days alive and out of hospital (DAOOH) at 30 days was the main exploratory outcome.
No significant difference in the proportion of patients with B-lines ≤15 at 6 hours (25.0% LUS vs 27.5% usual care; P = 0.83) or the number of B-lines at 6 hours (35.4 ± 26.8 LUS vs 34.3 ± 26.2 usual care; P = 0.82) was observed between groups. There were also no differences in DAOOH (21.3 ± 6.6 LUS vs 21.3 ± 7.1 usual care; P = 0.99). However, a significantly greater reduction in the number of B-lines was observed in LUS-guided patients compared with those receiving usual structured care during the first 48 hours (P = 0.04).
In this pilot trial, ED use of LUS to target pulmonary congestion conferred no benefit compared with usual care in reducing the number of B-lines at 6 hours or in 30 days DAOOH. However, LUS-guided patients had faster resolution of congestion during the initial 48 hours. (B-lines Lung Ultrasound-Guided ED Management of Acute Heart Failure Pilot Trial; NCT03136198).
本研究旨在确定 6 小时肺部超声（LUS）指导的治疗策略是否优于急诊科（ED）常规管理，从而改善肺部充血。次要目标是探讨早期靶向干预是否能改善结局。
急性心力衰竭的目标仍然是靶向肺充血。B 线是一种对肺部充血的半定量评估。通过靶向治疗，急性心力衰竭患者的 B 线是否减少尚不清楚。
一项多中心、单盲、基于 ED 的急性心力衰竭患者 pilot 试验，将 130 例患者随机分为接受 6 小时 LUS 指导治疗策略组或接受常规结构性治疗组。患者在整个住院期间和出院后 90 天内接受随访。主要结局是 6 小时时 B 线≤15，主要探索性结局是 30 天时存活和出院天数（DAOOH）。
两组在 6 小时时 B 线≤15 的患者比例（LUS 组为 25.0%，常规护理组为 27.5%；P=0.83）或 6 小时时 B 线数量（LUS 组为 35.4±26.8，常规护理组为 34.3±26.2；P=0.82）均无显著差异。DAOOH 也没有差异（LUS 组为 21.3±6.6，常规护理组为 21.3±7.1；P=0.99）。然而，与接受常规结构性护理的患者相比，LUS 指导组在最初的 48 小时内 B 线数量的减少更为显著（P=0.04）。
在这项 pilot 试验中，与常规护理相比，ED 使用 LUS 靶向肺部充血并不能减少 6 小时或 30 天 DAOOH 时的 B 线数量。然而，LUS 指导组在最初的 48 小时内充血的缓解更快。（B 线肺部超声指导 ED 管理急性心力衰竭 pilot 试验；NCT03136198）。
