Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Emerg Med J. 2023 Oct;40(10):700-707. doi: 10.1136/emermed-2022-212694. Epub 2023 Aug 18.
Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. The objective was to investigate if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS and usual care could reduce the severity of dyspnoea compared with usual care alone.
This was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021. Patients aged ≥18 years admitted with a primary complaint of dyspnoea were allocated 1:1 with block randomisation to usual care, which included a single cardiopulmonary PoCUS within 1 hour of arrival (control group) or usual care (including a PoCUS within 1 hour of arrival) plus two additional PoCUS performed at 2 hours interval from the initial PoCUS (serial ultrasound group). The primary outcome was a reduction of dyspnoea measured on a verbal dyspnoea scale (VDS) from 0 to 10 recorded at inclusion and after 2, 4 and 5 hours.
There were 206 patients recruited, 102 in the serial ultrasound group and 104 in the control group, all of whom had complete follow-up. The mean difference in VDS between patients in the serial ultrasound and the control group was -1.09 (95% CI -1.51 to -0.66) and -1.66 (95% CI -2.09 to -1.23) after 4 and 5 hours, respectively. The effect was more pronounced in patients with a presumptive diagnosis of acute heart failure (AHF). A larger proportion of patients received diuretics in the serial ultrasound group.
Therapy guided by serial cardiopulmonary PoCUS may, together with usual care, facilitate greater improvement in the severity of dyspnoea, especially in patients with AHF compared with usual care with a single PoCUS in the ED. Serial PoCUS should therefore be considered for routine use to aid the physician in stabilising the patient faster.
NCT04091334.
连续床边超声（PoCUS）可以通过根据动态超声发现调整治疗，从而有可能改善急性患者的护理。目的是研究通过连续心肺 PoCUS 监测急性呼吸困难患者并辅以常规护理与仅常规护理相比，是否可以减轻呼吸困难的严重程度。
这是一项于 2019 年 10 月 9 日至 2021 年 5 月 26 日在丹麦的 3 家急诊室进行的随机、对照、盲法结局试验。年龄≥18 岁、因呼吸困难为主诉入院的患者按 1:1 比例用区组随机法分配至常规护理组（对照组）或常规护理加 2 次在初始 PoCUS 后 2 小时间隔进行的额外 PoCUS（连续超声组）。主要结局是在纳入时和 2、4、5 小时记录的从 0 到 10 的口头呼吸困难量表（VDS）评分降低。
共纳入 206 例患者，连续超声组 102 例，对照组 104 例，均完成了随访。连续超声组和对照组患者的 VDS 差值分别为-1.09（95%CI -1.51 至-0.66）和-1.66（95%CI -2.09 至-1.23），分别在 4 小时和 5 小时时。该效应在疑似急性心力衰竭（AHF）的患者中更为明显。连续超声组中接受利尿剂治疗的患者比例较大。
与常规护理相比，连续心肺 PoCUS 指导的治疗可能会更有助于改善呼吸困难的严重程度，特别是在急诊科接受单次 PoCUS 的 AHF 患者中。因此，应考虑将连续 PoCUS 常规用于帮助医生更快地稳定患者。
NCT04091334。
