Experience in using focused cardiac ultrasound in patients with acute heart failure in the intensive care unit

Abstract

Portable ultrasound devices in initial cardiac patient examination in intensive care units are seen as an essential addition to conventional physical examinations. Aim. To assess the potential of using focused cardiac ultrasound for patients admitted in the intensive care unit with a clinical performance of acute heart failure. Material and methods . The study included 180 patients, 110 of whom were men. The mean age was 57 (40; 74) years. The patients included in the study were divided into 2 groups: group 1 consisted of patients who, upon admission, underwent a general clinical examination and an ultrasound with a portable device; group 2 — patients who, upon admission, underwent only a conventional examination. Using portable ultrasound scanners, the doctors evaluated ventricular contractility, the presence of significant valve regurgitation, the diameter and degree of inferior vena cava collapse, as well as the presence, prevalence and number of B-lines. The differences in the time required for the diagnosis using various methods were determined. Structural changes in the heart and lungs, identified using a portable ultrasound device, were also assessed. Results . In the group of patients who underwent focused cardiac ultrasound, the time from admission to initiation of therapy was 11 (7; 18) minutes. In the group 2, the median time from admission to initiation of intravenous diuretic administration was 86 (52; 116) min (p<0,001). According to the results of an ultrasound with a portable device, the following changes were noted: significant left ventricular contractility decrease were found in 32,4% of patients; a decrease in right ventricle contractility — in 16,2%. In 50% of patients, the left ventricular contractility was sufficient. In 43,3% of patients, bilateral B lines were identified as a sign of interstitial pulmonary syndrome; in 38,8%, there were signs of hypervolemia when assessing the inferior vena cava. Hemodynamically relevant mitral regurgitation was noted in 28,8% of cases; hemodynamically relevant tricuspid regurgitation — 21,1%; relevant aortic regurgitation — 6,6%. In 10% of patients, there was restricted mobility of aortic valve leaflets, which was suspected as aortic stenosis. In 18% of cases, no significant intracardiac hemodynamic changes were noted. Conclusion . It has been shown that examination with focused cardiac ultrasound in the intensive care unit reduces decision time by more than an hour. Initial examination of a patient with acute heart failure using pocket cardiac ultrasound devices reveals clinically relevant intracardiac hemodynamic disorders.