scholarly journals Dynamic Changes in Portal Vein Flow during Decongestion in Patients with Heart Failure and Cardio-Renal Syndrome: A POCUS Case Series

2021 ◽  
pp. 1-8
Author(s):  
Eduardo R. Argaiz ◽  
Philippe Rola ◽  
Gerardo Gamba
Keyword(s):  
Heart Failure ◽  
Portal Vein ◽  
Point Of Care ◽  
Vena Cava ◽  
Case Series ◽  
Kidney Injury ◽  
Venous Congestion ◽  
Point Of Care Ultrasound ◽  
Optimal Method ◽  
Portal Vein Flow

<b><i>Introduction:</i></b> Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of abdominal venous congestion and have been associated with acute kidney injury (AKI) in cardiac surgery patients. It is currently unknown if portal vein flow (PVF) alterations in heart failure can be reversed with diuretic treatment and track decongestion. <b><i>Objective:</i></b> The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment. <b><i>Methods:</i></b> Assessment of venous congestion using point-of-care ultrasound was performed in 12 patients with ADHF (6 patients with left-sided heart failure and 6 patients with right-sided heart failure). Evaluation included inferior vena cava (IVC) size and collapsibility in addition to PV Doppler to determine pulsatility fraction (PF). <b><i>Results:</i></b> Increased PV PF (81.75 ± 13%) was found on admission. After effective decongestive treatment, it improved to (17.43 ± 2.2%). Improvement in IVC size and collapsibility was seen in most patients with left-sided heart failure and none of the patients with right-sided heart failure. Improvement in PV PF coincided with return to baseline of Serum Cr in patients that presented with AKI. <b><i>Conclusions:</i></b> Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.

scholarly journals First diagnosis of multisystem inflammatory syndrome in children (MIS-C): an analysis of PoCUS findings in the ED

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Angelo G. Delmonaco ◽  
Andrea Carpino ◽  
Irene Raffaldi ◽  
Giulia Pruccoli ◽  
Emanuela Garrone ◽  
...  
Keyword(s):  
Clinical Condition ◽  
Inferior Vena ◽  
Point Of Care ◽  
Vena Cava ◽  
Case Series ◽  
Signs And Symptoms ◽  
Therapeutic Management ◽  
Point Of Care Ultrasound ◽  
Multiple Systems ◽  
Inflammatory Syndrome

AbstractChildren with multisystem inflammatory syndrome (MIS-C) tend to develop a clinical condition of fluid overload due both to contractile cardiac pump deficit and to endotheliitis with subsequent capillary leak syndrome. In this context, the ability of point-of-care ultrasound (PoCUS) to simultaneously explore multiple systems and detect polyserositis could promote adequate therapeutic management of fluid balance. We describe the PoCUS findings in a case-series of MIS-C patients admitted to the Emergency Department. At admission 10/11 patients showed satisfactory clinical condition without signs and symptoms suggestive for cardiovascular impairment/shock, but PoCUS showed pathological findings in 11/11 (100%). In particular, according to Rapid Ultrasound in SHock (RUSH) protocol, cardiac hypokinesis was detected in 5/11 (45%) and inferior vena cava dilatation in 3/11 (27%). Peritoneal fluid was reported in 6/11 cases (54%). Lung ultrasound (LUS) evaluation revealed an interstitial syndrome in 11/11 (100%), mainly localized in posterior basal lung segments. We suggest PoCUS as a useful tool in the first evaluation of children with suspected MIS-C for the initial therapeutic management and the following monitoring of possible cardiovascular deterioration.

scholarly journals Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort

2021 ◽  
Author(s):  
Marta Torres-Arrese ◽  
Gonzalo García de Casasola-Sánchez ◽  
Manuel Méndez-Bailón ◽  
Esther Montero-Hernández ◽  
Marta Cobo-Marcos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Point Of Care ◽  
Vena Cava ◽  
Common Disease ◽  
Point Of Care Ultrasound ◽  
High Morbidity ◽  
Major Health Problem ◽  
Study Results ◽  
The Impact

Background and Objectives: Acute Heart Failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying the pulmonary hypertension (PH) in patients admitted due to AHF, predict the evolution of the disease during hospitalization and identify areas of improvement in the care of patients with AHF. Materials and Methods: Patients were evaluated with a standard exam of lung ultrasound, echocardiography, inferior vena cava (IVC) and femoral, renal, hepatic, portal venous Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation &ndash; SD 13,4). Seven patients (23.3%) had a renal function worsening. Regarding ultrasound findings, venous excess ultrasonography score (VExUS) score was calculated at admission and at discharge, surprisingly remaining unchanged or even worsened in most of them (21 patients, 70.0%). The area under the curve for the Lung Score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (p &amp;lt;0.001), hepatic vein Doppler (p &amp;lt;0.001), portal vein Doppler (p = 0.030), intra-renal vein Doppler (p = 0.025) and VExUS score (p = 0.023), remaining similar the femoral vein Doppler (p = 0.177) and IVC (p = 0.132). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VExUS score, should be further studied in different populations before expanding its use in AHF patients.

P0304POINT OF CARE ULTRASOUND IN NEPHROLOGY: THE SOONER THE BETTER!

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mirela Liana Gliga ◽  
Mihail Gheorghe Gliga ◽  
Cristian Chirila ◽  
Raluca-Maria Lie-Ungurean ◽  
Paula Chirila
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Ct Scan ◽  
Point Of Care ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Portable Device ◽  
Diagnostic Tools ◽  
Point Of Care Ultrasound ◽  
Linear Probe

Abstract Background and Aims Point of care ultrasound (POCUS) is performed at the bedsite of the patient by de treating clinician. In nephrology a particular situation is related to severly ill patients, immobilized with elevated creatinine, which can not be deffered to imaging investigations such as CT scan or MRI. Using a small portable device, important clinical problems can be solved in no time. Method We examined 360 out of 670 patients admitted to the nephrology departament in a period of one year. They were severely ill due to following pathologies: 35 severe sepsis with hypotension, 53 decompensated heart failure, 24 stroke, 248 with renal failure and acido-basic or electrolitic disturbances. Evaluation was made using a portable US device with a 10 MHz linear probe and 3.5 MHz convexe probe with abdomen and thoracic software. Diameter of inferior vena cava (IVC), respiratory collapse of IVC, effusions in pleura, pericardium or peritoneum, liver dimensions, kidneys and spleen were described. Results 31 out of 35 patients with hypotension had collapsed IVC, diameter less than 1cm, PPV 88.5%; 48 from 53 heart failure had enlarged IVC with reduced respiratory collapse, PPV 90.6% and 201 from 248 renal failure patients had kidney changes, 81.04%. As compared with standard diagnostic tools (echocardiography, native CT scan and clinical examination, Sensitivity was over 98% in all cases. Conclusion POCUS is a very usefull test for the rapid bed-site examination of kidney patients, were a rapid decision has to be made using a portable device. Sensitivity of the method proved to be comparable as with standard diagnostic tools.

scholarly journals Interstitial syndrome-lung ultrasound B lines: a potential marker for pulmonary metastases? A case series

2018 ◽  
Vol 12 (3) ◽  
pp. 223-226 ◽  
Author(s):  
Maria Viviana Carlino ◽  
Costantino Mancusi ◽  
Giovanni De Simone ◽  
Filomena Liccardi ◽  
Mario Guarino ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Point Of Care ◽  
Case Series ◽  
Point Of Care Ultrasound ◽  
Interstitial Syndrome ◽  
Potential Marker ◽  
Bilateral Lung ◽  
Enhanced Computed Tomography

Four patients presented to the Emergency Department with dyspnea and they underwent point-of-care ultrasound. Lung ultrasound showed a diffuse bilateral B-profile pattern-interstitial syndrome, they underwent contrast-enhanced computed tomography scan of thorax that showed multiple bilateral lung metastases. The detection, in a dyspneic patient, of a diffuse Bprofile pattern not attributable to traditional interstitial syndrome conditions (pulmonary fibrosis, acute respiratory distress syndrome, acute pulmonary edema, interstitial pneumonia) could be indicative of multiple pulmonary metastases.

Abstract 16244: Point of Care Ultrasound of the Jugular Venous Pulse in the Upright Position (u 2 Jvp) Predicts Elevated Right Atrial Pressure and Pulmonary Capillary Wedge Pressure on Right Heart Catheterization in Obese and Non-obese Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Libo Wang ◽  
Jonathan Harrison ◽  
Elizabeth Dranow ◽  
Lillian Khor
Keyword(s):  
Heart Failure ◽  
Predictive Value ◽  
Point Of Care ◽  
Right Heart Catheterization ◽  
Upright Position ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Clinically Significant

Introduction: Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. The visual inspection of jugular venous pulsation (JVP) in a reclined position and measuring its height from the sternal notch has been used as a surrogate for right atrial pressure (RAP). There are no studies on the predictive value of a visible internal jugular vein (IJV) in the upright position (U 2 JVP). Hypothesis: Point of care ultrasound (POCUS) for volume assessment in the upright position is predictive of clinically significant hypervolemia. Methods: Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV and its size in comparison to the carotid artery was identified on ultrasound with the patient upright. Elevated RAP and PCWP was present if the IJV was still visible and not collapsed throughout the entirety of the respiratory cycle. Valsalva was used to confirm the position of a collapsed IJV. Results: 72 participants underwent U 2 JVP assessment on the same day prior to RHC. Average BMI was 31.9 kg/m2. The area under the curve (AUC) of U 2 JVP predicting RAP greater than 10 mmHg and PCWP of 15 mmhg or higher on RHC was 0.78 (95% CI 0.66-0.9, p<0.001), with AUC of 0.86 and 0.74 for non-obese and obese subgroups respectively, p= 0.38. The finding of a visible U 2 JVP in the upright position was 70.6 % sensitive and 85.5 % specific with a negative predictive value of 90.4% for identifying both RAP greater than 10 mmHg and PCWP equal or greater than 15 mmHg. Conclusions: The U 2 JVP is novel and pragmatic bed-side approach to the assessment of clinically significant elevated intra-cardiac pressures in our increasingly obese heart failure population.

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