Ultrasonographic evaluation of patients' response to diuretic therapy in the emergency department

Introduction and Aim: Dyspnea is one of the most common complaints of admission to emergency services. Rapid management of dyspneic patients is essential. In some patients, the cause of shortness of breath is cardiac insufficiency. Cardiac insufficiency is a growing problem of the 21st century. Pulmonary edema, seen in cardiac insufficiency, can be fatal. Pulmonary edema is defined as an increase in fluid in the interstitial and alveolar spaces of the lung parenchyma. This study aims to examine the diagnostic values of B lines and IVC measurements by using lung ultrasonography to clarify the presence of pulmonary edema and to evaluate the effectiveness of diuretic therapy in patients presenting to the emergency department with shortness of breath. Materials and Methods: This study was conducted in accordance with the Declaration of Helsinki, with the approval of the Ethics Committee. It was performed on patients who applied to the emergency department with dyspnea, as a prospective and single-center study, between 01 April 2023 and 30 June 2023. Reverse-FALLS protocol, an ultrasonography protocol, was used to guide diuretic therapy in patients with pulmonary edema. The number of B lines seen in USG performed for the purpose of evaluating the extravascular area before and after diuretic treatment was recorded in the prepared forms. In this study, version 21.0 of the SPSS (Statistical Package for the Social Sciences, Chicago, IL, USA) program was used for statistical analysis of the data. In the analysis of continuous variables, T-test in Independent Groups was used for those normally distributed, and the Mann-Whitney U test for those not normally distributed. The Wilcoxon test was used to evaluate the USG data applied at the time of admissio n and the USG data applied after the treatment. The results were evaluated within the 95% confidence interval, and p<0.05 was accepted as statistical significance. Results: 40 patients who met the inclusion criteria were included in the study. Twenty-six (65%) of the patients were female, 14 (35%) were male, and the mean age was 75.5. A decrease in B lines was detected in 82.5% of our patients when compared xiv before and after diuretic treatment. When the number of B lines detected in the upper- right (p=0.005), lower-right (p=0.013), upper-left (p<0.001), lower-left (p<0.001) regions of the USG applied at the time of arrival, and the USG performed after diuretic therapy were compared, a statistically significant difference was found. There was no statistically significant difference between IVC 1 a diameter, IVC 1 b diameter, IVC 2 a diameter, and IVC 2 b diameter variables (p=0.667, p=0.498, p=0.682, p=0.379). Conclusion: The results of the study show that lung ultrasonograp hy performed in patients seeking emergency services with shortness of breath will shorten the initiation of diuretic therapy and can be used effectively in patient follow-up. The use of ultrasonography devices, which guides doctors very quickly and effectively in emergency services, should become more widespread. Keywords: Lung ultrasound, B lines, Inferior Vena Cava