Bedside Lung Ultrasonography by Nurses in Acute Dyspnea.

Study Overview
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Brief Summary
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This study assesses the potential of lung ultrasonography to diagnose heart failure.

Detailed Description
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Dyspnea is one of the most distressing situations for the patient . Emergency cases do not always present in conditions that are ideal for immediate diagnosis, which sometimes compromises outcome. Physical examination, laboratory findings and radiography are imperfect, resulting in a need for sophisticated test results that delay management. Lung ultrasonography is becoming a standard tool in critical cases in the ED. the investigators aim to perform ultrasonography on consecutive patients admitted to the ICU with dyspnea, comparing lung ultrasonography results on initial presentation with the final diagnosis by the nurses. Three items were assessed: artifacts (horizontal A lines or vertical B lines indicating interstitial syndrome), lung sliding, and alveolar consolidation and/or pleural effusion, these items were grouped to assess ultrasound profiles. the study aimed to evaluate the accuracy and reproducibility of B-lines testing assessed by emergency nurses after 12-h training in the diagnosis of HF in patients admitted to the emergency department with acute dyspnea.

Official Title
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Bedside Lung Ultrasonography by Emergency Department Nurses as an Aid for Identifying Heart Failure in Patients With Acute Dyspnea

Conditions
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Dyspnea; Cardiac

Intervention / Treatment
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* Diagnostic Test: we perform a lung ultrasound to all the patients admitted for dyspnea independantly from the final diagnosis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: non traumatic dyspnea with the final diagnosis of heart failure Exclusion Criteria: age less than 18 years impossibility to give consent to participate in the study post-traumatic dyspnea pregnant women need for endotracheal intubation or inotropic drugs patients who were deemed too unstable for sonography by the treating team

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| nurses<br>ED nurses trained to perform LUS and blinded to the final diagnosis | Diagnostic Test: we perform a lung ultrasound to all the patients admitted for dyspnea independantly from the final diagnosis<br>* Patients were placed in a semi-recumbent or supine position depending on their respiratory tolerance. For each side of the chest, 4 zones have to be assessed : 2 anterior and 2 lateral. The operator should calculate the number of B-lines when present .<br>* Other names: lus;|
| emergency physician<br>certified emergency physician who had accomplished a full mentoring program for Ultra-Sound Life Support. | Diagnostic Test: we perform a lung ultrasound to all the patients admitted for dyspnea independantly from the final diagnosis<br>* Patients were placed in a semi-recumbent or supine position depending on their respiratory tolerance. For each side of the chest, 4 zones have to be assessed : 2 anterior and 2 lateral. The operator should calculate the number of B-lines when present .<br>* Other names: lus;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the accuracy of LUS performed by nurses in the diagnosis of heart failure | the accuracy of LUS in the diagnosis of heart failure measured by sensitivity . | 0 days | 
| the Specificity of LUS by nurses in the diagnosis of heart failure | the accuracy of LUS in the diagnosis of heart failure measured by specificity. | 0 days | 
| the reproducibility of LUS in by nurses the diagnosis of heart failure | the accuracy of LUS in the diagnosis of heart failure measured by area under the roc curve | 0 days | 
| Agreement between nurses and expert's | Agreement between nurses and expert's interpretation was assessed by kappa agreement index for ordinal LUS scale classification | 0 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lung ultrasound, heart failure, diagnosis, accuracy, nurses