Objective Acute cardiogenic pulmonary edema (ACPE) is a frequently encountered medical emergency associated with high early mortality rates, but existing tools to predict short-term outcomes for risk stratification have several limitations. Our aim was to derive and validate a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests for accurate prediction of short-term mortality in individuals experiencing ACPE.
Methods This retrospective cohort study comprised 1,088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio for comprehensive examination and validation of the prognostic model. Independent predictors of mortality (P<0.05) from the multivariable model were included in the risk score. Discriminant ability of the model was tested by receiver operating characteristic analysis.
Results In the derivation cohort (623 patients), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring each of these factors as 0 or 1. The SABIHA (systolic blood pressure, age, blood urea nitrogen, invasive mechanical ventilation requirement, heart rate, and anemia) score provided good calibration with a concordance index of 0.879 (95% confidence interval, 0.821–0.937). While the probability of short-term mortality was 80.0% in the high-risk group, this rate was only 3.3% in the low-risk group. The SABIHA score also performed well on the validation set.
Conclusion A simple clinical score consisting of routinely obtained variables can be used to predict short-term outcomes in patients with ACPE.
Objective The aim of this study was to evaluate the effectiveness of teaching A- and B-lines, and lung sliding with a novel simulation methods using hand ultrasound.
Methods All subjects enrolled were medical school students who were novices in lung ultrasound. All subjects attended a 20-minute lecture about lung ultrasound using simulated video clips of A-lines, B-lines, and lung sliding; and then a 20-minute post-test was administered. The post-test included questions on the presence or absence of A-lines, B-lines, and lung sliding using a random mixture of 20 real video clips and 20 simulated video clips created by using hand ultrasound with or without foam dressing materials. A Wilcoxon signed rank test was used to compare the scores of A-lines, B-lines, and lung sliding between the real images (RG) and simulated models (SG).
Results There was a statistically significant difference in the median score of the correct answers for A-lines (RG, 18; SG, 17; P=0.037). Correct answers for B-line were significantly different between RG and SG group (RG, 18; SG, 17; P=0.008). There was a statistically significant difference in the median score of the correct answers for lung sliding (RG, 16; SG, 18; P<0.001).
Conclusion We found this novel B-line teaching model by using a hand ultrasound with a wet foam dressing material is effective for beginners who are less experienced with lung ultrasound and pulmonary interstitial syndrome.
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Objective Pulmonary edema is frequently observed after a successful resuscitation in out-of hospital cardiac arrest (OHCA) patients. Currently, its risk factors and prognostic implications are mostly unknown.
Methods Adult OHCA patients with a presumed cardiac etiology who achieved sustained return of spontaneous circulation (ROSC) in emergency department were retrospectively analyzed. The patients were grouped according to the severity of consolidation on their initial chest X-ray (group I, no consolidation; group II, patchy consolidations; group III, consolidation involving an
entire lobe; group IV, total white-out of any lung). The primary objective was to identify the risk factors of developing severe pulmonary edema (group III or IV). The secondary objective was to evaluate the association between long-term prognosis and the severity of pulmonary edema.
Results One hundred and seven patients were included. Total duration of cardiopulmonary resuscitation (CPR) and initial pCO2 level were both independent predictors of developing severe pulmonary edema with their odds ratio (OR) being 1.02 (95% confidence interval [CI], 1.00 to 1.04; per 1 minute) and 1.04 (95% CI, 1.01 to 1.07; per 1 mmHg), respectively. The long term
prognosis was significantly poor in patients with severe pulmonary edema with a OR for good outcome (6-month cerebral performance category 1 or 2) being 0.22 (95% CI, 0.06 to 0.79) in group III and 0.16 (95% CI, 0.04 to 0.63) in group IV compared to group I.
Conclusion The duration of CPR and initial pCO2 level were both independent predictors for the development of severe pulmonary edema after resuscitation in emergency department. The severity of the pulmonary edema was significantly associated with long-term outcome.
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