Clinical application of cardiopulmonary ultrasound combined with pulse index continuous cardiac output monitoring on body fluid management in patients with heart failure

Objective To evaluate the value of cardiopulmonary ultrasound combined with pulse index continuous cardiac output (PICCO) monitoring on body fluid management in patients with heart failure (HF). Methods A prospective self-controlled study was used. HF patients with reduced ejection fraction were enrolled from March to October 2018 in the Department of Cardiology, Xinjiang Uygur Autonomous Region People's Hospital. They were monitored by PICCO for assessment of cardiac output (CO), extravascular lung water index (EVLWI), and central venous pressure (CVP). Meanwhile, cardiopulmonary ultrasound was used to monitor the left ventricular outflow tract blood flow velocity integral (VTI), change of inferior vena cava (IVC) width and lung water B line. All participants were evaluated by the two methods for body fluid management guidance. Results A total of 32 patients were enrolled with a mean age of 66.92±6.59 years, 18 of them were male and 14 of them were female. The maximum width of IVC, minimum width of IVC were linear positively associated with CVP (r=0.768 and 0.891 respectively, P<0.01). The lung ultra-B line had a linear correlation with EVLWI. The echocardiographic and PICCO method did not show statistical difference in the assessment of CO (t=1.327, P=0.68). There was a linear correlation between the two methods (r=0.919, P<0.001). Conclusion In addition to conventional PICCO monitoring, combination of cardiopulmonary ultrasound for fluid management in severe HF patients could be an option. For those patients not appropriate for PICCO monitoring, cardiopulmonary ultrasound may be helpful for fluid management. Key words: Severe heart failure; Pulse index continuous cardiac output; Cardiopulmonary combined ultrasound; Fluid management