Monitoring patients with acute dyspnea with serial focused ultrasound of the heart and the lungs (MODUS): a randomized, controlled, open-label, pragmatic, and multicenter trial
Patients with dyspnea are often admitted to an emergency department and have high mortality. The current monitoring tools lack precision and other approaches are warranted to improve patient care. Focused ultrasound of the heart and the lungs are novel in this aspect.
The aim is to investigate whether therapy guided monitoring of patients admitted with acute dyspnea with serial ultrasound examinations of the heart and the lungs can improve the severity of dyspnea and in the long run the prognosis of the patients.
Acute dyspnea is one of the most common chief complaints in the emergency department and is caused by a wide variety of diseases among which chronic obstructive lung disease, pneumonia, heart failure, and pulmonary embolism are the frequently. These conditions have high in-hospital mortality, and increased length of stay in the elderly population admitted to an emergency setting.
After initial diagnostic evaluation, the patients with acute dyspnea are typically monitored by a combination of different symptoms scores, physical examination, vital signs and medical tests. The current methods of monitoring lack both sensitivity and specificity, and therefore other approaches are warranted. Ultrasound is a fast and bedside tool used in both the diagnostic evaluation and in the monitoring of the patients with acute dyspnea. Focused lung ultrasound (FLUS) can be used in the clinical assessment of the patient with dyspnea to diagnose different conditions, e.g., pulmonary edema/congestion (seen as B-lines on the ultrasound), pleural effusion, and pneumonia. In addition, ultrasound of the inferior vena cava (IVC) as part of a focused cardiac ultrasound (FoCUS) or echocardiography (evaluated by the size of IVC and the IVC collapsibility index (IVC-CI)) can be used to evaluate the patient's volume status and has in some trials been used to distinguish between dyspnea of cardiac and non-cardiac causes.
In parallel to the diagnostic value up front both FLUS and ultrasound of IVC can be used to monitor and guide therapy in the dyspneic patient, but the studies are heterogenic both clinical and methodological and are primarily conducted with patients with heart failure and not undifferentiated dyspnea caused by other conditions. Only a few studies have been carried out where the patients were monitored with FLUS in combination with an ultrasound of IVC; however, these studies were inconclusive.
Monitoring the patients with acute dyspnea is essential to decrease in-hospital mortality, to guide and optimize treatment, contribute to earlier discharge, and to improve the prognosis of the patients. Further studies are necessary to improve the diagnostic and prognostic evaluation of the patients to achieve better patient-centered care.
The primary aim is to investigate whether therapy guided monitoring of patients admitted with acute dyspnea with serial ultrasound examinations of the lungs and IVC can improve the severity of dyspnea. The secondary aims are to investigate if length of stay, mortality rates, and the number of readmissions can be improved by treatment guided by ultrasound monitoring.
Description of the cohort
- Patients admitted to an emergency ward
- Patients 18 years old or older
- The primary complaint for referral is dyspnea
- Informed consent should be obtained
- Patients primary admitted because of a trauma is excluded
Data and biological material
1. Past medical history, medications, smoker status, alcohol consumption
2. Symptoms on a verbal dyspnea scale from 0-10
3. Vitals (blood pressure, heart rate, respiratory rate, saturation, temperature)
4. Blood samples, arterial blood gasses, imaging
5. Ultrasound findings on lung and heart ultrasound
Collaborating researchers and departments
Department of Emergency Medicine, Slagelse Hospital
- Consultant, project manager, Michael Dan Arvig, PhD student
Department of Emergency Medicine, Odense University Hospital
- Consultant, principial supervisor, Annmarie Touborg Lassen, PhD, DMSc
Department of Respiratory Medicine, Odense University Hospital
- Consultant, Christian B. Laursen, PhD
Department of Cardiology and Enocrinology, Slagelse Hospital
- Consultant, Peter Haulund Gæde, DMSc
- Emergency departments at Slagelse Hospital
- Koege Hospital
- Holbaek Hospital
- Horsens Hospital
- Herning Hospital
- Hvidovre Hospital
- Odense University Hospital.