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Role of ultrasound and biomarkers
1. Congestion
The key target in acute heart failure
Role of ultrasound and biomarkers
Pr Semir Nouira
Emergency Department
Fattouma Bourguiba University Hospital
Monastir Tunisia
12. • Situations where the use of E/e' may be unreliable
– Tachycardia
– Mitral regurgitation or replacement
– LBBB
èSurrogate indices
─ PFV
─ LA Ø
─ LV Ø
• Hemodynamic and pulmonary congestion discrepancy
E/E’ Limits
18. q Sensitive but not specific
üARDS
ü Pulmonary fibrosis…
q Methodological biais
üPosition of the patient
üEquipment (probe type…)
LIMITS OF LUNG ULTRASOUND
19. Trovato GM. Am J Resp Crit Care Med 2013
LIMITS OF LUNG ULTRASOUND
26. BIOMARKERS AND CONGESTION
q Mid-region pro-atrial natriuretic peptide (MR-
proANP)
q Mid-regional adrenomedullin (MR-proADM)
as BNP are elevated in fluid overloaded patients
who have elevated filling pressures