Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Viale Morgagni 85, 50134, Florence, Italy.
Anesth Analg. 2010 Sep;111(3):687-92. doi: 10.1213/ANE.0b013e3181e7cc42.
Chest radiography has been reported to have low diagnostic accuracy in critically ill intensive care unit (ICU) patients, and chest computed tomography (CT) scans require patients to be transported out of the ICU, putting them at risk of adverse events. In this study we assessed the efficacy of routine bedside lung ultrasound (LUS) in the evaluation of pleural effusions (PE) in the ICU.
Three hundred seventy-six patients admitted to the ICU for major trauma (46.3%), medical pathology (41.5%), and postsurgical complications (12.2%) (May 2008 to April 2009) were included in this study. Patients were placed into either the control group (group C) or the study group (group S), on the basis of the introduction of routine LUS performed by a single group of intensivists in 1 tertiary care ICU. To reduce provider bias, the physicians conducting the LUS were not aware of the study. Collected data included patient demographics, clinical course, and number of chest radiographs and CT scans performed. As a secondary goal, we assessed the reliability of Balik's formula in PE estimation.
No significant differences were found between the 2 groups with regard to their demographics and ICU clinical course. Group S had a significant reduction in the total number of chest radiographs obtained (-26%; P < 0.001) and CT scans (-47%; P < 0.001) in comparison with the comparison group C. A 6-month follow-up analysis of the ICU LUS protocol revealed a time-dependent decrease in the number of radiological examinations requested for patients with PE. Lastly, PE volume estimation using the LUS and Balik's formula correlates well with the effective volume drained (r = 0.65; P < 0.0001).
Routine use of LUS in the ICU setting can be associated with a reduction of the number of chest radiographs and CT scans performed.
已有报道称，在重症监护病房（ICU）的危重病患者中，胸部 X 光检查的诊断准确性较低，而胸部计算机断层扫描（CT）需要将患者转运出 ICU，使他们面临不良事件的风险。在这项研究中，我们评估了常规床边肺部超声（LUS）在 ICU 中评估胸腔积液（PE）的疗效。
本研究纳入了 2008 年 5 月至 2009 年 4 月期间因重大创伤（46.3%）、医学病理学（41.5%）和术后并发症（12.2%）而入住 ICU 的 376 名患者。根据一组 ICU 医师在 1 家三级护理 ICU 中引入常规 LUS 的情况，将患者分为对照组（C 组）或研究组（S 组）。为了减少提供者的偏见，进行 LUS 的医生并不知道该研究。收集的数据包括患者的人口统计学资料、临床病程以及进行的胸部 X 光片和 CT 扫描的数量。作为次要目标，我们评估了 Balik 公式在 PE 估计中的可靠性。
两组患者的人口统计学资料和 ICU 临床病程无显著差异。与对照组 C 相比，S 组获得的胸部 X 光片总数（-26%；P < 0.001）和 CT 扫描总数（-47%；P < 0.001）显著减少。对 ICU LUS 方案进行的 6 个月随访分析显示，PE 患者的放射学检查请求数量随时间呈下降趋势。最后，LUS 和 Balik 公式的 PE 容积估计与有效引流量（r = 0.65；P < 0.0001）相关性良好。
在 ICU 环境中常规使用 LUS 可能与减少胸部 X 光片和 CT 扫描的数量有关。
