Department of Surgery, University of Texas Southwestern/Parkland Memorial Hospital, Dallas, TX, USA.
Department of Surgery, Baystate Medical Center, Springfield, MA, USA.
J Crit Care. 2015 Feb;30(1):196-200. doi: 10.1016/j.jcrc.2014.09.017. Epub 2014 Oct 2.
Traumatically injured patients have multiple causes for acute respiratory decompensation. We reviewed the use of computed tomography pulmonary angiography (CTPA) in critically injured patients to evaluate the results and impact on patient care.
The charts of trauma patients (age >16 years) admitted to our intensive care unit for greater than 48 hours, who underwent CTPA for acute respiratory decompensation, were reviewed to determine the results of these studies and the effect on patient care.
We identified 188 patients who underwent CTPA for acute physiologic changes. Pertinent clinical finding were identified in 95% of studies and included atelectasis/collapse (56%), pleural effusion (18%), pneumonia (15%), and pulmonary embolus (18%). These results prompted interventions designed to improve patient outcome. The most frequent interventions were modifications of ventilator therapy (52%), antibiotic therapy (28%), mini-bronchoalveolar lavage (15%), or bronchoscopy (15%). Diagnostic agreement between chest x-ray and CTPA was poor to moderate (κ = 0.013-0.512).
Computed tomography pulmonary angiography is valuable in the evaluation of cardiopulmonary deterioration in critically ill traumatically injured patients. Computed tomography pulmonary angiography offers the ability to identify causes of acute physiologic changes not detected using standard chest x-ray. The results of these studies provide insight into the underlying pathophysiology and offer an opportunity to direct subsequent patient care.
创伤患者急性呼吸失代偿的原因有很多。我们回顾了在严重创伤患者中使用计算机断层扫描肺动脉造影（CTPA）的情况，以评估其结果并对患者治疗产生的影响。
我们对入住我院重症监护病房超过 48 小时的创伤患者（年龄＞16 岁）的病历进行了回顾，这些患者因急性呼吸失代偿而行 CTPA 检查，以确定这些研究的结果及其对患者治疗的影响。
我们共确定了 188 例因急性生理变化而行 CTPA 的患者。95%的研究中都发现了相关的临床发现，包括肺不张/塌陷（56%）、胸腔积液（18%）、肺炎（15%）和肺栓塞（18%）。这些结果促使我们采取了旨在改善患者预后的干预措施。最常见的干预措施是改变呼吸机治疗（52%）、抗生素治疗（28%）、迷你支气管肺泡灌洗（15%）或支气管镜检查（15%）。胸部 X 线和 CTPA 的诊断一致性较差到中度（κ=0.013-0.512）。
CTPA 对评估严重创伤患者心肺恶化具有重要价值。CTPA 能够识别标准胸部 X 线无法检测到的急性生理变化的原因。这些研究的结果可以深入了解潜在的病理生理学，并为指导后续的患者治疗提供机会。
