Laursen Christian B, Hänselmann Anja, Posth Stefan, Mikkelsen Søren, Videbæk Lars, Berg Henrik
Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
Clinical Institute, University of Southern Denmark, Odense, Denmark.
Scand J Trauma Resusc Emerg Med. 2016 Aug 2;24:96. doi: 10.1186/s13049-016-0288-2.
An improved prehospital diagnostic accuracy of cardiogenic pulmonary oedema could potentially improve initial treatment, triage, and outcome. A pilot study was conducted to assess the feasibility, time-use, and diagnostic accuracy of prehospital lung ultrasound (PLUS) for the diagnosis of cardiogenic pulmonary oedema.
A prospective observational study was conducted in a prehospital setting. Patients were included if the physician based prehospital mobile emergency care unit was activated and one or more of the following two were present: respiratory rate >30/min., oxygen saturation <90 %. Exclusion criteria were: age <18 years, permanent mental disability or PLUS causing a delay in life-saving treatment or transportation. Following clinical assessment PLUS was performed and presence or absence of interstitial syndrome was registered. Audit by three physicians using predefined diagnostic criteria for cardiogenic pulmonary oedema was used as gold standard.
A total of 40 patients were included in the study. Feasibility of PLUS was 100 % and median time used was 3 min. The gold standard diagnosed 18 (45.0 %) patients with cardiogenic pulmonary oedema. The diagnostic accuracy of PLUS for the diagnosis of cardiogenic pulmonary oedema was: sensitivity 94.4 % (95 % confidence interval (CI) 72.7-99.9 %), specificity 77.3 % (95 % CI 54.6-92.2 %), positive predictive value 77.3 % (95 % CI 54.6-92.2 %), negative predictive value 94.4 % (95 % CI 72.7-99.9 %).
The sensitivity of PLUS is high, making it a potential tool for ruling-out cardiogenic pulmonary. The observed specificity was lower than what has been described in previous studies.
Performed, as part of a physician based prehospital emergency service, PLUS seems fast and highly feasible in patients with respiratory failure. Due to its diagnostic accuracy, PLUS may have potential as a prehospital tool, especially to rule out cardiogenic pulmonary oedema.
提高心源性肺水肿的院前诊断准确性可能会改善初始治疗、分诊及预后。开展了一项前瞻性研究以评估院前肺部超声（PLUS）诊断心源性肺水肿的可行性、用时及诊断准确性。
在院前环境中进行一项前瞻性观察性研究。如果基于医生的院前移动急救单元启动，且患者出现以下两种情况中的一种或多种，则纳入研究：呼吸频率>30次/分钟、氧饱和度<90%。排除标准为：年龄<18岁、永久性精神残疾或PLUS导致挽救生命的治疗或转运延迟。临床评估后进行PLUS检查，并记录是否存在间质综合征。由三名医生根据预定义的心源性肺水肿诊断标准进行审核作为金标准。
共40例患者纳入研究。PLUS的可行性为100%，中位用时为3分钟。金标准诊断出18例（45.0%）心源性肺水肿患者。PLUS诊断心源性肺水肿的诊断准确性为：敏感性94.4%（95%置信区间（CI）72.7 - 99.9%），特异性77.3%（95%CI 54.6 - 92.2%），阳性预测值77.3%（95%CI 54.6 - 92.2%），阴性预测值94.4%（95%CI 72.7 - 99.9%）。
PLUS的敏感性较高，使其成为排除心源性肺水肿的潜在工具。观察到的特异性低于先前研究中所描述的。
作为基于医生的院前急救服务的一部分，PLUS在呼吸衰竭患者中似乎快速且高度可行。由于其诊断准确性，PLUS可能具有作为院前工具的潜力，尤其是用于排除心源性肺水肿。
