肺部超声可用于预测急性呼吸窘迫综合征患者俯卧位通气的可能性并评估其预后。
Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome.
作者信息
Wang Xiao-Ting, Ding Xin, Zhang Hong-Min, Chen Huan, Su Long-Xiang, Liu Da-Wei
机构信息
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
出版信息
Crit Care. 2016 Nov 30;20(1):385. doi: 10.1186/s13054-016-1558-0.
BACKGROUND
It is very important to assess the effectiveness of prone positioning (PP) in patients with severe acute respiratory distress syndrome (ARDS). However, it is difficult to identify patients who may benefit from PP. The purpose of this study was to investigate whether prone positioning potential (PPP) can be predicted by lung ultrasound in patients with ARDS.
METHODS
In this prospective study, 45 patients with ARDS were included for the assessment of PPP. A PP lung ultrasound examination (PLUE) protocol was performed in the dorsal regions of the lung in 16 areas at H0, H3, and H6 (0, 3, and 6 h after PP). The ultrasonography videos were blindly evaluated by two expert clinicians to classify the lung regions as normal pattern (N), moderate loss of lung aeration (B1), severe loss of lung aeration (B2), and consolidation (C). The aeration scores were collected at H0, H3, and H6. According to the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F ratio) at 7 days, patients were classified into PPP-positive (P/F ratio >300) and PPP-negative groups; also, the patients were classified into survival and nonsurvival groups according to 28-day mortality.
RESULTS
Aeration scores was compared at H0, H3, and H6. The scores were significantly reduced between H3 and H0, but there was no difference between H3 and H6. The aeration score variation (ASV) of the PPP-positive group between H3 and H0 was significantly higher than that in the PPP-negative group, and the sensitivity and specificity of ASV ≥5.5 for the PPP-positive group were 73.9% and 86.4%, respectively. The area under the receiver operating characteristic curve (AUROC) was 0.852 for the ASV. The ASV between H3 and H0 in the survival group was significantly higher than in the nonsurvival group. The sensitivity and specificity of ASV ≥7 for survival were 51.5% and 75%, respectively. The AUROC was 0.702 for the ASV.
CONCLUSIONS
The PLUE protocol can be used to predict PPP and assess prognosis in patients with ARDS.
背景
评估俯卧位通气（PP）对重症急性呼吸窘迫综合征（ARDS）患者的有效性非常重要。然而，很难识别可能从PP中获益的患者。本研究的目的是探讨肺部超声能否预测ARDS患者的俯卧位通气潜力（PPP）。
方法
在这项前瞻性研究中，纳入45例ARDS患者以评估PPP。在PP后0小时（H0）、3小时（H3）和6小时（H6），在肺部背侧区域的16个部位进行PP肺部超声检查（PLUE）方案。两名专家临床医生对超声检查视频进行盲法评估，将肺区域分为正常模式（N）、中度肺通气丧失（B1）、重度肺通气丧失（B2）和实变（C）。在H0、H3和H6收集通气评分。根据7天时动脉血氧分压与吸入氧分数之比（P/F比），将患者分为PPP阳性（P/F比>300）组和PPP阴性组；此外，根据28天死亡率将患者分为存活组和非存活组。
结果
比较了H0、H3和H6时的通气评分。H3和H0之间的评分显著降低，但H3和H6之间没有差异。PPP阳性组H3和H0之间的通气评分变化（ASV）显著高于PPP阴性组，ASV≥5.5对PPP阳性组的敏感性和特异性分别为73.9%和86.4%。ASV的受试者工作特征曲线下面积（AUROC）为0.852。存活组H3和H0之间的ASV显著高于非存活组。ASV≥7对存活的敏感性和特异性分别为51.5%和75%。ASV的AUROC为0.702。
结论
PLUE方案可用于预测ARDS患者的PPP并评估预后。
Zotero 插件