Anesthesiology, Intensive Care and Pain Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Anesthesia and Intensive care, Centre Hospitalier Universitaire de Dijon, France.
Ultraschall Med. 2017 Oct;38(5):530-537. doi: 10.1055/s-0042-120260. Epub 2017 Mar 14.
Lung Ultrasound Score (LUSS) is a useful tool for lung aeration assessment but presents two theoretical limitations. First, standard LUSS is based on longitudinal scan and detection of number/coalescence of B lines. In the longitudinal scan pleura visualization is limited by intercostal space width. Moreover, coalescence of B lines to define severe loss of aeration is not suitable for non-homogeneous lung pathologies where focal coalescence is possible. We therefore compared longitudinal vs. transversal scan and also cLUSS (standard coalescence-based LUSS) vs. qLUSS (quantitative LUSS based on % of involved pleura). 38 ICU patients were examined in 12 thoracic areas in longitudinal and transversal scan. B lines (number, coalescence), subpleural consolidations (SP), pleural length and pleural involvement (> or ≤ 50 %) were assessed. cLUSS and qLUSS were computed in longitudinal and transversal scan. Transversal scan visualized wider (3.9 [IQR 3.8 - 3.9] vs 2.0 [1.6 - 2.5] cm, p < 0.0001) and more constant (variance 0.02 vs 0.34 cm, p < 0.0001) pleural length, more B lines (70 vs 59 % of scans, p < 0.0001), coalescence (39 vs 28 %, p < 0.0001) and SP (22 vs 14 %, p < 0.0001) compared to longitudinal scan. Pleural involvement > 50 % was observed in 17 % and coalescence in 33 % of cases. Focal coalescence accounted for 52 % of cases of coalescence. qLUSS-transv generated a different distribution of aeration scores compared to cLUSS-long (p < 0.0001). In unselected ICU patients, variability of pleural length in longitudinal scans is high and focal coalescence is frequent. Transversal scan and quantification of pleural involvement are simple measures to overcome these limitations of LUSS.
肺部超声评分（LUSS）是一种用于评估肺部通气的有用工具，但存在两个理论局限性。首先，标准的 LUSS 基于纵向扫描和检测 B 线的数量/融合。在纵向扫描中，胸膜的可视化受到肋间隙宽度的限制。此外，融合 B 线以定义严重通气丧失并不适用于非均匀性肺部病变，在这些病变中可能存在局灶性融合。因此，我们比较了纵向扫描与横向扫描，以及基于标准融合的 cLUSS（基于融合的 LUSS）与基于 %受累胸膜的 qLUSS（定量 LUSS）。对 38 名 ICU 患者的 12 个胸部区域进行了纵向和横向扫描检查。评估了 B 线（数量、融合）、胸膜下实变（SP）、胸膜长度和胸膜受累（＞或≤50%）。在纵向和横向扫描中计算了 cLUSS 和 qLUSS。与纵向扫描相比，横向扫描可视化的胸膜长度更宽（3.9 [IQR 3.8-3.9] vs 2.0 [1.6-2.5] cm，p＜0.0001）且更恒定（方差 0.02 vs 0.34 cm，p＜0.0001），B 线更多（70%与 59%的扫描，p＜0.0001）、融合（39%与 28%，p＜0.0001）和 SP（22%与 14%，p＜0.0001）。在 17%的情况下观察到胸膜受累＞50%，在 33%的情况下观察到融合。局灶性融合占融合病例的 52%。qLUSS-transv 与 cLUSS-long 相比，通气评分的分布不同（p＜0.0001）。在未选择的 ICU 患者中，纵向扫描中胸膜长度的变异性较大，且局灶性融合较为常见。横向扫描和胸膜受累程度的量化是克服 LUSS 这些局限性的简单措施。
