Phillips Colin T, Manning Warren J
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Echocardiography. 2017 May;34(5):656-661. doi: 10.1111/echo.13509. Epub 2017 Mar 14.
Pocket ultrasonography may enhance patient diagnosis and care. We sought to assess pocket ultrasound in detecting common conditions in the coronary care unit (CCU) compared to portable daily chest radiography (CXR) and conventional transthoracic echocardiography (TTE).
An experienced pocket ultrasound user performed a pocket ultrasound examination for interstitial edema, pneumonia, central line seen in the right ventricle, pleural and pericardial effusions, left atrial enlargement, and cardiomegaly. Data were blindly compared to the radiologist CXR interpretation and cardiologist TTE interpretation.
A total of 102 CXR and pocket ultrasound examinations were performed in 66 patients. The most common CXR indication was "interval change" (37%) and finding central line (65%). Pocket ultrasound demonstrated overall good concordance with CXR ranging from 77% for pleural effusion to 92% for pneumonia. Additionally, the pocket ultrasound examination appeared to anticipate resolution of pulmonary edema prior to the CXR. Compared to TTE, pocket ultrasound had excellent sensitivity for cardiac findings with values ranging from 85% for left atrial enlargement to 100% for cardiomegaly, but limited specificity of cardiomegaly at just 51%.
In the CCU, bedside pocket ultrasound reliably diagnoses common conditions identified by CXR with the advantage of lack of ionizing radiation and the suggestion of detecting the resolution of pulmonary edema prior to CXR. Pitfalls include only modest concordance for pleural effusions and limited specificity for cardiomegaly. Larger, multicenter studies are needed to determine whether pocket ultrasound can reduce routine daily CXR in the CCU and other intensive care settings.
便携式超声检查可能会改善患者的诊断和护理。我们试图评估便携式超声在冠心病监护病房（CCU）中检测常见病症的效果，并与便携式每日胸部X线摄影（CXR）和传统经胸超声心动图（TTE）进行比较。
一位经验丰富的便携式超声使用者对间质性水肿、肺炎、右心室内可见的中心静脉导管、胸腔和心包积液、左心房扩大及心脏扩大进行便携式超声检查。将数据与放射科医生对CXR的解读以及心脏病专家对TTE的解读进行盲法比较。
共对66例患者进行了102次CXR和便携式超声检查。CXR最常见的指征是“间期变化”（37%）和发现中心静脉导管（65%）。便携式超声与CXR总体一致性良好，胸腔积液的一致性为77%，肺炎为92%。此外，便携式超声检查似乎能在CXR之前预测肺水肿的消退。与TTE相比，便携式超声对心脏检查结果具有出色的敏感性，左心房扩大的敏感性为85%，心脏扩大为100%，但心脏扩大的特异性有限，仅为51%。
在CCU中，床边便携式超声能够可靠地诊断CXR所发现的常见病症，其优点是无电离辐射，并能在CXR之前提示检测到肺水肿的消退。不足之处包括胸腔积液的一致性一般，心脏扩大的特异性有限。需要开展更大规模的多中心研究，以确定便携式超声是否能减少CCU和其他重症监护环境中的常规每日CXR检查。
