Anile Antonio, Russo Jole, Castiglione Giacomo, Volpicelli Giovanni
Intensive Care Unit, Ospedale Vittorio Emanuele, AOU Policlinico-Vittorio Emanuele, Catania, Italy.
Department of Anesthesia and Intensive Care, Ospedale Vittorio Emanuele, ASP Caltanissetta, Gela, Italy.
Crit Ultrasound J. 2017 Dec;9(1):13. doi: 10.1186/s13089-017-0068-x. Epub 2017 Jun 13.
The quantification of B-lines at lung ultrasonography is a valid tool to estimate the extravascular lung water (EVLW) in patients after major cardiac surgery. However, there is still uncertainty about the correlation between B-lines and EVLW in a general population of critically ill.
To evaluate a simplified lung ultrasonographic assessment as a tool to estimate the EVLW in critically ill patients admitted to a polyvalent intensive care unit (ICU).
Nineteen consecutive critically ill patients requiring mechanical ventilation and hemodynamic monitoring were enrolled. Lung ultrasonography and the thermodilution methodology (PiCCO system) were performed by two independent operators. The positive scan at lung ultrasound was defined by visualization of at least 3 B-lines. We then compared the number of chest areas positive for B-lines with the EVLW index obtained by the invasive procedure.
A significant correlation was found between the number of lung quadrants positive for B-lines and EVLW indexed using both actual body weight (rho = 0.612 p = 0.0053) and predicted body weight (rho = 0.493 p = 0.032). Presence of more than 3 positive lung quadrants showed a good performance in identifying an EVLW index value >10 ml/kg of actual body weight(area under the ROC 0.894; 95% CI 0.668-0.987 p < 0.0001). Presence of of more than 4 positive lung quadrants indentified an EVLW index value >10 ml/kg of predicted body weight (area under the ROC 0.8; 95% CI 0.556-0.945 p = 0.0048).
A simplified lung ultrasound approach can by used as a reliable noninvasive bedside tool to predict EVLW in emergency and critically ill patients.
在心脏大手术后的患者中，肺部超声检查时B线的量化是评估血管外肺水（EVLW）的有效工具。然而，在危重症患者的总体人群中，B线与EVLW之间的相关性仍存在不确定性。
评估一种简化的肺部超声检查方法，作为估计入住综合重症监护病房（ICU）的危重症患者EVLW的工具。
连续纳入19例需要机械通气和血流动力学监测的危重症患者。由两名独立操作人员进行肺部超声检查和热稀释法（PiCCO系统）。肺部超声检查阳性定义为至少可见3条B线。然后，我们将B线阳性的胸部区域数量与通过侵入性操作获得的EVLW指数进行比较。
使用实际体重（rho = 0.612，p = 0.0053）和预测体重（rho = 0.493，p = 0.032）时，B线阳性的肺象限数量与EVLW指数之间均存在显著相关性。超过3个阳性肺象限在识别EVLW指数值>10 ml/kg实际体重方面表现良好（ROC曲线下面积0.894；95%可信区间0.668 - 0.987，p < 0.0001）。超过4个阳性肺象限可识别EVLW指数值>10 ml/kg预测体重（ROC曲线下面积0.8；95%可信区间0.556 - 0.945，p = 0.0048）。
一种简化的肺部超声检查方法可作为一种可靠的无创床边工具，用于预测急诊和危重症患者的EVLW。
