Yin Wanhong, Li Yi, Zeng Xueying, Qin Yao, Wang Dong, Zou Tongjuan, Su Ling, Kang Yan
Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America.
PLoS One. 2017 Aug 14;12(8):e0182881. doi: 10.1371/journal.pone.0182881. eCollection 2017.
Critical care ultrasound (CCUS) has been used by many Intensive Care Units(ICUs) worldwide, so as to guiding the diagnosis and the treatment. However, none of the publications currently systematically describe the utilization of CCUS to analyze the characteristics of hemodynamics and lung pathology upon the new admission to ICU and its potential role in patients' prognosis prediction. In this retrospective clinical study, we have demonstrated and analyzed the characteristics of hemodynamics and lung pathology assessed by CCUS and investigated its potential to predict patient outcome.
We have described and analyzed the epidemic characteristics of hemodynamics and lung pathology assessed by CCUS on ICU admission, which based on our database of 451 cases from the biggest medical center in Western China, between November 2014 and October 2015. The patients' demographics, clinical characteristics, prognosis and ultrasonic pattern of hemodynamics and lung pathology had been analyzed. A bivariate logistic regression model was established to identify the correlation between the ultrasonic variables on admission and the ICU mortality.
The mean age of the 451 patients was 56.7±18.7 years; the mean APACHE II score was 19.0±7.9, the ICU mortality was 30.6%. Patients received CCUS examination of pericardial, right ventricle (RV) wall motion, left ventricle (LV) wall motion, LV systolic function, LV diastolic function, lung and volume of inferior vena cava (IVC) were 423(93.8%), 418(92.7%), 392(86.9%), 389(86.3%), 383(84.9%), 440(97.6%), 336(74.5%), respectively; The univariate analysis revealed that length of mechanical ventilation was significantly correlated with the diameter of IVC, tricuspid annular plane systolic excursion(TAPSE), mitral annular plane systolic excursion(MAPSE), early diastolic transmitral velocity to early mitral annulus diastolic velocity(E/e') (p = 0.016, 0.011, 0.000, 0.049, respectively); The TAPSE, ejection fraction(EF), MAPSE, lung ultrasound score (LUS score) (p = 0.000, 0.028, 0.000, 0.011, respectively) were significantly related to ICU mortality. The multivariate analysis demonstrated that APACHE II, age, TAPSE, E/e' are the independent risk factors for ICU mortality in our study.
CCUS examination on ICU admission which performed by the experienced physician provide valuable information to assist the caregivers in understanding the comprehensive outlook of the characteristics of hemodynamics and lung pathology. Those key variables obtained by CCUS predict the possible prognosis of patients, hence deserve more attention in clinical decision making.
重症超声（CCUS）已被全球许多重症监护病房（ICU）用于指导诊断和治疗。然而，目前尚无出版物系统描述CCUS在分析ICU新入院患者血流动力学和肺部病理特征方面的应用及其在预测患者预后中的潜在作用。在这项回顾性临床研究中，我们展示并分析了通过CCUS评估的血流动力学和肺部病理特征，并研究了其预测患者预后的潜力。
我们描述并分析了基于2014年11月至2015年10月期间中国西部最大医疗中心的451例病例数据库，在ICU入院时通过CCUS评估的血流动力学和肺部病理的流行特征。分析了患者的人口统计学、临床特征、预后以及血流动力学和肺部病理的超声模式。建立了二元逻辑回归模型以确定入院时超声变量与ICU死亡率之间的相关性。
451例患者的平均年龄为56.7±18.7岁；平均急性生理学与慢性健康状况评分系统（APACHE II）评分为19.0±7.9，ICU死亡率为30.6%。接受CCUS检查心包、右心室（RV）壁运动、左心室（LV）壁运动、LV收缩功能、LV舒张功能、肺部和下腔静脉（IVC）容积的患者分别为423例（93.8%）、418例（92.7%）、392例（86.9%）、389例（86.3%）、383例（84.9%）、440例（97.6%）、336例（74.5%）；单因素分析显示机械通气时间与IVC直径、三尖瓣环平面收缩期位移（TAPSE）、二尖瓣环平面收缩期位移（MAPSE）、舒张早期二尖瓣血流速度与二尖瓣环舒张早期速度比值（E/e'）显著相关（p分别为0.016、0.011、0.000、0.049）；TAPSE、射血分数（EF）、MAPSE、肺部超声评分（LUS评分）（p分别为0.000、0.028、0.000、0.011）与ICU死亡率显著相关。多因素分析表明，在我们的研究中，APACHE II、年龄、TAPSE、E/e'是ICU死亡率的独立危险因素。
由经验丰富的医生在ICU入院时进行的CCUS检查提供了有价值的信息，有助于医护人员了解血流动力学和肺部病理特征的全面情况。通过CCUS获得的这些关键变量可预测患者的可能预后，因此在临床决策中值得更多关注。
