Mallow Christopher, Isakow Warren
Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, MO.
J Bronchology Interv Pulmonol. 2019 Apr;26(2):102-107. doi: 10.1097/LBR.0000000000000525.
Point of care bedside ultrasound is widely utilized as a rapid technique to evaluate patients with acute pulmonary emergencies, including acute pneumothorax. The presence of a pneumothorax is a known cause of loss of lung sliding by ultrasound examination, but no other risk factors have been clearly identified. We attempted to identify demographic and patient characteristics that are risk factors for loss of ultrasonographic lung sliding in the absence of a pneumothorax.
Data were collected on 159 patients admitted to the medical intensive care unit with acute respiratory failure, undergoing routine admission lung ultrasound. The lung ultrasound examination consisted of 3 views of each hemithorax using a phased array abdominal probe.
There were 4 confirmed pneumothoraces out of 20 patients with loss of lung sliding at ≥1 ultrasound interrogation points on either hemithorax. Hypercarbic respiratory failure [odds ratio (OR), 5.59] and low body mass index (OR, 0.88) were statistically significant risk factors for the loss of lung sliding in the absence of pneumothorax. There was a trend toward significance in patients with a known history of a decreased forced expiratory volume 1/forced vital capacity ratio (OR, 0.02), COPD/asthma exacerbation as the cause of their respiratory failure (OR, 4.52) and previous pneumothorax (OR, 11.53).
Common diagnoses and comorbidities are associated with the loss of ultrasonographic lung sliding, in the absence of pneumothorax.
床旁即时超声作为一种快速评估急性肺部急症患者（包括急性气胸）的技术被广泛应用。气胸的存在是超声检查中肺滑动消失的已知原因，但尚未明确识别出其他风险因素。我们试图识别在无气胸情况下作为超声肺滑动消失风险因素的人口统计学和患者特征。
收集了159例入住医学重症监护病房且患有急性呼吸衰竭并接受常规入院肺部超声检查患者的数据。肺部超声检查使用相控阵腹部探头对每个半胸进行3个视图的检查。
在20例在任一胸侧的≥1个超声检查点出现肺滑动消失的患者中，有4例确诊为气胸。高碳酸血症性呼吸衰竭（比值比[OR]，5.59）和低体重指数（OR，0.88）是无气胸情况下肺滑动消失的统计学显著风险因素。已知用力呼气量1/用力肺活量比值降低病史的患者（OR，0.02）、慢性阻塞性肺疾病/哮喘加重作为呼吸衰竭原因的患者（OR，4.52）和既往有气胸病史的患者（OR，11.53）存在显著趋势。
在无气胸情况下，常见诊断和合并症与超声肺滑动消失有关。
