评估急性呼吸窘迫综合征患者的 CT 扫描和超声肺通气和复张。

Assessment of Lung Aeration and Recruitment by CT Scan and Ultrasound in Acute Respiratory Distress Syndrome Patients.

机构信息

Centro di Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy.

Dipartimento di Emergenza-Urgenza, SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Milan, Italy.

出版信息

Crit Care Med. 2018 Nov;46(11):1761-1768. doi: 10.1097/CCM.0000000000003340.

DOI:10.1097/CCM.0000000000003340

PMID:30048331

Abstract

OBJECTIVES

Lung ultrasound is commonly used to evaluate lung morphology in patients with acute respiratory distress syndrome. Aim of this study was to determine lung ultrasound reliability in assessing lung aeration and positive end-expiratory pressure-induced recruitment compared with CT.

DESIGN

Randomized crossover study.

SETTING

University hospital ICU.

PATIENTS

Twenty sedated paralyzed acute respiratory distress syndrome patients: age 56 years (43-72 yr), body mass index 25 kg/m (22-27 kg/m), and PaO2/FIO2 160 (113-218).

INTERVENTIONS

Lung CT and lung ultrasound examination were performed at positive end-expiratory pressure 5 and 15 cm H2O.

MEASUREMENTS AND MAIN RESULTS

Global and regional Lung Ultrasound scores were compared with CT quantitative analysis. Lung recruitment (i.e., decrease in not aerated tissue as assessed with CT) was compared with global Lung Ultrasound score variations. Global Lung Ultrasound score was strongly associated with average lung tissue density at positive end-expiratory pressure 5 (R = 0.78; p < 0.0001) and positive end-expiratory pressure 15 (R = 0.62; p < 0.0001). Regional Lung Ultrasound score strongly correlated with tissue density at positive end-expiratory pressure 5 (rs = 0.79; p < 0.0001) and positive end-expiratory pressure 15 (rs = 0.79; p < 0.0001). Each step increase of regional Lung Ultrasound score was associated with significant increase of tissue density (p < 0.005). A substantial agreement was found between regional Lung Ultrasound score and CT classification at positive end-expiratory pressure 5 (k = 0.69 [0.63-0.75]) and at positive end-expiratory pressure 15 (k = 0.70 [0.64-0.75]). At positive end-expiratory pressure 15, both global Lung Ultrasound score (22 [16-27] vs 26 [21-29]; p < 0.0001) and not aerated tissue (42% [25-57%] vs 52% [39-67%]; p < 0.0001) decreased. However, Lung Ultrasound score variations were not associated with lung recruitment (R = 0.01; p = 0.67).

CONCLUSIONS

Lung Ultrasound score is a valid tool to assess regional and global lung aeration. Global Lung Ultrasound score variations should not be used for bedside assessment of positive end-expiratory pressure-induced recruitment.

摘要

目的

肺部超声常用于评估急性呼吸窘迫综合征患者的肺部形态。本研究旨在确定肺部超声在评估肺通气和呼气末正压诱导复张方面的可靠性，与 CT 相比。

设计

随机交叉研究。

地点

大学医院 ICU。

患者

20 名镇静麻痹性急性呼吸窘迫综合征患者：年龄 56 岁（43-72 岁），体重指数 25kg/m（22-27kg/m），PaO2/FIO2 160（113-218）。

干预

在呼气末正压 5cmH2O 和 15cmH2O 时进行肺部 CT 和肺部超声检查。

测量和主要结果

比较了全肺和区域肺超声评分与 CT 定量分析。将肺复张（即 CT 评估的未充气组织减少）与全肺超声评分变化进行比较。全肺超声评分与呼气末正压 5cmH2O 时的平均肺组织密度（R = 0.78；p < 0.0001）和呼气末正压 15cmH2O 时的平均肺组织密度（R = 0.62；p < 0.0001）高度相关。区域肺超声评分与呼气末正压 5cmH2O 时（rs = 0.79；p < 0.0001）和呼气末正压 15cmH2O 时（rs = 0.79；p < 0.0001）的组织密度强烈相关。区域肺超声评分每增加一个等级，组织密度就会显著增加（p < 0.005）。在呼气末正压 5cmH2O 时（k = 0.69 [0.63-0.75]）和呼气末正压 15cmH2O 时（k = 0.70 [0.64-0.75]），区域肺超声评分与 CT 分类之间存在显著一致性。在呼气末正压 15cmH2O 时，全肺超声评分（22 [16-27] 与 26 [21-29]；p < 0.0001）和未充气组织（42% [25-57%] 与 52% [39-67%]；p < 0.0001）均降低。然而，肺超声评分变化与肺复张无关（R = 0.01；p = 0.67）。