Inserm UMR_S 999, Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France.
Intensive Care Med. 2019 May;45(5):601-608. doi: 10.1007/s00134-019-05573-6. Epub 2019 Mar 12.
Detecting weaning-induced pulmonary oedema (WIPO) is important because its treatment might prompt extubation. For this purpose, lung ultrasound might be an attractive tool, since it demonstrates pulmonary oedema through the appearance of B-lines.
To test the ideal profile (increase in the number of B-lines) for diagnosing WIPO.
Before and at the end of 62 spontaneous breathing trials (SBT) performed in 42 patients, we prospectively assessed lung ultrasound on four anterior chest wall points. B-lines were counted before and at the end of SBT. We looked for the threshold of B-line increase (Delta-B-lines) that provided the best diagnostic accuracy, compared to the reference diagnosis of WIPO established by experts blinded to lung ultrasound.
SBT failed in 33 cases. WIPO occurred in 17 cases and all failed. The best diagnostic accuracy was reached with a Delta-B-lines ≥ 6. Among WIPO, the number of B-lines increased by ≥ 6 in 15 cases (including 13 cases with an increase of ≥ 8 B-lines). Among the 16 cases with SBT failure but without WIPO, the Delta-B-lines was ≥ 6 in two cases. Among the 33 cases with SBT failure, this profile diagnosed WIPO with a sensitivity of 88% (64-98) and a specificity of 88% (62-98) [area under the receiver operating characteristic curve 0.91 (0.75-0.98)]. Among the 29 cases with SBT success, a Delta-B-lines ≥ 6 occurred in two cases.
This study suggests that a Delta-B-lines ≥ 6 on four anterior points allows the diagnosis of WIPO with the best accuracy. This should be confirmed in larger populations.
检测脱机诱导性肺水肿（WIPO）很重要，因为其治疗可能会促使拔管。为此，肺部超声可能是一种有吸引力的工具，因为它通过 B 线的出现来显示肺水肿。
测试诊断 WIPO 的理想特征（B 线数量增加）。
在 42 名患者进行的 62 次自主呼吸试验（SBT）之前和结束时，我们前瞻性地评估了四个前胸壁点的肺部超声。在 SBT 前后计数 B 线。我们寻找 B 线增加的阈值（Delta-B-lines），与专家盲法评估的肺部超声建立的 WIPO 参考诊断相比，提供最佳的诊断准确性。
33 例 SBT 失败。17 例发生 WIPO，均失败。Delta-B-lines≥6 时达到最佳诊断准确性。在 WIPO 中，15 例 B 线数量增加≥6（包括 13 例增加≥8 条 B 线）。在 16 例无 WIPO 但 SBT 失败的病例中，Delta-B-lines≥6 有 2 例。在 33 例 SBT 失败的病例中，该特征诊断 WIPO 的敏感性为 88%（64-98），特异性为 88%（62-98）[受试者工作特征曲线下面积 0.91（0.75-0.98）]。在 29 例 SBT 成功的病例中，有 2 例 Delta-B-lines≥6。
本研究表明，四个前点的 Delta-B-lines≥6 可实现 WIPO 诊断的最佳准确性。这应在更大的人群中得到证实。
