Vaidya Tanvi, D'costa Pradeep, Pande Satish
Resident, Department of Radio Diagnosis,Department Of Radio Diagnosis,K.E.M Hospital, Pune, Maharashtra.
Chief of Intensive Care Unit,Department Of Radio Diagnosis,K.E.M Hospital, Pune, Maharashtra.
J Assoc Physicians India. 2018 Aug;66(8):17-13.
To classify shock, using ultrasonography as the modality of choice for imaging and to assess the diagnostic accuracy of ultrasound as a tool to classify shock.
Prospective study.
KEM Hospital, Pune in the ICU (Intensive care unit).
100 patients admitted to the ICU with undifferentiated shock.
Bedside ultrasound examination was performed within 1 hour of admission to the ICU. These patients were also evaluated clinically and biochemically to confirm the type of shock. All patients immediately received standard diagnostic emergent interventions including physical examination, intravenous access for whole blood assays, arterial gas analysis, electrocardiography, continuous cardiac monitoring, supplemental oxygen and chest radiograph. Clinical parameters, urine output, ECG and biochemical tests were performed within 12 hours of USG. Additional investigations were performed wherever required. The ultrasonographic diagnoses were compared with the respective final clinical diagnoses by employing the Cohen kappa inter-rater coefficient of agreement. In addition, various ultrasound parameters were also analyzed to assess the best predictors for each type of shock.
The ultrasound diagnosis showed an overall good agreement (Cohen's kappa coefficient > or = 0.6) with the final clinical diagnosis, in identifying the type of shock, in the emergency setting, when ultrasound was done within 1 hour after admission to the ICU. In our study, ultrasound showed maximum sensitivity, specificity, negative and positive predictive values in the setting of obstructive shock. In addition, perfect agreement was seen between the ultrasound and clinical diagnosis, with a Cohen kappa coefficient of 1 in obstructive shock. The least sensitivity, specificity, negative and positive predictive values of ultrasound were seen in the setting of distributive shock. Least agreement between the ultrasound and clinical diagnosis was also seen in distributive shock, as most ultrasound findings were found to overlap with those in the other types of shock. (Cohen kappa coefficient of 0.6).
Ultrasonography carried out within 1 hour of admission to the ICU plays a major role in correct diagnosis of the type of shock and subsequent patient management. The best ultrasonographic predictors for diagnosis of each type of shock, can help the clinician to start timely specific interventions in critical care settings for each type of shock.
使用超声作为首选成像方式对休克进行分类，并评估超声作为休克分类工具的诊断准确性。
前瞻性研究。
浦那市KEM医院重症监护病房。
100名入住重症监护病房的未分化休克患者。
在患者入住重症监护病房后1小时内进行床边超声检查。这些患者还接受了临床和生化评估以确定休克类型。所有患者立即接受标准诊断性紧急干预措施，包括体格检查、建立全血检测的静脉通路、动脉血气分析、心电图检查、持续心脏监测、补充氧气和胸部X光检查。在超声检查后12小时内进行临床参数、尿量、心电图和生化检查。根据需要进行其他检查。通过使用科恩kappa评分者间一致性系数，将超声诊断结果与各自最终的临床诊断结果进行比较。此外，还分析了各种超声参数，以评估每种休克类型的最佳预测指标。
当在入住重症监护病房后1小时内进行超声检查时，在急诊情况下，超声诊断结果与最终临床诊断结果在确定休克类型方面总体一致性良好（科恩kappa系数≥0.6）。在我们的研究中，超声在梗阻性休克情况下显示出最高的敏感性、特异性以及阴性和阳性预测值。此外，在梗阻性休克中，超声与临床诊断完全一致，科恩kappa系数为1。超声在分布性休克情况下的敏感性、特异性、阴性和阳性预测值最低。分布性休克中超声与临床诊断的一致性也最低，因为大多数超声检查结果与其他类型休克的结果重叠（科恩kappa系数为0.6）。
在入住重症监护病房后1小时内进行超声检查，对正确诊断休克类型及后续患者管理起着重要作用。每种休克类型诊断的最佳超声预测指标，可帮助临床医生在重症监护环境中针对每种休克类型及时启动特定干预措施。
