Danish Mohammad, Agarwal Aarti, Goyal Puneet, Gupta Devendra, Lal Hira, Prasad Raghunandan, Dhiraaj Sanjay, Agarwal Anil, Mishra Prabhaker
Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
Turk J Anaesthesiol Reanim. 2019 Aug;47(4):307-319. doi: 10.5152/TJAR.2019.73603. Epub 2019 Mar 12.
To evaluate the diagnostic performance of a rapid bedside 6-point lung ultrasonography (LUS) performed by an intensive care unit (ICU) physician for detection of four common pathological conditions of the lung, such as alveolar consolidation, pleural effusion, interstitial syndrome and pneumothorax, in critically ill patients and its comparison with bedside chest X-ray (CXR) and high-resolution computed tomography (CT) scan of the thorax. Volume of pleural effusion measured by LUS and CT thorax was also compared.
This was a cross-sectional, observational study of 90 adult patients with an acute lung injury score of ≥1 admitted to the medical-surgical ICU. They were examined by CXR and 6-point LUS as per BLUE protocol at bedside, followed by CT thorax in the radiology department.
The sensitivity of 6-point LUS for detecting alveolar consolidation, pleural effusion, interstitial syndrome and pneumothorax was 76%, 88%, 83% and 89%, respectively, which was remarkably higher than that of CXR. The specificity of LUS was 100% for all pathologies, which was again notably higher than that of CXR except for interstitial syndrome for which it was 88.5%. Measurement of volume of pleural effusion by LUS was comparable and had a strong absolute agreement with CT thorax.
6-Point LUS can be a useful diagnostic tool and is better than CXR in diagnosing respiratory pathologies in critically ill patients. Owing to the comparable diagnostic performance of LUS and CT scan and with increasing evidence in favour of LUS, the requirement of CT thorax can be reduced. Radiation hazards associated with CXR and CT, as well as potentially risky transfer of patients to CT room, can also be minimised.
评估重症监护病房（ICU）医生进行的快速床旁6分制肺部超声检查（LUS）对危重症患者四种常见肺部病理状况（如肺泡实变、胸腔积液、间质综合征和气胸）的诊断效能，并将其与床旁胸部X线（CXR）及胸部高分辨率计算机断层扫描（CT）进行比较。同时比较LUS和胸部CT测量的胸腔积液量。
这是一项横断面观察性研究，纳入90例入住内科-外科ICU且急性肺损伤评分≥1分的成年患者。在床旁按照BLUE方案对他们进行CXR和6分制LUS检查，随后在放射科进行胸部CT检查。
6分制LUS检测肺泡实变、胸腔积液、间质综合征和气胸的敏感性分别为76%、88%、83%和89%，显著高于CXR。LUS对所有病理状况的特异性均为100%，同样显著高于CXR，除间质综合征的特异性为88.5%外。LUS测量的胸腔积液量与胸部CT相当，且两者具有很强的绝对一致性。
6分制LUS可作为一种有用的诊断工具，在诊断危重症患者的呼吸道疾病方面优于CXR。由于LUS和CT扫描具有相当的诊断效能，且越来越多的证据支持LUS，因此可以减少对胸部CT的需求。与CXR和CT相关的辐射危害，以及将患者转运至CT室可能存在的风险也可降至最低。
