Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Pediatr Crit Care Med. 2021 Aug 1;22(8):722-732. doi: 10.1097/PCC.0000000000002716.
Determine the sensitivity and specificity of point-of-care lung ultrasound in identifying the etiology of acute respiratory failure at admission to the PICU.
Prospective observational study.
Tertiary PICU.
Children older than 37 weeks gestational age and less than or equal to 18 years old admitted to the PICU with acute respiratory failure from December 2018 to February 2020.
Point-of-care lung ultrasound performed within 14 hours of admission to the PICU by physicians blinded to patient history and clinical course. Two physicians, blinded to all clinical information, independently interpreted the point-of-care lung ultrasound and then established a consensus diagnosis (ultrasound diagnosis). The ultrasound diagnosis was compared with an independent, standardized review of the medical record following hospital discharge (final diagnosis).
Eighty-eight patients were enrolled in the study. Forty-eight patients had a final diagnosis of bronchiolitis/viral pneumonitis (55%), 29 had pneumonia (33%), 10 had status asthmaticus (11%), and one was excluded because of an inability to differentiate the final diagnosis. Point-of-care lung ultrasound correctly identified the etiology of acute respiratory failure in 56% of patients (49/87; 95% CI, 46-66%). It identified bronchiolitis/viral pneumonitis with 44% sensitivity (95% CI, 0.31-0.58) and 74% specificity (95% CI, 0.59-0.85), pneumonia with 76% sensitivity (95% CI, 0.58-0.88) and 67% specificity (95% CI 0.54-0.78), and status asthmaticus with 60% sensitivity (95% CI, 0.31-0.83) and 88% specificity (95% CI, 0.79-0.94).
In contrast to literature demonstrating high utility differentiating the cause of acute respiratory failure in adults, blinded point-of-care lung ultrasound demonstrates moderate sensitivity and specificity in identifying the etiology of pediatric acute respiratory failure at admission to the PICU among children with bronchiolitis, pneumonia, and status asthmaticus.
确定床边肺部超声在识别 PIC U 入院时急性呼吸衰竭病因方面的敏感性和特异性。
前瞻性观察性研究。
三级 PIC U。
2018 年 12 月至 2020 年 2 月期间，胎龄超过 37 周且年龄在 18 岁以下的急性呼吸衰竭患儿，入住 PIC U。
由对患者病史和临床病程不知情的医师在入住 PIC U 后 14 小时内进行床边肺部超声检查。两名对所有临床资料均不知情的医师独立解读床边肺部超声，然后确定共识诊断（超声诊断）。将超声诊断与住院出院后对病历的独立、标准化审查（最终诊断）进行比较。
本研究共纳入 88 例患者。48 例患者的最终诊断为细支气管炎/病毒性肺炎（55%），29 例为肺炎（33%），10 例为哮喘状态（11%），1 例因无法区分最终诊断而被排除。床边肺部超声正确识别了 87 例患者中 56%（49/87）的急性呼吸衰竭病因。它识别细支气管炎/病毒性肺炎的敏感性为 44%（95%CI，0.31-0.58），特异性为 74%（95%CI，0.59-0.85），肺炎的敏感性为 76%（95%CI，0.58-0.88），特异性为 67%（95%CI，0.54-0.78），哮喘状态的敏感性为 60%（95%CI，0.31-0.83），特异性为 88%（95%CI，0.79-0.94）。
与文献中证明的在区分成人急性呼吸衰竭病因方面具有较高实用性相反，在患有细支气管炎、肺炎和哮喘状态的儿童中，床边肺部超声在识别 PIC U 入院时急性呼吸衰竭的病因方面表现出中等敏感性和特异性。
