急危重症 COVID-19 患者肺部栓塞的多器官床旁超声检测 - 一项诊断准确性研究。
Multi-organ point-of-care ultrasound for detection of pulmonary embolism in critically ill COVID-19 patients - A diagnostic accuracy study.
机构信息
Acute Internal Medicine, Amsterdam UMC, Location VUmc, the Netherlands; Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, the Netherlands..
Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, the Netherlands.; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, the Netherlands.
出版信息
J Crit Care. 2022 Jun;69:153992. doi: 10.1016/j.jcrc.2022.153992. Epub 2022 Feb 2.
PURPOSE
Critically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time-to-diagnosis.
MATERIALS & METHODS: This prospective, observational study included adult ICU patients with COVID-19. Multi-organ (lungs, deep vein, cardiac) POCUS was performed within 24 h of CTPA, looking for subpleural consolidations, deep venous thrombosis (DVT), and right ventricular strain (RVS). We reported the scan time, and calculated diagnostic accuracy measures for these signs separately and in combination.
RESULTS
70 consecutive patients were included. 23 patients (32.8%) had a PE. Median scan time was 14 min (IQR 11-17). Subpleural consolidations' diagnostic accuracy was: 42.9% (95%CI [34.1-52.0]). DVT's and RVS' diagnostic accuracy was: 75.6% (95%CI [67.1-82.9]) and 74.4% (95%CI [65.8-81.8]). Their sensitivity was: 24.0% (95%CI [9.4-45.1]), and 40.0% (95%CI [21.3-61.3]), while their specificity was: 88.8% (95%CI [80.8-94.3]), and: 83.0% (95%CI [74.2-89.8]), respectively. Multi-organ POCUS sensitivity was: 87.5% (95%CI [67.6-97.3]), and specificity was: 25% (95%CI [16.9-34.7]).
CONCLUSIONS
Multi-organ rather than single-organ POCUS can be of aid in ruling out PE in critically ill COVID-19 and help select patients for CTPA. In addition, finding RVS can make PE more likely, while a DVT would preclude the need for a CTPA.
REGISTRATION
www.trialregister.nl: NL8540.
目的
危重症 COVID-19 患者发生肺栓塞（PE）的风险增加。床边超声（POCUS）诊断 PE 可减少对 CT 肺动脉造影（CTPA）的需求，同时缩短诊断时间。
材料与方法
这项前瞻性观察性研究纳入了 ICU 内患有 COVID-19 的成年患者。在 CTPA 后 24 小时内进行多器官（肺、深静脉、心脏）POCUS，观察是否存在胸膜下实变、深静脉血栓（DVT）和右心室应变（RVS）。我们分别和联合报告了扫描时间，并计算了这些征象的诊断准确性。
结果
共纳入 70 例连续患者。23 例（32.8%）患者存在 PE。中位扫描时间为 14 分钟（IQR 11-17）。胸膜下实变的诊断准确性为 42.9%（95%CI [34.1-52.0]）。DVT 和 RVS 的诊断准确性为 75.6%（95%CI [67.1-82.9]）和 74.4%（95%CI [65.8-81.8]）。其敏感性分别为 24.0%（95%CI [9.4-45.1]）和 40.0%（95%CI [21.3-61.3]），特异性分别为 88.8%（95%CI [80.8-94.3]）和 83.0%（95%CI [74.2-89.8]）。多器官 POCUS 的敏感性为 87.5%（95%CI [67.6-97.3]），特异性为 25%（95%CI [16.9-34.7]）。
结论
多器官而非单器官 POCUS 有助于排除危重症 COVID-19 患者的 PE，并帮助选择 CTPA 患者。此外，发现 RVS 可使 PE 更有可能，而 DVT 则可排除 CTPA 的需求。
注册
www.trialregister.nl: NL8540。
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