Le Neindre Aymeric, Hansell Louise, Wormser Johan, Gomes Lopes Andreia, Diaz Lopez Carlos, Romanet Christophe, Choukroun Gerald, Nguyen Maxime, Philippart François, Guinot Pierre-Grégoire, Buscher Hergen, Bouhemad Bélaid, Ntoumenopoulos George
Respiratory Intensive Care and Clinical Research Units, Hopital Forcilles, Ferolles-Attilly, France.
UMR1231 - Lipide Nutrition Cancer, Université de Bourgogne, Dijon, France.
Thorax. 2023 Feb;78(2):169-175. doi: 10.1136/thoraxjnl-2021-218217. Epub 2022 Mar 23.
The potential influence of thoracic ultrasound on clinical decision-making by physiotherapists has never been studied. The aim of this study was to assess the impact of thoracic ultrasound on clinical decision-making by physiotherapists for critical care patients.
This prospective, observational multicentre study was conducted between May 2017 and November 2020 in four intensive care units in France and Australia. All hypoxemic patients consecutively admitted were enrolled. The primary outcome was the net reclassification improvement (NRI), quantifying how well the new model (physiotherapist's clinical decision-making including thoracic ultrasound) reclassifies subjects as compared with an old model (clinical assessment). Secondary outcomes were the factors associated with diagnostic concordance and physiotherapy treatment modification.
A total of 151 patients were included in the analysis. The NRI for the modification of physiotherapist's clinical decisions was-40% (95% CI (-56 to -22%), p=0.02). Among the cases in which treatment was changed after ultrasound, 41% of changes were major (n=38). Using a multivariate analysis, the physiotherapist's confidence in their clinical diagnosis was associated with diagnostic concordance (adjusted OR=3.28 95% CI (1.30 to 8.71); p=0.014). Clinical diagnosis involving non-parenchymal conditions and clinical signs reflecting abolished lung ventilation were associated with diagnostic discordance (adjusted OR=0.06 95% CI (0.01 to 0.26), p<0.001; adjusted OR=0.26 95% CI (0.09 to 0.69), p=0.008; respectively).
Thoracic ultrasound has a high impact on the clinical decision-making process by physiotherapists for critical care patients.
NCT02881814; https://clinicaltrials.gov.
胸部超声对物理治疗师临床决策的潜在影响从未被研究过。本研究的目的是评估胸部超声对物理治疗师针对重症患者临床决策的影响。
这项前瞻性观察性多中心研究于2017年5月至2020年11月在法国和澳大利亚的四个重症监护病房进行。连续收治的所有低氧血症患者均被纳入。主要结局是净重新分类改善（NRI），用于量化新模型（包括胸部超声的物理治疗师临床决策）与旧模型（临床评估）相比对受试者重新分类的效果。次要结局是与诊断一致性和物理治疗方案修改相关的因素。
共有151例患者纳入分析。物理治疗师临床决策修改的NRI为-40%（95%CI（-56至-22%），p=0.02）。在超声检查后改变治疗方案的病例中，41%的改变是重大改变（n=38）。通过多变量分析，物理治疗师对其临床诊断的信心与诊断一致性相关（调整后的OR=3.28，95%CI（1.30至8.71）；p=0.014）。涉及非实质病变的临床诊断以及反映肺通气消失的临床体征与诊断不一致相关（调整后的OR=0.06，95%CI（0.01至0.26），p<0.001；调整后的OR=0.26，95%CI（0.09至0.69），p=0.008）。
胸部超声对物理治疗师针对重症患者的临床决策过程有很大影响。
NCT02881814；https://clinicaltrials.gov 。
