Hansell Louise, Milross Maree, Delaney Anthony, Koo Chung Mo, Tian David H, Ntoumenopoulos George
Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, Australia.
Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Physiotherapy. 2023 Jun;119:26-33. doi: 10.1016/j.physio.2022.11.003. Epub 2022 Nov 17.
Lung ultrasound (LUS) is a novel and emerging tool for physiotherapists in ICU and may provide a way of monitoring lung aeration change in response to respiratory physiotherapy treatment during a patient's ICU stay.
To measure change in the LUS score associated with a respiratory physiotherapy treatment; to determine whether change in LUS score correlates with other physiological measures.
A single-centre prospective cohort study was undertaken in a tertiary teaching hospital in Sydney, Australia.
Adult mechanically ventilated patients in ICU with suspicion of atelectasis.
Primary outcome: pre-post difference in LUS score.
PaO/FiO (PF) ratio, tidal volume (V), lung auscultation score, driving pressure (DP) and the modified radiological atelectasis score (mRAS) on CXR.
43 patients were included. There was a mean improvement in total LUS score after physiotherapy treatment of - 2.9 (95%CI -4.4, -1.4), and a mean improvement in LUS of the right and left lungs of - 1.6 (-2.5, -0.7) and - 1.3 (-2.5, -0.1) respectively. There was a mean improvement in PF ratio, V and auscultation score of 10.4 (-11.89, 32.7), 19 (-7.4, 44.5) and - 1.8 (-2.6, -1.0) respectively. There was no improvement in mRAS or DP. There was a weak correlation between change in LUS score compared with change in mRAS score.
Limitations included the prospective cohort single site design and the small sample size.
The LUS score can be used to detect changes in lung aeration associated with respiratory physiotherapy treatment for acute lobar atelectasis in mechanically ventilated patients. Australian and New Zealand Clinical Trials Registry Number: ACTRN12619000783123. CONTRIBUTION OF THE PAPER.
肺部超声（LUS）是重症监护病房（ICU）物理治疗师使用的一种新兴工具，可能为监测患者在ICU住院期间对呼吸物理治疗的反应时肺通气变化提供一种方法。
测量与呼吸物理治疗相关的LUS评分变化；确定LUS评分变化是否与其他生理指标相关。
在澳大利亚悉尼的一家三级教学医院进行了一项单中心前瞻性队列研究。
ICU中怀疑有肺不张的成年机械通气患者。
主要结局：LUS评分的前后差异。
动脉血氧分压/吸入氧分数（PF）比值、潮气量（V）、肺部听诊评分、驱动压（DP）以及胸部X线片上的改良放射学肺不张评分（mRAS）。
纳入43例患者。物理治疗后LUS总分平均改善-2.9（95%置信区间-4.4，-1.4），右肺和左肺LUS平均改善分别为-1.6（-2.5，-0.7）和-1.3（-2.5，-0.1）。PF比值、V和听诊评分平均分别改善10.4（-11.89，32.7）、19（-7.4，44.5）和-1.8（-2.6，-1.0）。mRAS或DP无改善。与mRAS评分变化相比，LUS评分变化之间存在弱相关性。
局限性包括前瞻性队列单中心设计和样本量小。
LUS评分可用于检测机械通气患者急性肺叶肺不张呼吸物理治疗相关的肺通气变化。澳大利亚和新西兰临床试验注册号：ACTRN12619000783123。论文贡献。
