在患有新型冠状病毒肺炎急性呼吸窘迫综合征（COVID-19 ARDS）的有创通气患者中，肺部超声测定脉搏指示连续心输出量（PiCCO）衍生的血管外肺水的诊断准确性。
The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS.
作者信息
Atmowihardjo Leila N, Schippers Job R, Haaksma Mark E, Smit Marry R, Bogaard Harm J, Heunks Leo, Juffermans Nicole P, Schultz Marcus J, Endeman Henrik, van Velzen Patricia, Tuinman Pieter R, Aman Jurjan, Bos Lieuwe D J
机构信息
Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Room G3-228, 1105 AZ, Amsterdam, The Netherlands.
出版信息
Ultrasound J. 2023 Oct 2;15(1):40. doi: 10.1186/s13089-023-00340-7.
BACKGROUND
Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS.
OBJECTIVES
This study examined the diagnostic accuracy of four LUS scores with the extravascular lung water index (EVLWi) assessed by transpulmonary thermodilution in patients with moderate-to-severe COVID-19 ARDS.
METHODS
In this predefined secondary analysis of a multicenter randomized-controlled trial (InventCOVID), patients were enrolled within 48 hours after intubation and underwent LUS and EVLWi measurement on the first and fourth day after enrolment. EVLWi and ∆EVLWi were used as reference standards. Two 12-region scores (global LUS and LUS-ARDS), an 8-region anterior-lateral score and a 4-region B-line score were used as index tests. Pearson correlation was performed and the area under the receiver operating characteristics curve (AUROCC) for severe pulmonary edema (EVLWi > 15 mL/kg) was calculated.
RESULTS
26 out of 30 patients (87%) had complete LUS and EVLWi measurements at time point 1 and 24 out of 29 patients (83%) at time point 2. The global LUS (r = 0.54), LUS-ARDS (r = 0.58) and anterior-lateral score (r = 0.54) correlated significantly with EVLWi, while the B-line score did not (r = 0.32). ∆global LUS (r = 0.49) and ∆anterior-lateral LUS (r = 0.52) correlated significantly with ∆EVLWi. AUROCC for EVLWi > 15 ml/kg was 0.73 for the global LUS, 0.79 for the anterior-lateral and 0.85 for the LUS-ARDS score.
CONCLUSIONS
Overall, LUS demonstrated an acceptable diagnostic accuracy for detection of pulmonary edema in moderate-to-severe COVID-19 ARDS when compared with PICCO. For identifying patients at risk of severe pulmonary edema, an extended score considering pleural morphology may be of added value.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT04794088, registered on 11 March 2021. European Clinical Trials Database number 2020-005447-23.
背景
肺部超声（LUS）可检测肺水肿，目前正考虑将其纳入更新的急性呼吸窘迫综合征（ARDS）标准。然而，不同的LUS评分是否可用于量化ARDS患者的肺水肿仍不确定。
目的
本研究在中度至重度新型冠状病毒肺炎（COVID-19）ARDS患者中，检验了四种LUS评分与经肺热稀释法评估的血管外肺水指数（EVLWi）的诊断准确性。
方法
在一项多中心随机对照试验（InventCOVID）的预定义二次分析中，患者在插管后48小时内入组，并在入组后的第一天和第四天接受LUS和EVLWi测量。EVLWi和∆EVLWi用作参考标准。两个12区域评分（整体LUS和LUS-ARDS）、一个8区域前外侧评分和一个4区域B线评分用作指标测试。进行Pearson相关性分析，并计算严重肺水肿（EVLWi>15 ml/kg）的受试者操作特征曲线下面积（AUROCC）。
结果
30例患者中有26例（87%）在时间点1完成了LUS和EVLWi测量，29例患者中有24例（83%）在时间点2完成了测量。整体LUS（r = 0.54）、LUS-ARDS（r = 0.58）和前外侧评分（r = 0.54）与EVLWi显著相关，而B线评分则不然（r = 0.32）。∆整体LUS（r = 0.49）和∆前外侧LUS（r = 0.52）与∆EVLWi显著相关。对于EVLWi>15 ml/kg，整体LUS的AUROCC为0.73，前外侧为0.79，LUS-ARDS评分为0.85。
结论
总体而言，与脉搏指示连续心输出量监测（PICCO）相比，LUS在检测中度至重度COVID-19 ARDS患者的肺水肿方面显示出可接受的诊断准确性。对于识别有严重肺水肿风险的患者，考虑胸膜形态的扩展评分可能具有附加价值。
试验注册
ClinicalTrials.gov标识符NCT04794088，于202,1年3月11日注册。欧洲临床试验数据库编号2020-005447-23。
Zotero 插件