Schmidt Stefan, Behnke Nico, Dieks Jana-Katharina
Department of Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany.
Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany.
Diagnostics (Basel). 2023 Dec 29;14(1):82. doi: 10.3390/diagnostics14010082.
Data comparing lung ultrasound (LUS) and chest X-rays (CXRs) have increased over the past years. However, there still is a lack of knowledge as to how these modalities compare with one another in the critical care setting, and several factors, including artificial study conditions, limit the generalizability of most published studies. Our study aimed to analyze the performance of LUS in comparison with CXRs in real-world critical care practice.
This study presents new data from the prospective FASP-ICU trial. A total of 209 corresponding datasets of LUS and CXR results from 111 consecutive surgical ICU patients were subanalyzed, and categorial findings were compared. Statistical analysis was performed on the rates of agreement between the different imaging modalities.
A total of 1162 lung abnormalities were detected by LUS in ICU patients compared with 1228 detected by CXR, a non-significant difference ( = 0.276; 95% CI -0.886 to 0.254). However, the agreement rates varied between the observed abnormalities: the rate of agreement for the presence of interstitial syndrome ranged from 0 to 15%, consolidation from 0 to 56%, basal atelectasis from 33.9 to 49.34%, pleural effusion from 40.65 to 50%, and compression atelectasis from 14.29 to 19.3%. The rate of agreement was 0% for pneumothorax and 20.95% for hypervolemia.
LUS does not detect more lung abnormalities in real-world critical care practice than CXRs, although a higher sensitivity of LUS has been reported in previous studies. Overall, low agreement rates between LUS and CXRs suggest that these diagnostic techniques are not equivalent but instead are complementary and should be used alongside each other.
在过去几年中，比较肺部超声（LUS）和胸部X光（CXR）的相关数据有所增加。然而，对于这些检查方式在重症监护环境中如何相互比较，仍存在知识空白，并且包括人为研究条件在内的几个因素限制了大多数已发表研究的可推广性。我们的研究旨在分析在实际重症监护实践中LUS与CXR相比的表现。
本研究展示了前瞻性FASP-ICU试验的新数据。对111例连续手术重症监护病房患者的209组相应的LUS和CXR结果数据集进行了亚分析，并比较了分类结果。对不同成像方式之间的一致性率进行了统计分析。
重症监护病房患者中，LUS检测到1162例肺部异常，CXR检测到1228例，差异无统计学意义（P = 0.276；95%可信区间 -0.886至0.254）。然而，观察到的异常之间的一致性率各不相同：间质综合征存在的一致性率为0%至15%，实变为0%至56%，基底肺不张为33.9%至49.34%，胸腔积液为40.65%至50%，压迫性肺不张为14.29%至19.3%。气胸的一致性率为0%，血容量过多的一致性率为20.95%。
在实际重症监护实践中，LUS检测到的肺部异常并不比CXR多，尽管先前研究报告LUS具有更高的敏感性。总体而言，LUS和CXR之间的低一致性率表明，这些诊断技术并不等效，而是互补的，应相互配合使用。
