用于早产儿持续气道正压通气撤机的床旁肺超声检查
Point-of-care lung ultrasound for continuous positive airway pressure discontinuation in preterm infants.
作者信息
Myers Faith, Dasani Reedhi, Tong Jacklin, Vallandingham-Lee Shelby, Manipon Christine, Dahlen Alex, De Luca Daniele, Singh Yogen, Davis Alexis S, Chock Valerie Y, Bhombal Shazia
机构信息
Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, USA.
出版信息
J Perinatol. 2025 Jan;45(1):68-72. doi: 10.1038/s41372-024-02157-1. Epub 2024 Nov 4.
OBJECTIVE
To determine if the lung ultrasound score (LUS) is predictive of successful continuous positive airway pressure (CPAP) discontinuation in preterm neonates born <32 weeks' gestation with history of respiratory distress syndrome.
STUDY DESIGN
Retrospective study of preterm infants requiring CPAP. Univariate and multivariate logistic regression performed to formulate a predictive score using clinical variables with and without LUS. Area under the curve (AUC) was compared to determine the added predictive ability of LUS.
RESULTS
Forty-one patients with discontinuation attempts associated with a LUS were included. Lower LUS obtained within 0-7 days prior to CPAP discontinuation was associated with successful CPAP discontinuation (OR 0.46 [0.23, 0.91]; p = 0.025). Cross-validated AUC for clinical variables alone (Model 1) was 0.85 (95% CI: 0.74-0.93) versus 0.90 (95% CI: 0.81-0.97) when LUS was incorporated (Model 2, p < 0.001). AUC of LUS alone was 0.83 (95% CI: 0.68-0.93, p < 0.0001).
CONCLUSIONS
In preterm infants requiring CPAP, LUS aids in the prediction of successful CPAP discontinuation and may significantly improve a predictive tool.
目的
确定肺部超声评分（LUS）是否可预测胎龄小于32周且有呼吸窘迫综合征病史的早产儿持续气道正压通气（CPAP）撤机成功。
研究设计
对需要CPAP的早产儿进行回顾性研究。采用单因素和多因素逻辑回归，使用有无LUS的临床变量制定预测评分。比较曲线下面积（AUC）以确定LUS的附加预测能力。
结果
纳入41例与LUS相关的撤机尝试患者。CPAP撤机前0至7天内获得的较低LUS与CPAP撤机成功相关（比值比0.46 [0.23, 0.91]；p = 0.025）。单独临床变量（模型1）的交叉验证AUC为0.85（95%可信区间：0.74 - 0.93），纳入LUS时（模型2）为0.90（95%可信区间：0.81 - 0.97）（p < 0.001）。单独LUS的AUC为0.83（95%可信区间：0.68 - 0.93，p < 0.0001）。
结论
在需要CPAP的早产儿中，LUS有助于预测CPAP撤机成功，且可能显著改善预测工具。
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