Leote João, Gonçalves Andreia, Fonseca Júlia, Loução Ricardo, Dias Hermínia, Inês Ribeiro Maria, Meireles Ricardo, Varudo Rita, Bacariza Jacobo, Gonzalez Filipe
Critical Care Department, Hospital Garcia de Orta EPE, Almada, Portugal.
Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal.
ERJ Open Res. 2025 Jan 13;11(1). doi: 10.1183/23120541.00483-2024. eCollection 2025 Jan.
The number of vertical artefacts (VAs) in lung ultrasound (LUS) impacts patients' clinical management. This study aimed to demonstrate the influence of ultrasound settings on the number of VAs in patients under invasive mechanical ventilation (IMV).
Patients under IMV were recruited for LUS, including three breathing cycles with a motionless curvilinear probe on the thoracic region with the most VAs. Three experts in LUS were asked about the number of VAs at random, and blinded after altering the settings for a total of 20 test recordings per patient. The correlation between expert classifications was tested after grading the classifications. The number of VAs across clinicians was compared between baseline recordings and test condition recordings to determine statistical differences.
29 patients were enrolled with a median Sequential Organ Failure Assessment score of 6 (interquartile range (IQR) 3). IMV was mainly due to stroke (n=10) and pneumonia (n=6). LUS was made between days 1 and 6 (IQR). Baseline recordings showed a median of 2±2 VAs in inspiration and a median of 1±2 in expiration from a total of 3636 expert classifications, with a strong agreement within patients. A probe frequency of 8 MHz, artefact filtering, speckle reduction and frame average reduced the median VA number by one. A power of -20 dB and dynamic range of 32 dB abolished the VAs. A gain above 90% increased the median number of VAs by one.
In this study, the LUS settings influenced the VA number in IMV patients, after controlling for physiological and operator confounders.
肺部超声（LUS）中垂直伪像（VA）的数量会影响患者的临床管理。本研究旨在证明超声设置对有创机械通气（IMV）患者VA数量的影响。
招募接受IMV的患者进行LUS检查，使用无活动的曲线探头在VA数量最多的胸部区域进行三个呼吸周期的检查。询问三位LUS专家关于VA的数量，在改变设置后对每位患者总共20次测试记录进行盲法评估。对分类进行分级后测试专家分类之间的相关性。比较基线记录和测试条件记录之间不同临床医生的VA数量，以确定统计学差异。
纳入29例患者，序贯器官衰竭评估评分中位数为6（四分位间距（IQR）为3）。IMV主要由中风（n = 10）和肺炎（n = 6）引起。LUS检查在第1天至第6天（IQR）进行。从总共3636次专家分类来看，基线记录显示吸气时VA中位数为2±2，呼气时为1±2，患者内部一致性较强。8 MHz的探头频率、伪像过滤、斑点减少和帧平均使VA中位数减少一个。-20 dB的功率和32 dB的动态范围消除了VA。增益高于90%使VA中位数增加一个。
在本研究中，在控制生理和操作者混杂因素后，LUS设置影响了IMV患者的VA数量。
