Pre-hospital lung ultrasound for cardiac heart failure and COPD: is it worthwhile?

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Mirko Zanatta, Piero Benato, Sigilfredo De Battisti, Concetta Pirozzi, Renato Ippolito, Vito Cianci
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引用次数: 15

Abstract

Background: Pre-hospital ultrasound is a new challenge and lung ultrasound could be an interesting opportunity in the pre-hospital medical service. The aim of our study was to evaluate the efficacy of lung ultrasound in out-of-hospital non-traumatic respiratory insufficiency.

Methods: We planned a case-controlled study in the ULSS 5 ovest vicentino area (Vicenza-Italy) enrolling subjects with severe dyspnea caused by cardiac heart failure or acute exacerbation of chronic obstructive pulmonary disease. We compared drugs administration, oxygen delivery, and laboratory tests between those patients with ultrasound integrated management and those without ultrasound.

Results: Pre-hospital lung ultrasound had a high specificity (94.4%) and sensitivity (100%) for the correct identification of alveolar interstitial syndrome using B lines, whereas the percentages obtained with pleural effusion were lower (83.3, 53.3%, respectively). The patients with ultrasound integrated management received a more appropriate pharmacological therapy (p 0.01), as well as non-invasive ventilation (CPAP) was used more frequently in those with an acute exacerbation of chronic obstructive pulmonary disease (p 0.011). Laboratory tests and blood gases analysis were not significant different between the two study groups. In a sub-analysis of the patients with an A profile, we observed a significant lower concentration of PCO2 in those with an ultrasound integrated management (PCO2: 42.62 vs 52.23 p 0.049). According with physicians' opinion, pre-hospital lung ultrasound gave important information or changed the therapy in the 42.3% of cases, whereas it just confirmed physical examination in the 67.7% of cases.

Conclusions: Pre-hospital lung ultrasound is easy and feasible, and learning curve is rapid. Our study suggests that cardiac heart failure and acute exacerbation of chronic obstructive pulmonary disease can be considered two indications for pre-hospital ultrasound, and can improve the management of patient with acute respiratory insufficiency.

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院前肺部超声治疗心力衰竭和慢性阻塞性肺病:值得吗?
背景:院前超声是一项新的挑战,肺部超声在院前医疗服务中可能是一个有趣的机会。本研究的目的是评价肺超声在院外非创伤性呼吸功能不全中的疗效。方法:我们计划在意大利维森蒂诺地区(Vicenza-Italy)的ULSS 5进行一项病例对照研究,纳入由心力衰竭或慢性阻塞性肺疾病急性加重引起的严重呼吸困难的受试者。我们比较了超声综合治疗组与非超声综合治疗组的给药、给氧和实验室检查结果。结果院前肺超声B线对肺泡间质综合征的正确鉴别具有较高的特异性(94.4%)和敏感性(100%),而胸膜积液的正确率较低(分别为83.3%和53.3%)。超声综合治疗的患者更适合药物治疗(p < 0.01),慢性阻塞性肺疾病急性加重期患者使用无创通气(CPAP)的频率更高(p < 0.011)。实验室测试和血气分析在两个研究组之间没有显著差异。在a型血患者的亚组分析中,我们观察到超声综合治疗组PCO2浓度显著降低(PCO2: 42.62 vs 52.23 p 0.049)。42.3%的病例认为院前肺部超声提供了重要信息或改变了治疗方法,67.7%的病例认为院前肺部超声只是确认了体格检查。结论:院前肺部超声检查简单可行,学习曲线快速。本研究提示,心衰和慢性阻塞性肺疾病急性加重期可作为院前超声的两种指征,可改善急性呼吸功能不全患者的管理。
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来源期刊
Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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