肺超声诊断方法鉴别危重病人休克类型的有效性

T. Mawla, Aliaa Elhameed, Areeg Abdallah, O. Momtaz
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摘要

背景急性循环衰竭是icu最常见的挑战之一。认为肺超声(LUS)产生的伪影有助于诊断和治疗。使用LUS的FALLS-protocol是一种用于管理不明原因休克的工具。目的探讨LUS FALLS-protocol在鉴别危重症患者休克类型中的作用。患者与方法共50例出现未确诊休克的患者。应用快速床边超声心动图和LUS FALLS-protocol,同时测量下腔静脉直径和溃散性。结果19例脓毒性休克患者首发时均为A型,其中3例为AB型,复苏后均转化为B型,敏感性100%,特异性90.5%,阳性预测值90.5%,阴性预测值100%。总体而言,16例低血容量性休克患者在出现时和复苏后均为A型,敏感性为100%,特异性为94.1%,PPV为88.9%,NPV为100%。此外,8例心源性休克患者在就诊时均为B型,敏感性100%,特异性95.2%,PPV 80%, NPV 100%;3例梗阻性休克患者就诊时均为A型,敏感性100%,特异性25.5%,PPV 7.9%, NPV 100%;2例过敏性休克患者入院时均为A型,复苏后转为B型,敏感性100%,特异性50%,PPV 9.5%, NPV 100%。我们的研究结果表明,在指导液体治疗方面,falls方案比下腔静脉直径和溃散性更受青睐。结论床边胸部超声fall -方案在复苏途径中应予以考虑,对患者管理可能有显著影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validity of lung ultrasound FALLS-protocol in differentiating types of shock in critically ill patients
Background Acute circulatory collapse is one of the most familiar challenges in ICUs. It is considered that artefacts generated by lung ultrasound (LUS) can help in diagnosis and management. FALLS-protocol using LUS is a tool proposed for the management of unexplained shock. Objectives To investigate the role of LUS FALLS-protocol in differentiating types of shock in critically ill patients. Patients and methods A total of 50 patients presented with undiagnosed shock. Fast bedside echocardiography and LUS FALLS-protocol were applied along with inferior vena cava diameter and collapsibility measurement. Results A total of 19 patients with septic shock on presentation had A profile in all of them and AB profile in three of them, and after resuscitation, they were transformed to B profile with 100% sensitivity, 90.5% specificity, 90.5% positive predictive value (PPV), and 100% negative predictive value (NPV). Overall, 16 patients with hypovolemic shock had A profile in all of them on presentation and after resuscitation, with 100% sensitivity, 94.1% specificity, 88.9% PPV, and 100% NPV. Moreover, eight patients with cardiogenic shock had B profile in all of them on presentation with 100% sensitivity, 95.2% specificity, 80% PPV, and 100% NPV; three patients with obstructive shock had A profile in all of them on presentation, with 100% sensitivity, 25.5% specificity, 7.9% PPV, and 100% NPV; and two patients with anaphylactic shock had A profile in all of them on presentation and transformed to B profile after resuscitation with 100% sensitivity, 50% specificity, 9.5% PPV, and 100% NPV. Our findings showed preference of FALLS-protocol than inferior vena cava diameter and collapsibility in directing fluid therapy. Conclusion Bedside chest ultrasound FALLS-protocol should be considered in the resuscitation pathways with a possible significant effect on patient management.
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