超便携式超声波(UPUS)检查在检测临床复发性气胸方面的时机选择。

Abdul Hafiz Al Tannir, Courtney J Pokrzywa, Thomas W Carver, Elise A Biesboer, Juan F Figueroa, Basil Karam, Marc A de Moya, Patrick B Murphy
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引用次数: 0

摘要

背景:复发性气胸(rPTX)是胸部创伤患者拔除胸腔造口管(TT)后常见的并发症。虽然胸部 X 光(CXR)最常用于检测复发性气胸,但床边便携式超声波(UPUS)是一种可行、低成本且无辐射的替代方法。关于在 TT 移除后评估 rPTX 的最佳诊断成像时机,目前尚未达成共识。因此,我们试图找出检测 rPTX 的理想 UPUS 时机。 方法:我们对因胸部创伤入院的成人(≥18 岁)患者进行了一项单中心前瞻性研究。使用 Butterfly iQ+™ 超声波进行 UPUS 检查。评估了三个肋间(ICS)(第 2 至第 4 个)。拔管后的 UPUS 检查在拔管后的不同时间点(1-6 小时)进行。UPUS检查中的rPTX定义为一个或多个肋间隙无肺滑动,如果≥2个肋间隙无肺滑动,则被认为是临床相关的rPTX。将 UPUS 结果与 CXR 进行比较:共有 92 例患者(97 例半胸)纳入分析。共有 58 名患者在 TT 切除术后出现 rPTX,其中 11 名患者出现临床症状或症状扩大。将 UPUS 结果与 CXR 进行比较,TT 移除后 3 小时的超声检查具有最高的灵敏度。到第 4 小时时,没有 rPTX 显示出扩大。有三位患者因临床上引起关注的rPTX而需要介入治疗,他们都是在TT取出后3小时进行UPUS检查时发现的:结论:TT 移除后 3 小时进行的床旁 UPUS 在检测临床相关的 rPTX 方面具有最高的灵敏度。在没有临床症状的情况下,重复成像或观察超过 4 小时的非显著 rPTX 可能不会带来更多临床益处:证据级别:II级,诊断测试或标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Timing of ultra-portable ultrasound (UPUS) Examinations in detecting clinically concerning recurrent pneumothorax.

Background: Recurrent pneumothorax (rPTX) is a common complication following thoracostomy tube (TT) removal in chest trauma patients. While chest X-ray (CXR) is most commonly used to detect a rPTX, bedside ultraportable ultrasound (UPUS) is a feasible, low cost, and radiation free alternative. No consensus exists with regards to the optimal timing of diagnostic imaging to assess for rPTX post-TT removal. Accordingly, we sought to identify an ideal UPUS timing to detect a rPTX METHODS: We conducted a single center prospective study of adult (≥18years) patients admitted with a chest trauma. UPUS examinations were performed using the Butterfly iQ+™ ultrasound. Three intercostal spaces (ICS) were evaluated (2nd through 4th). Post-TT UPUS examinations were performed at different timepoints following tube removal (1-6 h). A rPTX on UPUS was defined as the absence of lung-sliding in one or more intercostal spaces, and was considered a clinically concerning rPTX if lung-sliding was absent in ≥2 ICS. UPUS findings were compared to CXR.

Results: Ninety-two patients (97 hemi-thoraces) were included in the analysis. A total of 58 patients had a post-TT removal rPTX of which 11 were either clinically concerning or expanding. Comparing UPUS findings to CXR, the 3-hour post-TT removal ultrasound examinations were associated with the highest sensitivity. By hour 4, no rPTX showed expansion in size. Three patients required an intervention for a clinically concerning rPTX, all of whom were detected on UPUS 3-hour post-TT removal.

Conclusion: Bedside UPUS performed at 3-hour post-TT removal has the highest sensitivity in detecting clinically concerning rPTX. Size of rPTX appears to stabilize by hour 4. In the absence of clinical symptoms, repeat imaging or observation of non-significant rPTX beyond 4 h may not provide added clinical benefit.

Level of evidence: Level II, Diagnostic Tests or Criteria.

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