肺超声测定新冠肺炎ARDS侵袭性通气患者血管外肺水的诊断准确性。

IF 3.4 Q2 Medicine
Leila N Atmowihardjo, Job R Schippers, Mark E Haaksma, Marry R Smit, Harm J Bogaard, Leo Heunks, Nicole P Juffermans, Marcus J Schultz, Henrik Endeman, Patricia van Velzen, Pieter R Tuinman, Jurjan Aman, Lieuwe D J Bos
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引用次数: 0

摘要

背景:肺部超声(LUS)可以检测肺水肿,目前正在考虑将其添加到最新的急性呼吸窘迫综合征(ARDS)标准中。然而目前尚不确定是否可以使用不同的LUS评分来量化ARDS患者的肺水肿。目的:本研究通过经肺热稀释评估新冠肺炎中度至重度ARDS患者血管外肺水分指数(EVLWi),检查了四种LUS评分的诊断准确性随机对照试验(InventCOVID),患者在插管后48小时内入组,并在入组后的第一天和第四天接受LUS和EVLWi测量。EVLWi和∆EVLWi被用作参考标准。两个12区评分(整体LUS和LUS-ARDS)、一个8区前外侧评分和一个4区B线评分用作指标测试。对严重肺水肿(EVLWi)的受试者操作特征曲线下面积(AUROCC)进行Pearson相关分析 > 15mL/kg)。结果:30名患者中有26名(87%)在时间点1进行了完整的LUS和EVLWi测量,29名患者中的24名(83%)在时间点将进行了完整测量。全球LUS(r = 0.54),LUS-RDS(r = 0.58)和前外侧评分(r = 0.54)与EVLWi显著相关,而B线评分与EVLWi无关(r = 0.32)。∆全局LUS(r = 0.49)和∆前外侧LUS(r = 0.52)与∆EVLWi显著相关。EVLWi的AUROCC > 15ml/kg对于整体LUS为0.73,对于前外侧为0.79,对于LUS-ARDS评分为0.85。结论:总体而言,与PICCO相比,LUS对中重度新冠肺炎ARDS肺水肿的检测具有可接受的诊断准确性。对于识别有严重肺水肿风险的患者,考虑胸膜形态的扩展评分可能具有附加价值。试验注册:ClinicalTrials.gov标识符NCT04794088,于2021年3月11日注册。欧洲临床试验数据库编号2020-005447-23。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS.

The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS.

The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS.

The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS.

Background: Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS.

Objectives: This study examined the diagnostic accuracy of four LUS scores with the extravascular lung water index (EVLWi) assessed by transpulmonary thermodilution in patients with moderate-to-severe COVID-19 ARDS.

Methods: In this predefined secondary analysis of a multicenter randomized-controlled trial (InventCOVID), patients were enrolled within 48 hours after intubation and underwent LUS and EVLWi measurement on the first and fourth day after enrolment. EVLWi and ∆EVLWi were used as reference standards. Two 12-region scores (global LUS and LUS-ARDS), an 8-region anterior-lateral score and a 4-region B-line score were used as index tests. Pearson correlation was performed and the area under the receiver operating characteristics curve (AUROCC) for severe pulmonary edema (EVLWi > 15 mL/kg) was calculated.

Results: 26 out of 30 patients (87%) had complete LUS and EVLWi measurements at time point 1 and 24 out of 29 patients (83%) at time point 2. The global LUS (r = 0.54), LUS-ARDS (r = 0.58) and anterior-lateral score (r = 0.54) correlated significantly with EVLWi, while the B-line score did not (r = 0.32). ∆global LUS (r = 0.49) and ∆anterior-lateral LUS (r = 0.52) correlated significantly with ∆EVLWi. AUROCC for EVLWi > 15 ml/kg was 0.73 for the global LUS, 0.79 for the anterior-lateral and 0.85 for the LUS-ARDS score.

Conclusions: Overall, LUS demonstrated an acceptable diagnostic accuracy for detection of pulmonary edema in moderate-to-severe COVID-19 ARDS when compared with PICCO. For identifying patients at risk of severe pulmonary edema, an extended score considering pleural morphology may be of added value.

Trial registration: ClinicalTrials.gov identifier NCT04794088, registered on 11 March 2021. European Clinical Trials Database number 2020-005447-23.

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来源期刊
Ultrasound Journal
Ultrasound Journal Health Professions-Radiological and Ultrasound Technology
CiteScore
6.80
自引率
2.90%
发文量
45
审稿时长
22 weeks
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