Assessment of Lung Aeration and Recruitment by CT Scan and Ultrasound in Acute Respiratory Distress Syndrome Patients*
Assessment of Lung Aeration and Recruitment by CT Scan and Ultrasound in Acute Respiratory Distress Syndrome Patients*
复制标题
DOI：
10.1097/ccm.0000000000003340
复制
发表时间：
2018-11-01
影响因子：
8.8
通讯作者：
Mojoli, Francesco
中科院分区：
文献类型：
--
作者：
Chiumello, Davide;Mongodi, Silvia;Mojoli, Francesco
目的：肺部超声通常用于评估急性呼吸窘迫综合征患者的肺部形态。本研究的目的是确定与 CT 相比，肺部超声在评估肺通气和呼气末正压诱导肺复张方面的可靠性。设计：随机交叉研究。地点：大学医院 ICU。患者：20 名镇静麻痹性急性呼吸窘迫综合征患者：年龄 56 岁（43-72 岁），体重指数 25kg/m(2) (22-27kg/m(2))，并且Pao(2)/Fio(2) 160 (113-218)。干预措施：在呼气末正压5和15cm H2O下进行肺部CT和肺部超声检查。测量和主要结果：将整体和区域肺部超声评分与CT定量分析进行比较。将肺复张（即通过 CT 评估的未通气组织的减少）与总体肺超声评分变化进行比较。整体肺部超声评分与呼气末正压 5（R-2 = 0.78；p < 0.0001）和呼气末正压 15（R-2 = 0.62；p < 0.0001）时的平均肺组织密度密切相关。区域肺部超声评分与呼气末正压 5（r(s) = 0.79；p < 0.0001）和呼气末正压 15（r(s) = 0.79；p < 0.0001）时的组织密度密切相关。区域肺部超声评分的每一步增加都与组织密度的显着增加相关（p < 0.005）。在呼气末正压 5 (k = 0.69 [0.63-0.75]) 和呼气末正压 15 (k = 0.70 [0.64-0.75]) 时，区域肺部超声评分和 CT 分类之间存在显着一致性。在呼气末正压 15 时，总体肺超声评分（22 [16-27] vs 26 [21-29]；p < 0.0001）和无气组织评分（42% [25-57%] vs 52% [39-67%]；p < 0.0001）均下降。然而，肺超声评分变化与肺复张无关（R-2 = 0.01；p = 0.67）。结论：肺超声评分是评估区域和整体肺通气的有效工具。全球肺部超声评分变化不应用于呼气末正压诱导肺复张的床边评估。
Objectives: Lung ultrasound is commonly used to evaluate lung morphology in patients with acute respiratory distress syndrome. Aim of this study was to determine lung ultrasound reliability in assessing lung aeration and positive end-expiratory pressure-induced recruitment compared with CT.Design: Randomized crossover study.Setting: University hospital ICU.Patients: Twenty sedated paralyzed acute respiratory distress syndrome patients: age 56 years (43-72 yr), body mass index 25kg/m(2) (22-27kg/m(2)), and Pao(2)/Fio(2) 160 (113-218).Interventions: Lung CT and lung ultrasound examination were performed at positive end-expiratory pressure 5 and 15cm H2O.Measurements and Main Results: Global and regional Lung Ultrasound scores were compared with CT quantitative analysis. Lung recruitment (i.e., decrease in not aerated tissue as assessed with CT) was compared with global Lung Ultrasound score variations. Global Lung Ultrasound score was strongly associated with average lung tissue density at positive end-expiratory pressure 5 (R-2 = 0.78; p < 0.0001) and positive end-expiratory pressure 15 (R-2 = 0.62; p < 0.0001). Regional Lung Ultrasound score strongly correlated with tissue density at positive end-expiratory pressure 5 (r(s) = 0.79; p < 0.0001) and positive end-expiratory pressure 15 (r(s) = 0.79; p < 0.0001). Each step increase of regional Lung Ultrasound score was associated with significant increase of tissue density (p < 0.005). A substantial agreement was found between regional Lung Ultrasound score and CT classification at positive end-expiratory pressure 5 (k = 0.69 [0.63-0.75]) and at positive end-expiratory pressure 15 (k = 0.70 [0.64-0.75]). At positive end-expiratory pressure 15, both global Lung Ultrasound score (22 [16-27] vs 26 [21-29]; p < 0.0001) and not aerated tissue (42% [25-57%] vs 52% [39-67%]; p < 0.0001) decreased. However, Lung Ultrasound score variations were not associated with lung recruitment (R-2 = 0.01; p = 0.67).Conclusions: Lung Ultrasound score is a valid tool to assess regional and global lung aeration. Global Lung Ultrasound score variations should not be used for bedside assessment of positive end-expiratory pressure-induced recruitment.