Lung ultrasound in the critically ill.
Lung ultrasound in the critically ill.
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DOI：
10.1186/2110-5820-4-1
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发表时间：
2014-01-09
影响因子：
8.1
通讯作者：
Lichtenstein DA
中科院分区：
文献类型：
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作者：
Lichtenstein DA
肺部超声是关键超声的基本应用，被定义为将紧急诊断与立即治疗决策相关联的循环。它需要掌握十个标志：蝙蝠标志（胸膜线），肺滑动（让步海岸标志），A线（水平伪影），四征和窦征指示胸腔积液，分形和组织样征指示肺实变，B线和肺火箭指示间质综合征，消除了肺滑动，平流层征指示气胸，肺点显示气胸另外两个征象，肺脉搏和动态支气管充气图，也可用于区分肺不张和肺炎。所有这些疾病都使用CT作为“金标准”进行评估，灵敏度和特异性范围为90%至100%，使超声被认为是危重病中合理的床旁“金标准”。蓝光协议是一种快速协议（<3分钟），可以诊断急性呼吸衰竭。它包括在适当情况下进行的静脉分析。肺水肿、肺栓塞、肺炎、慢性阻塞性肺病、哮喘和气胸产生特定的特征。肺水肿，例如，产生与肺滑动相关的前肺火箭，形成“B型”。BLUE协议适用于急性循环衰竭。它使用简单的实时超声心动图（右心室扩张、心包积液）顺序搜索阻塞性、心源性、低血容量性和分布性休克，然后使用肺部超声评估临床血容量的直接参数：示意性地将B线的出现视为液体治疗的终点。肺部超声的其他目的是减少医疗辐射：LUCIFLR计划（大多数ARDS或创伤的CT可以推迟），用于创伤科，重症监护病房，新生儿（体征与成人相同），许多学科（肺病学，心脏病学......），严峻的国家，以及任何程序（胸腔穿刺术）的帮助。1992年，具有成本效益的灰度单位，没有多普勒，和微凸探头是有效的。肺部超声是一门整体学科，原因有很多（例如，一个探头，非常适合肺部，能够扫描全身）。它的纳入可以为优先事项提供新的定义。BLUE协议和BLULS协议允许简化专家超声心动图，当正确的心脏窗口丢失时，这是一个明显的优势。
Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. It requires the mastery of ten signs: the bat sign (pleural line), lung sliding (yielding seashore sign), the A-line (horizontal artifact), the quad sign, and sinusoid sign indicating pleural effusion, the fractal, and tissue-like sign indicating lung consolidation, the B-line, and lung rockets indicating interstitial syndrome, abolished lung sliding with the stratosphere sign suggesting pneumothorax, and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. All of these disorders were assessed using CT as the “gold standard” with sensitivity and specificity ranging from 90% to 100%, allowing ultrasound to be considered as a reasonable bedside “gold standard” in the critically ill. The BLUE-protocol is a fast protocol (<3 minutes), which allows diagnosis of acute respiratory failure. It includes a venous analysis done in appropriate cases. Pulmonary edema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax yield specific profiles. Pulmonary edema, e.g., yields anterior lung rockets associated with lung sliding, making the “B-profile.” The FALLS-protocol adapts the BLUE-protocol to acute circulatory failure. It makes sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography (right ventricle dilatation, pericardial effusion), then lung ultrasound for assessing a direct parameter of clinical volemia: the apparition of B-lines, schematically, is considered as the endpoint for fluid therapy. Other aims of lung ultrasound are decreasing medical irradiation: the LUCIFLR program (most CTs in ARDS or trauma can be postponed), a use in traumatology, intensive care unit, neonates (the signs are the same than in adults), many disciplines (pulmonology, cardiology…), austere countries, and a help in any procedure (thoracentesis). A 1992, cost-effective gray-scale unit, without Doppler, and a microconvex probe are efficient. Lung ultrasound is a holistic discipline for many reasons (e.g., one probe, perfect for the lung, is able to scan the whole-body). Its integration can provide a new definition of priorities. The BLUE-protocol and FALLS-protocol allow simplification of expert echocardiography, a clear advantage when correct cardiac windows are missing.