Comparative diagnostic performances of auscultation, chest radiography, and lung utrasonography in acute respiratory distress syndrome
Comparative diagnostic performances of auscultation, chest radiography, and lung utrasonography in acute respiratory distress syndrome
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DOI：
10.1097/00000542-200401000-00006
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发表时间：
2004-01-01
期刊：
影响因子：
8.8
通讯作者：
Rouby, JJ
中科院分区：
文献类型：
--
作者：
Lichtenstein, D;Goldstein, I;Rouby, JJ
工作背景：肺部听诊和床边胸部X线检查是评估急性呼吸窘迫综合征（ARDS）患者呼吸状况的常规方法。临床经验表明，这些程序的诊断准确性是poor.Methods：32例ARDS患者和10名健康志愿者进行了前瞻性研究，比较听诊，床边胸部X线摄影，肺部超声诊断的准确性与胸部计算机断层扫描。三个病理实体进行了评估，在384个肺区域（12每例患者）：胸腔积液，肺泡实变，肺泡间质syndrome.Results：听诊胸腔积液的诊断准确率为61%，肺泡实变36%，肺泡间质综合征55%。床旁胸片对胸腔积液、肺泡实变和肺泡间质综合征的诊断准确率分别为47%、75%和72%。肺部超声对胸腔积液、肺泡实变和肺泡间质综合征的诊断准确率分别为93%、97%和95%。与听诊和胸部X线片相比，肺部超声检查可以量化肺损伤的程度。通过kappa统计量评估，观察者间超声检查结果的一致性令人满意：检测肺泡间质综合征、肺泡实变和胸腔积液的一致性分别为0.74、0.77和0.73。在床旁，肺部超声检查具有高度敏感性，特异性，并且对于诊断患有ARDS的患者的主要肺部病理实体是可重复的，并且可以被认为是床边胸部X线摄影和胸部计算机断层摄影的有吸引力的替代方案。
Background: Lung auscultation and bedside chest radiography are routinely used to assess the respiratory condition of ventilated patients with acute respiratory distress syndrome (ARDS). Clinical experience suggests that the diagnostic accuracy of these procedures is poor.Methods: This prospective study of 32 patients with ARDS and 10 healthy volunteers was performed to compare the diagnostic accuracy of auscultation, bedside chest radiography, and lung ultrasonography with that of thoracic computed tomography. Three pathologic entities were evaluated in 384 lung regions (12 per patient): pleural effusion, alveolar consolidation, and alveolar-interstitial syndrome.Results: Auscultation had a diagnostic accuracy of 61% for pleural effusion, 36% for alveolar consolidation, and 55% for alveolar-interstitial syndrome. Bed-side chest radiography had a diagnostic accuracy of 47% for pleural effusion, 75% for alveolar consolidation, and 72% for alveolar-interstitial syndrome. Lung ultrasonography had a diagnostic accuracy of 93% for pleural effusion, 97% for alveolar consolidation, and 95% for alveolar-interstitial syndrome. Lung ultrasonography, in contrast to auscultation and chest radiography, could quantify the extent of lung injury. Interobserver agreement for the ultrasound findings as assessed by the kappa statistic was satisfactory: 0.74, 0.77, and 0.73 for detection of alveolar-interstitial syndrome, alveolar consolidation, and pleural effusion, respectively.Conclusions: At the bedside, lung ultrasonography is highly sensitive, specific, and reproducible for diagnosing the main lung pathologic entities in patients with ARDS and can be considered an attractive alternative to bedside chest radiography and thoracic computed tomography.