Relevance of lung ultrasound in the diagnosis of acute respiratory failure:: The BLUE protocol
Relevance of lung ultrasound in the diagnosis of acute respiratory failure:: The BLUE protocol
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DOI：
10.1378/chest.07-2800
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发表时间：
2008-07-01
期刊：
影响因子：
9.6
通讯作者：
Meziere, Gilbert A.
中科院分区：
文献类型：
--
作者：
Lichtenstein, Daniel A.;Meziere, Gilbert A.
背部，圆形：本研究评估肺部超声检查诊断急性呼吸衰竭的潜力。方法：本观察性研究在大学附属教学医院ICU进行。我们对连续入住ICU的急性呼吸衰竭患者进行了超声检查，将最初表现的肺部超声检查结果与ICU团队的最终诊断进行了比较。排除不确定的诊断和罕见原因（频率< 2%）。我们纳入了260例确诊为呼吸困难的患者。评估了三个项目：伪影（水平A线或垂直B线表示间质综合征）、肺滑动和肺泡实变和/或胸腔积液。结合静脉分析，这些项目进行分组，以评估超声profiles.Results：占主导地位的A线加肺滑动表示哮喘（n = 34）或COPD（n = 49）与89%的敏感性和97%的特异性。多条弥漫性B线伴肺滑动提示肺水肿（n = 64），敏感性为97%，特异性为95%。正常的前部轮廓加上深静脉血栓形成提示肺栓塞（n = 21），敏感性为81%，特异性为99%。前肺缺失滑动+A线+肺点诊断气胸9例，敏感性81%，特异性100%。前部肺泡实变、内部弥漫性B线伴肺滑动消失、前部不对称间质模式、后部实变或积液不伴前部弥漫性B线提示肺炎（n = 83），敏感性为89%，特异性为94%。使用这些配置文件将提供正确的诊断在90.5%的cases.Conclusions：肺部超声可以帮助临床医生作出快速诊断急性呼吸衰竭患者，从而满足优先目标，节省时间。
Back,round: This study assesses the potential of lung ultrasonography to diagnose acute respiratory failure.Methods: This observational study was conducted in university-affiliated teaching-hospital ICUs. We performed ultrasonography on consecutive patients admitted to the ICU with acute respiratory failure, comparing lung ultrasonography results on initial presentation with the final diagnosis by the ICU team. Uncertain diagnoses and rare causes (frequency < 2%) were excluded. We included 260 dyspneic patients with a definite diagnosis. Three items were assessed: artifacts (horizontal A lines or vertical B lines indicating interstitial syndrome), lung sliding, and alveolar consolidation and/or pleural effusion. Combined with venous analysis, these items were grouped to assess ultrasound profiles.Results: Predominant A lines plus lung sliding indicated asthma (n = 34) or COPD (n = 49) with 89% sensitivity and 97% specificity. Multiple anterior diffuse B lines with lung sliding indicated pulmonary edema (n = 64) with 97% sensitivity and 95% specificity. A normal anterior profile plus deep venous thrombosis indicated pulmonary embolism (n = 21) with 81% sensitivity and 99% specificity. Anterior absent lung sliding plus A lines plus lung point indicated pneumothorax (n = 9) with 81% sensitivity and 100% specificity. Anterior alveolar consolidations, interior diffuse B lines with abolished lung sliding, anterior asymmetric interstitial patterns, posterior consolidations or effusions without anterior diffuse B lines indicated pneumonia (n = 83) with 89% sensitivity and 94% specificity. The use of these profiles would have provided correct diagnoses in 90.5% of cases.Conclusions: Lung ultrasound can help the clinician make a rapid diagnosis in patients with acute respiratory failure, thus meeting the priority objective of saving time.