The Use of Point-of-Care Bedside Lung Ultrasound Significantly Reduces the Number of Radiographs and Computed Tomography Scans in Critically Ill Patients
The Use of Point-of-Care Bedside Lung Ultrasound Significantly Reduces the Number of Radiographs and Computed Tomography Scans in Critically Ill Patients
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DOI：
10.1213/ane.0b013e3181e7cc42
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发表时间：
2010-09-01
影响因子：
5.7
通讯作者：
Balik, Martin
中科院分区：
文献类型：
--
作者：
Peris, Adriano;Tutino, Lorenzo;Balik, Martin
背景：据报道，胸部x线摄影对重症监护病房（ICU）患者的诊断准确性较低，胸部计算机断层扫描（CT）需要将患者运出ICU，使他们面临不良事件的风险。在本研究中，我们评估了常规床边肺超声（LUS）在ICU中评估胸腔积液（PE）的有效性。方法：2008年5月至2009年4月期间因严重创伤（46.3%）、医学病理（41.5%）和术后并发症（12.2%）入住ICU的376例患者。患者被分为对照组（C组）或研究组（S组），在1个三级护理ICU中由一组重症医师进行常规LUS的基础上。为了减少提供者偏见，进行LUS的医生不知道这项研究。收集的数据包括患者人口统计、临床病程、胸片和CT扫描次数。作为次要目标，我们评估了Balik公式在PE估计中的可靠性。结果：两组患者的人口学特征及ICU临床病程无显著差异。与对照组c相比，S组获得的胸片总次数（-26%,P < 0.001）和CT扫描次数（-47%,P < 0.001）显著减少。对ICU LUS方案进行的6个月随访分析显示，PE患者要求的放射检查次数呈时间依赖性减少。最后，使用LUS和Balik公式估算的PE体积与有效排气量有很好的相关性（r = 0.65; P < 0.0001）。结论：在ICU环境中常规使用LUS可减少胸片和CT扫描的次数。（Anesth Analg 2010;111:687-92）
BACKGROUND: Chest radiography has been reported to have low diagnostic accuracy in critically ill intensive care unit (ICU) patients, and chest computed tomography (CT) scans require patients to be transported out of the ICU, putting them at risk of adverse events. In this study we assessed the efficacy of routine bedside lung ultrasound (LUS) in the evaluation of pleural effusions (PE) in the ICU.METHODS: Three hundred seventy-six patients admitted to the ICU for major trauma (46.3%), medical pathology (41.5%), and postsurgical complications (12.2%) (May 2008 to April 2009) were included in this study. Patients were placed into either the control group (group C) or the study group (group S), on the basis of the introduction of routine LUS performed by a single group of intensivists in 1 tertiary care ICU. To reduce provider bias, the physicians conducting the LUS were not aware of the study. Collected data included patient demographics, clinical course, and number of chest radiographs and CT scans performed. As a secondary goal, we assessed the reliability of Balik's formula in PE estimation.RESULTS: No significant differences were found between the 2 groups with regard to their demographics and ICU clinical course. Group S had a significant reduction in the total number of chest radiographs obtained (-26%; P < 0.001) and CT scans (-47%; P < 0.001) in comparison with the comparison group C. A 6-month follow-up analysis of the ICU LUS protocol revealed a time-dependent decrease in the number of radiological examinations requested for patients with PE. Lastly, PE volume estimation using the LUS and Balik's formula correlates well with the effective volume drained (r = 0.65; P < 0.0001).CONCLUSIONS: Routine use of LUS in the ICU setting can be associated with a reduction of the number of chest radiographs and CT scans performed. (Anesth Analg 2010;111:687-92)