Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study.
Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study.
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DOI：
10.1186/s13054-018-2105-y
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发表时间：
2018-08-18
期刊：
影响因子：
--
通讯作者：
Taculod J
中科院分区：
文献类型：
--
作者：
See KC;Ong V;Tan YL;Sahagun J;Taculod J
肺部超声可能是一个合理的替代胸部X线检查的急性呼吸窘迫综合征（ARDS）的识别，但肺部超声对ARDS的诊断性能是不确定的。因此，我们分析了根据柏林定义诊断的ARDS的临床结局，使用胸部X线摄影（Berlin-CXR）或肺部超声（Berlin-LUS）作为替代成像方法。这是一项在20张病床的重症监护病房（ICU）中进行的回顾性观察研究。纳入了2014年8月至2017年3月期间因低氧性呼吸衰竭在ICU住院时需要无创通气或有创通气的患者。入住ICU后常规进行胸部X线摄影和肺部超声检查。比较使用Berlin-CXR或Berlin-LUS定义诊断ARDS的患者特征和每种定义的临床结局。ICU和住院死亡率是两种定义的主要结局指标。对456例不同患者的首次入院进行了分析。与符合Berlin-CXR定义的216名患者相比，（ICU死亡率19.4%，住院死亡率36.1%），229例符合Berlin-LUS定义的患者（ICU死亡率22.7%，住院死亡率34.5%）和79例符合Berlin-LUS但不符合Berlin-CXR定义的患者（ICU死亡率21.5%，住院死亡率29.1%）的结局相似。相比之下，符合任一定义的295例患者的死亡率高于不符合任一定义的161例患者（ICU死亡率20.0% vs 12.4%，P = 0.041;住院死亡率34.2% vs 24.2%，P = 0.027）。与Berlin-CXR相比，Berlin-LUS的阳性预测值为0.66（95%置信区间0.59-0.72），阴性预测值为0.71（0.65-0.77）。在216例Berlin-CXR ARDS患者中，150例患者（69.4%）也符合Berlin-LUS定义。对于使用柏林定义识别ARDS，胸部X线摄影和肺部超声与死亡率同样相关。使用肺部超声的柏林定义有助于识别死亡风险较高的患者，即使这些患者不符合使用胸部X线摄影的传统柏林定义。然而，当胸部成像模式不同时，患者的中度重叠表明胸部X线摄影和肺部超声应该是互补的，而不是互换使用。本文的在线版本（10.1186/s13054-018-2105-y）包含补充材料，可供授权用户使用。
Lung ultrasound may be a reasonable alternative to chest radiography for the identification of acute respiratory distress syndrome (ARDS), but the diagnostic performance of lung ultrasound for ARDS is uncertain. We therefore analyzed the clinical outcomes of ARDS diagnosed according to the Berlin Definition, using either chest radiography (Berlin-CXR) or lung ultrasound (Berlin-LUS) as an alternative imaging method. This was a retrospective observational study in a 20-bed medical intensive care unit (ICU). Patients who required noninvasive ventilation or invasive ventilation for hypoxemic respiratory failure on ICU admission from August 2014 to March 2017 were included. Both chest radiography and lung ultrasound were performed routinely upon ICU admission. Comparisons were made using either the Berlin-CXR or Berlin-LUS definitions to diagnose ARDS with respect to the patient characteristics and clinical outcomes for each definition. ICU and hospital mortality were the main outcome measures for both definitions. The first admissions of 456 distinct patients were analyzed. Compared with the 216 patients who met the Berlin-CXR definition (ICU mortality 19.4%, hospital mortality 36.1%), 229 patients who met the Berlin-LUS definition (ICU mortality 22.7%, hospital mortality 34.5%) and 79 patients who met the Berlin-LUS but not the Berlin-CXR definition (ICU mortality 21.5%, hospital mortality 29.1%) had similar outcomes. In contrast, the 295 patients who met either definition had higher mortality than the 161 patients who did not meet either definition (ICU mortality 20.0% versus 12.4%, P = 0.041; hospital mortality 34.2% versus 24.2%, P = 0.027). Compared with Berlin-CXR, Berlin-LUS had a positive predictive value of 0.66 (95% confidence interval 0.59–0.72) and a negative predictive value of 0.71 (0.65–0.77). Among the 216 Berlin-CXR ARDS patients, 150 patients (69.4%) also fulfilled Berlin-LUS definition. For the identification of ARDS using the Berlin definition, both chest radiography and lung ultrasound were equally related to mortality. The Berlin definition using lung ultrasound helped identify patients at higher risk of death, even if these patients did not fulfill the conventional Berlin definition using chest radiography. However, the moderate overlap of patients when chest imaging modalities differed suggests that chest radiography and lung ultrasound should be complementary rather than used interchangeably. The online version of this article (10.1186/s13054-018-2105-y) contains supplementary material, which is available to authorized users.
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影响因子：
8.8
作者：
Coudroy, Remi;Frat, Jean-Pierre;Thille, Arnaud W.
通讯作者：
Thille, Arnaud W.
影响因子：
8.8
作者：
Lichtenstein, D;Goldstein, I;Rouby, JJ
通讯作者：
Rouby, JJ
DOI：
10.1164/ajrccm.161.1.9809003
发表时间：
2000-01-01
影响因子：
24.7
作者：
Meade, MO;Cook, RJ;Stewart, TE
通讯作者：
Stewart, TE
DOI：
10.1186/s13054-015-0995-5
发表时间：
2015-07-21
期刊：
Critical care (London, England)
影响因子：
--
作者：
Bass CM;Sajed DR;Adedipe AA;West TE
通讯作者：
West TE
影响因子：
3.7
作者：
Figueroa-Casas, Juan B.;Brunner, Noemi;Ayyappan, Anoop P.
通讯作者：
Ayyappan, Anoop P.