Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study.
Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study.
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DOI：
10.1186/s13054-015-0995-5
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发表时间：
2015-07-21
期刊：
影响因子：
--
通讯作者：
West TE
中科院分区：
文献类型：
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作者：
Bass CM;Sajed DR;Adedipe AA;West TE
在低资源环境下，并不总是能够获得诊断急性呼吸窘迫综合征（ARDS）所需的信息。然而，超声和脉搏血氧饱和度可以在这些设置中使用。本研究旨在测试肺超声和脉搏血氧饱和度是否可以用来代替传统的影像学和氧合评价ARDS。本研究是一项前瞻性、单中心研究，在美国华盛顿西雅图的转诊医院Harborview Medical Center的ICU进行。对ICU有创机械通气患者进行床旁肺超声检查。记录或解释脉搏血氧饱和度（SpO 2）、氧分压（PaO 2）、吸入氧分数（FiO 2）、提供者诊断和最接近超声时间的胸片。对77例连续入组的呼吸衰竭患者进行了123次超声评估。35项评估符合ARDS的氧合和影像学标准。当SpO 2 ≤ 97%时，SpO 2/FiO 2和PaO 2/FiO 2之间的斯皮尔曼等级相关系数为0.83，p < 0.0001。先前报告的SpO 2/FiO 2 ≤ 315阈值对PaO 2/FiO 2 ≤ 300的敏感性和特异性分别为83%（95%置信区间（CI）68-93）和50%（95% CI 1-99）。SpO 2/FiO 2 ≤ 235对PaO 2/FiO 2 ≤ 200的敏感性和特异性分别为70%（95% CI 47-87）和90%（95% CI 68-99）。对于研究医生解释的肺部超声评估，对于ARDS的放射学标准，双侧超声间质性综合征和至少累及3个肺野的敏感性和特异性分别为80%（95%CI 63-92）和62%（95%CI 49-74）。结合SpO 2/FiO 2和超声确定氧合和影像学标准诊断ARDS的敏感性为83%（95%CI 52-98），特异性为62%（95%CI 38-82）。对于中重度ARDS标准（PaO 2/FiO 2 ≤ 200），灵敏度为64%（95%CI 31-89），特异性为86%（95%CI 65-97）。排除重复评估和超声图像的独立解释并没有显着改变敏感性措施。脉搏血氧饱和度和肺超声可能是有用的工具，以筛选或排除，受损的氧合或肺异常符合ARDS在资源不足的设置，动脉血气测试和胸部X线摄影是不容易获得。本文的在线版本（doi：10.1186/s13054-015-0995-5）包含补充材料，可供授权用户使用。
In low-resource settings it is not always possible to acquire the information required to diagnose acute respiratory distress syndrome (ARDS). Ultrasound and pulse oximetry, however, may be available in these settings. This study was designed to test whether pulmonary ultrasound and pulse oximetry could be used in place of traditional radiographic and oxygenation evaluation for ARDS. This study was a prospective, single-center study in the ICU of Harborview Medical Center, a referral hospital in Seattle, Washington, USA. Bedside pulmonary ultrasound was performed on ICU patients receiving invasive mechanical ventilation. Pulse oximetric oxygen saturation (SpO2), partial pressure of oxygen (PaO2), fraction of inspired oxygen (FiO2), provider diagnoses, and chest radiograph closest to time of ultrasound were recorded or interpreted. One hundred and twenty three ultrasound assessments were performed on 77 consecutively enrolled patients with respiratory failure. Oxygenation and radiographic criteria for ARDS were met in 35 assessments. Where SpO2 ≤ 97 %, the Spearman rank correlation coefficient between SpO2/FiO2 and PaO2/FiO2 was 0.83, p < 0.0001. The sensitivity and specificity of the previously reported threshold of SpO2/FiO2 ≤ 315 for PaO2/FiO2 ≤ 300 was 83 % (95 % confidence interval (CI) 68–93), and 50 % (95 % CI 1–99), respectively. Sensitivity and specificity of SpO2/FiO2 ≤ 235 for PaO2/FiO2 ≤ 200 was 70 % (95 % CI 47–87), and 90 % (95 % CI 68–99), respectively. For pulmonary ultrasound assessments interpreted by the study physician, the sensitivity and specificity of ultrasound interstitial syndrome bilaterally and involving at least three lung fields were 80 % (95 % CI 63–92) and 62 % (95 % CI 49–74) for radiographic criteria for ARDS. Combining SpO2/FiO2 with ultrasound to determine oxygenation and radiographic criteria for ARDS, the sensitivity was 83 % (95 % CI 52–98) and specificity was 62 % (95 % CI 38–82). For moderate–severe ARDS criteria (PaO2/FiO2 ≤ 200), sensitivity was 64 % (95 % CI 31–89) and specificity was 86 % (95 % CI 65–97). Excluding repeat assessments and independent interpretation of ultrasound images did not significantly alter the sensitivity measures. Pulse oximetry and pulmonary ultrasound may be useful tools to screen for, or rule out, impaired oxygenation or lung abnormalities consistent with ARDS in under-resourced settings where arterial blood gas testing and chest radiography are not readily available. The online version of this article (doi:10.1186/s13054-015-0995-5) contains supplementary material, which is available to authorized users.