肺部超声预测新冠肺炎急性呼吸衰竭患者无创通气结局的初步研究

2021-10-15 17:25

我们的数据提示LUS可以作为识别可能需要MV和ICU入院或NIMV试验失败的患者的一种可能的工具。

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肺部超声预测新冠肺炎急性呼吸衰竭患者无创通气结局的初步研究

贵州医科大学麻醉与心脏电生理课题组

翻译：陈锐编辑：张中伟审校：曹莹

背景

探讨新冠肺炎呼吸衰竭患者肺超声(LUS)评估的肺通气功能与无创通气结局（NIMV）、重症监护病房(ICU)入院和机械通气(MV)需求之间的关系。

方法

一组新冠肺炎呼吸衰竭的成人患者在最初评估期间接受了LUS检查。采用了简化的LU协议，包括扫描六个区域，每侧三个。每个地区都被分配了从0到3的分数。综合LUS评分(LUSsc)为各领域评分之和。将LUSsc、受累肺面积(LUSq)、肺内浸润象限数和入院时氧合损害程度(SpO2/FiO2比值)与NIMV结局、MV需求和ICU入院情况进行比较。

结果

在前瞻性纳入分析的85例患者中，61例中49例需要机械通气。需要机械通气的患者(中位数12[IQR8-14]和中位数6[IQR4-6])的LUSsc和LUSQ高于不需要机械通气的患者(分别为6[IQR2-9]和3[IQR1-5])，均P<0.001。NIMV试验在36名患者中有26名失败。NIMV失败患者的LUSsc和LUSq显著高于未通过NIMV的患者。在ROC分析中，LUSsc≧12和LUSq≧5预测NIMV失效的最佳临界值分别为AUC=0.95，95%CI 0.83~0.99和AUC=0.81，95%CI 0.6 5~0.91。

结论

我们的数据提示LUS可以作为识别可能需要MV和ICU入院或NIMV试验失败的患者的一种可能的工具。

原始文献来源

Biasucci DG, Buonsenso D, Piano A, Bonadia N, Vargas J, Settanni D, et al.; Gemelli Against COVID-19 Group. Lung ultrasound predicts non-invasive ventilation outcome in COVID-19 acute respiratory failure: a pilot study. Minerva Anestesiol 2021;87:1006-16.

Lung Ultrasound Predicts Non-Invasive Ventilation Outcome in COVID-19 Acute Respiratory Failure: A Pilot Study

ABSTRACT

BACKGROUND: The aim of this study is to determine relationships between lung aeration assessed by lung ultrasound (LUS) with non-invasive ventilation (NIMV) outcome, intensive care unit (ICU) admission and mechanical ventilation (MV) needs in COVID-19 respiratory failure.

METHODS: A cohort of adult patients with COVID-19 respiratory failure underwent LUS during initial assessment. A simplified LUS protocol consisting in scanning six areas, three for each side, was adopted. A score from 0 to 3 was assigned to each area. Comprehensive LUS score (LUSsc) was calculated as the sum of the score in all areas. LUSsc, the amount of involved sonographic lung areas (LUSq), the number of lung quadrants radiographically infiltrated and the degree of oxygenation impairment at admission (SpO₂/FiO₂ ratio) were compared to NIMV Outcome, MV needs and ICU admission.

RESULTS: Among 85 patients prospectively included in the analysis, 49 of 61 needed MV. LUSsc and LUSq were higher in patients who required MV (median 12 [IQR 8-14] and median 6 [IQR 4-6], respectively) than in those who did not (6 [IQR 2-9] and 3 [IQR 1-5], respectively), both P<0.001. NIMV trial failed in 26 patients out 36. LUSsc and LUSq were significantly higher in patients who failed NIMV than in those who did not. From ROC analysis, LUSsc ≥12 and LUSq ≥5 gave the best cut-off values for NIMV failure prediction (AUC=0.95, 95%CI 0.83–0.99 and AUC=0.81, 95% CI 0.65-0.91, respectively).

CONCLUSIONS: Our data suggest LUS as a possible tool for identifying patients who are likely to require MV and ICU admission or to fail a NIMV trial.