儿童肺部超声波评分、急性肺病严重程度和长期机械通气。

IF 19.3 1区 医学 Q1 CRITICAL CARE MEDICINE American journal of respiratory and critical care medicine Pub Date : 2024-10-17 DOI:10.1164/rccm.202404-0843oc
Ignacio Oulego-Erroz,María Del Pilar De Castro-Vecino,Rafael González-Cortés,Almudena Alonso-Ojembarrena,Antonio Rodríguez-Nuñez,Daniel Palanca-Arias,Úrsula Quesada-Ortega,Sonia Sanchiz-Cardenas,María Ángeles Murillo-Pozo,Jorge López-González,Pilar Sánchez-Yáñez,Juan Valencia-Ramos,Andrea Fernández-de la Ballina,Nuria Chaves-Caro,Raúl Borrego-Domínguez,María Sánchez-Porras,Manuel Rodríguez-Martínez,Pedro José Carballo-Martín,Lorena Bermúdez-Barrezueta,Javier Rodríguez-Fanjul,Ana Vivanco-Allende,Patricia Rodríguez-Campoy,Laia Vega-Puyal,Javier Gil-Antón,Idoia Sánchez-Martínez,Olivia Pérez-Quevedo,Marta Muñoyerro-Sesmero,Luisa Barón-González de Suso,Juan Mayordomo-Colunga
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引用次数: 0

摘要

目的评估肺部超声波评分是否与肺部疾病的严重程度有关,并预测重症监护病房中需要呼吸支持的 1 个月至 18 岁儿童的有创机械通气时间。排除了患有慢性肺实质疾病的儿童。分别在入院 12 小时和 48-72 小时时进行肺部超声评分。有创机械通气时间超过连续 7 天定义为长期有创机械通气。研究了肺部超声评分与氧合的相关性及其对长期有创机械通气的预后准确性。在这些受试者中,12 小时[24 (19-26) vs. 8 (3-14); p<0.001]和 48-72 小时[16 (10.5-22.5) vs. 6 (3-11) vs; p<0.001]的肺部超声评分较高。12小时时,肺部超声评分与氧合指数[R2= 0.435 (95% CI: 0.293-0.566), rho系数 -0.705, p<0.001]和血氧饱和度指数[R2 0.499 (95% CI: 0.370-0.613), rho系数 0.651, p<0.001p<0.001]相关。在预测有创机械通气时间延长方面,12 小时时的肺部超声评分具有良好的准确性[AUROC=0.87 (95% CI: 0.81-0.93)],而将其用于多变量模型在推导方面也具有极佳的准确性[AUROC=0.结论 在重症儿童中,入院后早期肺部超声评分可预测有创机械通气时间的延长。
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Lung Ultrasound Score, Severity of Acute Lung Disease and Prolonged Mechanical Ventilation in Children.
RATIONALE Lung ultrasound may be useful for prognostication of acute lung disease. OBJECTIVES To assess whether the lung ultrasound score is associated with the severity of lung disease and may predict prolonged invasive mechanical ventilation in critically ill children. METHODS Prospective observational multicenter study in children aged 1 month to 18 years who required respiratory support in the intensive care unit. Children with chronic parenchymal lung disease were excluded. The lung ultrasound score was obtained at 12 hours and 48-72 hours from admission. Prolonged invasive mechanical ventilation was defined as >7 consecutive days. Correlation of the lung ultrasound score with oxygenation as well as its prognostic accuracy for prolonged invasive mechanical ventilation were investigated. RESULTS 538 children were included and 62 (11.5%) required prolonged mechanical ventilation. In these subjects, the lung ultrasound score was higher at 12 [24 (19-26) vs. 8 (3-14); p<0.001] and 48-72 hours [16 (10.5-22.5) vs. 6 (3-11) vs; p<0.001]. At 12 hours the lung ultrasound score correlated with oxygenation index [R2= 0.435 (95% CI: 0.293-0.566), rho coefficient -0.705, p<0.001] and oxygen saturation index [R2 0.499 (95% CI: 0.370-0.613), rho coefficient 0.651, p<0.001p<0.001]. To predict prolonged invasive mechanical ventilation, the lung ultrasound score at 12 hours had a good accuracy [AUROC=0.87 (95% CI: 0.81-0.93)] while its use in a multivariable model had an excellent accuracy both in derivation [AUROC=0.92 (95% CI: 0.89-0.95)] and internal validation [AUROC=0.91 (95% CI: 0.90-0.92)]. CONCLUSION In critically ill children, the lung ultrasound score early after admission may predict prolonged invasive mechanical ventilation.
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来源期刊
CiteScore
27.30
自引率
4.50%
发文量
1313
审稿时长
3-6 weeks
期刊介绍: The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.
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