用于评估 ARDS 患者肺通气情况的肺部超声波评分:两种方法的比较。

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Ultrasound International Open Pub Date : 2024-10-21 eCollection Date: 2024-01-01 DOI:10.1055/a-2421-8709
Silvia Mongodi, Davide Chiumello, Francesco Mojoli
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引用次数: 0

摘要

目的 以前曾使用四步肺超声(LUS)评分来量化肺密度。我们比较了该评分系统的两个版本,以区分 ARDS 通气严重丧失和中度丧失:基于凝聚的评分(cLUS)与基于定量的评分(qLUS - >50% 胸膜被伪影占据)。材料和方法 我们将 qLUS 和 cLUS 与通过定量 CT 扫描测量的 12 个标准胸腔区域的肺密度进行了比较。我们将简化方法(每个区域扫描 1 次)与广泛方法(区域评分计算为所有相关肋间隙评分的平均值)进行了比较。结果 我们对 7 例 ARDS 患者的 13 种情况进行了检查(7 例 PEEP 为 5,6 例 PEEP 为 15 cmH2O-156 个区域,398 个片段)。从 cLUS 到 qLUS 的转换导致 117 个片段(29.4%,减少 1 分)和 41.7% 的区域(64 个减少(范围 0.2-1),1 个增加(0.2 分))的解释发生变化。区域 qLUS 与肺密度的相关性非常强(rs=0.85),高于 cLUS(rs=0.79;p=0.010)。cLUS 与 CT 对通气良好、通气不良和不通气组织分类的一致性为中等(一致性 65.4%;Cohen's K 系数 0.475 (95%CI 0.391-0.547);p 结论 在量化肺密度方面,基于胸膜占位百分比的 LUS 评分优于基于凝聚的方法。简化方法和广泛方法的效果一样好。
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Lung ultrasound score for the assessment of lung aeration in ARDS patients: comparison of two approaches.

Purpose  A 4-step lung ultrasound (LUS) score has been previously used to quantify lung density. We compared 2 versions of this scoring system for distinguishing severe from moderate loss of aeration in ARDS: coalescence-based score (cLUS) vs. quantitative-based score (qLUS - >50% pleura occupied by artefacts). Materials and Methods   We compared qLUS and cLUS to lung density measured by quantitative CT scan in 12 standard thoracic regions. A simplified approach (1 scan per region) was compared to an extensive one (regional score computed as the mean of all relevant intercostal space scores). Results   We examined 13 conditions in 7 ARDS patients (7 at PEEP 5, 6 at PEEP 15 cmH2O-156 regions, 398 clips). Switching from cLUS to qLUS resulted in a change in interpretation in 117 clips (29.4%, 1-point reduction) and in 41.7% of the regions (64 decreases (range 0.2-1), 1 increase (0.2 points)). Regional qLUS showed very strong correlation with lung density (rs=0.85), higher than cLUS (rs=0.79; p=0.010). The agreement with CT classification in well aerated, poorly aerated, and not aerated tissue was moderate for cLUS (agreement 65.4%; Cohen's K coefficient 0.475 (95%CI 0.391-0.547); p<0.0001) and substantial for qLUS (agreement 81.4%; Cohen's K coefficient 0.701 (95%CI 0.653-0.765), p<0.0001). The agreement between single spot and extensive approaches was almost perfect (cLUS: agreement 89.1%, Cohen's kappa coefficient 0.840 (95%CI 0.811-0.911), p<0.0001; qLUS: agreement 86.5%, Cohen's kappa coefficient 0.819 (95%CI 0.761-0.848), p<0.0001). Conclusion   A LUS score based on the percentage of occupied pleura performs better than a coalescence-based approach for quantifying lung density. A simplified approach performs as well as an extensive one.

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来源期刊
Ultrasound International Open
Ultrasound International Open RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
3.00
自引率
0.00%
发文量
7
审稿时长
12 weeks
期刊最新文献
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