BILL策略：重症心脏超声操作及解读中需要注意的问题

doi:10.24920/004357

摘要/Abstract

摘要： 为保证重症心脏超声的准确应用,临床医生在操作前和操作过程中需要对重症病人的临床情况进行精细解读,从而减少对重要超声信息的忽略或错误解读。本文提供了一个“BILL”策略以更好地完成重症心脏超声的过程,其中“B”指的是呼吸、循环的基线支持条件;“I”指的是通过有创监测获得的信息,包括中心静脉压以及热稀释法获得的心输出量等指标;第一个“L”指的是化验指标,包括中心静脉血氧饱和度、肌钙蛋白、脑钠肽等;第二个“L”指的是肺部超声信息。“BILL”策略与重症心脏超声的结合有助于更好地理解重症状态,提高诊断准确性并进而改善重症患者的结局。

关键词: 心脏超声, 重症, 临床情况

Abstract: The growing utilization of critical care echocardiography (CCE) by clinicians necessitates a meticulous review of clinical conditions in critically ill patients, both before and during the examination. The reviewing process of clinical conditions minimizes the risk of overlooking or misinterpreting crucial findings. This article proposes a comprehensive strategy, namely BILL strategy to integrated into the CCE protocol, where “B” represents baseline respiratory and hemodynamic support, “I” signifies information gleaned from invasive monitoring, including central venous pressure and thermodilution-derived cardiac output, the first “L” denotes laboratory results such as central venous oxygen saturation, troponin, and brain natriuretic peptide, and the second “L” refers to lung ultrasound data. xx Combining the BILL strategy with CCE enhances a more comprehensive understanding of critical illness, potentially leading to improved diagnostic accuracy and patient outcomes.

Key words: echocardiography, critical care, clinical condition

基金资助: 北京重症超声研究会临床科研专项基金（2022-CCUSG-A-01）; 中央高水平医院临床科研专项专科提升项目（2022-PUMCH-B-026）

Hong-Min Zhang, Hui Lian, Xiao-Ting Wang. BILL Strategy: Points to Consider During the Performance and Interpretation of Critical Care Echocardiography[J/OL].Chinese Medical Sciences Journal, .DOI:10.24920/004357.[Epub ahead of print].

参考文献

[1] Cecconi M, De Backer D, Antonelli M, et al.Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40(12): 1795-815. doi: 10.1007/s00134-014-3525-z.
[2] Vieillard-Baron A, Millington SJ, Sanfilippo F, et al.A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019; 45(6): 770-88. doi: 10.1007/s00134-019-05604-2.
[3] Mehta AB, Syeda SN, Wiener RS, et al.Epidemiological trends in invasive mechanical ventilation in the United States: a population-based study. J Crit Care 2015; 30:1217-21. doi: 10.1016/j.jcrc.2015.07.007.
[4] Si X, Xu H, Liu Z, et al.Does respiratory variation in inferior vena cava diameter predict fluid responsiveness in mechanically ventilated patients? A systematic review and meta-analysis. Anesth Analg 2018; 127(5): 1157-64. doi: 10.1213/ANE.0000000000003459.
[5] Via G, Tavazzi G, Price S.Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view. Intensive Care Med 2016; 42:1164-7. doi: 10.1007/s00134-016-4357-9.
[6] Harjola VP, Mebazaa A, Čelutkienė J, et al.Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail 2016; 18(3): 226-41. doi: 10.1002/ejhf.478.
[7] Vieillard-Baron A, Matthay M, Teboul JL, et al.Experts' opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation. Intensive Care Med 2016; 42(5): 739-49. doi: 10.1007/s00134-016-4326-3.
[8] Jardin F, Dubourg O, Bourdarias JP.Echocardiographic pattern of acute cor pulmonale. Chest 1997; 111(1): 209-17. doi: 10.1378/chest.111.1.209.
[9] Guazzi M, Bandera F, Pelissero G, et al.Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol 2013; 305(9): H1373-81. doi:10.1152/ajpheart.00157.2013.
[10] Cheifetz IM.Cardiorespiratory interactions: the relationship between mechanical ventilation and hemodynamics. Respir Care 2014; 59(12): 1937-45. doi: 10.4187/respcare.03486.
[11] de Meirelles Almeida CA, Nedel WL, Morais VD, et al. Diastolic dysfunction as a predictor of weaning failure: A systematic review and meta-analysis. J Crit Care 2016; 34: 135-41. doi: 10.1016/j.jcrc.2016.03.007.
[12] Douflé G, Roscoe A, Billia F, et al.Echocardiography for adult patients supported with extracorporeal membrane oxygenation. Crit Care 2015; 19: 326. doi: 10.1186/s13054-015-1042-2.
[13] Bunge J, Caliskan K, Gommers D, et al.Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation. J Thorac Dis 2018; 10:S674-82. doi: 10.21037/jtd.2017.10.75.
[14] Annane D, Ouanes-Besbes L, de Backer D, et al. A global perspective on vasoactive agents in shock. Intensive Care Med 2018; 44(6): 833-46. doi: 10.1007/s00134-018-5242-5.
[15] Pinsky MR, Guarracino F.How to assess ventriculoarterial coupling in sepsis. Curr Opin Crit Care. 2020. 26(3): 313-8. doi: 10.1097/MCC.0000000000000721.
[16] Mihaileanu S, Antohi EL.Revisiting the relationship between left ventricular ejection fraction and ventricular-arterial coupling. ESC Heart Fail 2020; 7(5): 2214-22. doi: 10.1002/ehf2.12880.
[17] Gaubert M, Resseguier N, Thuny F, et al.Doppler echocardiography for assessment of systemic vascular resistances in cardiogenic shock patients. Eur Heart J Acute Cardiovasc Care 2020; 9(2): 102-7. doi: 10.1177/2048872618795514.
[18] de Backer D, Arias Ortiz J, Levy B. The medical treatment of cardiogenic shock: cardiovascular drugs. Curr Opin Crit Care 2021; 27(4): 426-32. doi: 10.1097/MCC.0000000000000822.
[19] Price S, Platz E, Cullen L, et al.Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol 2017; 14(7): 427-40. doi: 10.1038/nrcardio.2017.56.
[20] Auer J, Berent R, Weber T, et al.Catecholamine therapy inducing dynamic left ventricular outflow tract obstruction. Int J Cardiol 2005; 101: 325-8. doi: 10.1016/j.ijcard.2004.02.011.
[21] Baulier C, Lessert M, Chauvet JL, et al.Left ventricular outflow tract obstruction in patients treated with milrinone for cerebral vasospasm: case report and literature review. JMIRx Med 2022; 3: e31019. doi:10.2196/31019.
[22] Reichert CL, Koolen JJ, Visser CA.Transesophageal echocardiographic evaluation of left ventricular function during intraaortic balloon pump counterpulsation. [J] Am Soc Echocardiogr. 1993; 6(5): 490-5. doi: 10.1016/s0894-7317(14)80468-9.
[23] Khir AW, Price S, Henein MY, et al.Intra-aortic balloon pumping: effects on left ventricular diastolic function. Eur J Cardiothorac Surg 2003; 24(2): 277-82. doi: 10.1016/s1010-7940(03)00268-9.
[24] Aissaoui N, Luyt CE, Leprince P, et al.Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 2011; 37: 1738-45. doi:10.1007/s00134-011-2358-2.
[25] Mahjoub Y, Pila C, Friggeri A, et al.Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit Care Med 2009; 37(9): 2570-5. doi: 10.1097/CCM.0b013e3181a380a3.
[26] Teboul JL, Monnet X, Chemla D, et al.Arterial Pulse Pressure Variation with Mechanical Ventilation. Am J Respir Crit Care Med 2019; 199(1): 22-31. doi: 10.1164/rccm.201801-0088CI.
[27] Magder S.Right Atrial Pressure in the Critically Ill: How to Measure, What Is the Value, What Are the Limitations. Chest 2017; 151(4): 908-16. doi: 10.1016/j.chest.2016.10.026.
[28] Berlin DA, Bakker J.Starling curves and central venous pressure. Crit Care 2015; 19(1): 55. doi: 10.1186/s13054-015-0776-1.
[29] Saugel B, Vincent JL.Cardiac output monitoring: how to choose the optimal method for the individual patient. Curr Opin Crit Care 2018; 24(3): 165-72. doi:10.1097/MCC.0000000000000492.
[30] Dannenberg V, Goliasch G, Hengstenberg C, et al.Detection of atrial shunt lesions with a single echocardiographic parameter. Wien Klin Wochenschr 2020; 132(11-12): 295-300. doi:10.1007/s00508-020-01659-0.
[31] Pinsky MR.A rose is still a rose: comparing estimates of cardiac output. Crit Care Med 2016; 44(7): 1438-40. doi:10.1097/CCM.0000000000001693.
[32] Walley KR.Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med 2011; 184(5): 514-20. doi:10.1164/rccm.201010-1584CI.
[33] Darki A, Schneck MJ, Agrawal A, et al.Correlation of elevated troponin and echocardiography in acute ischemic stroke. J Stroke Cerebrovasc Dis 2013; 22(7): 959-61. doi:10.1016/j.jstrokecerebrovasdis.2011.12.004.
[34] Doyen D, Dupland P, Morand L, et al.Characteristics of Cardiac Injury in Critically Ill Patients With Coronavirus Disease 2019. Chest 2021; 159(5): 1974-85. doi:10.1016/j.chest.2020.10.056.
[35] Y-Hassan S, De Palma R. Contemporary review on the pathogenesis of takotsubo syndrome: The heart shedding tears: Norepinephrine churn and foam at the cardiac sympathetic nerve terminals. Int J Cardiol 2017; 228: 528-36. doi: 10.1016/j.ijcard.2016.11.086.
[36] Palazzuoli A, Beltrami M, Ruocco G, et al.Diagnostic utility of contemporary echo and BNP assessment in patients with acute heart failure during early hospitalization. Eur J Intern Med 2016; 30: 43-8. doi: 10.1016/j.ejim.2015.11.031.
[37] Picano E, Scali MC, Ciampi Q, et al.Lung ultrasound for the cardiologist. JACC Cardiovasc Imaging 2018; 11(11): 1692-705. doi: 10.1016/j.jcmg.2018.06.023.
[38] Bataille B, Riu B, Ferre F, et al.Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure: a prospective observational study in ICU. Chest 2014; 146(6): 1586-93. doi: 10.1378/chest.14-0681.
[39] Lichtenstein DA.Lung ultrasound in the critically ill. Ann Intensive Care 2014; 4(1): 1. doi: 10.1186/2110-5820-4-1.
[40] Bouhemad B, Mongodi S, Via G, et al.Ultrasound for "lung monitoring" of ventilated patients. Anesthesiology 2015; 122(2): 437-47. doi: 10.1097/ALN.0000000000000558.
[41] Volpicelli G.Sonographic diagnosis of pneumothorax. Intensive Care Med 2011; 37(2): 224-32. doi: 10.1007/s00134-010-2079-y.
[42] Lichtenstein DA, Mezière GA.Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008; 134(1): 117-25. doi: 10.1378/chest.07-2800.
[43] Volpicelli G, Elbarbary M, Blaivas M, et al.International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38(4): 577-91. doi: 10.1007/s00134-012-2513-4.
[44] Tagami T, Ong M.Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when. Curr Opin Crit Care 2018; 24(3): 209-15. doi: 10.1097/MCC.0000000000000503.
[45] Schmickl CN, Pannu S, Al-Qadi MO, et al.Decision support tool for differential diagnosis of acute respiratory distress syndrome (ARDS) vs cardiogenic pulmonary edema (CPE): a prospective validation and meta-analysis. Crit Care 2014; 18(6): 659. doi: 10.1186/s13054-014-0659-x.
[46] Zhang H, Zhang Q, Chen X, et al.Respiratory variations of inferior vena cava fail to predict fluid responsiveness in mechanically ventilated patients with isolated left ventricular dysfunction. Ann Intensive Care 2019; 9(1): 113. doi: 10.1186/s13613-019-0589-5.
[47] Zhang H, Lian H, Wang X, et al.Tricuspid annular plane systolic excursion/mitral annular plane systolic excursion ratio in critically ill patients: an index of right- and left-ventricular function mismatch and a risk factor for cardiogenic pulmonary edema. BMC Anesthesiol 2023; 23(1): 175. doi: 10.1186/s12871-023-02142-9.

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