床旁心脏超声结合肺部超声在重症患者中的应用： 一项全国多中心观察性研究

doi:10.24920/003874

Abstract

Objective Focused cardiac ultrasound (FCU) and lung ultrasound (LU) are increasingly being used in critically ill patients. This study aimed to investigate the effect of FCU in combination with LU on these patients and to determine if the timing of ultrasound examination was associated with treatment change.
Methods This is a multicenter cross-sectional observational study. Consecutive patients admitted to the intensive care unit (ICU) were screened for enrollment. FCU and LU were performed within the first 24 h, and treatment change was proposed by the performer based on the ultrasound results and other clinical conditions.
Results Among the 992 patients included, 502 were examined within 6 h of ICU admission (early phase group), and 490 were examined after 6 h of admission (later phase group). The early phase group and the later phase group had similar proportions of treatment change (48.8% vs. 49.0%, χ ²=0.003, P=0.956). In the multivariable analysis, admission for respiratory failure was an independent variable associated with treatment change, with an odds ratio (OR) of 2.357 [95% confidence interval (CI): 1.284-4.326, P=0.006]; the timing of examination was not associated with treatment change (OR=0.725, 95%CI: 0.407-1.291, P=0.275).
Conclusions FCU in combination with LU, whether performed during the early phase or later phase, had a significant impact on the treatment of critically ill patients. Patients with respiratory failure were more likely to experience treatment change after the ultrasound examination.

Key words: cardiac ultrasound, lung ultrasound, critically ill, point-of-care

Hongmin Zhang, Lina Zhang, Lixia Liu, Ying Zhu, Wanhong Yin, Wei He, Xiuling Shang, Yangong Chao, Liwen Lv, Xiaoting Wang, Dawei Liu, Chinese Critical Ultrasound Study Group . Effect of Focused Cardiac Ultrasound in Combination with Lung Ultrasound on Critically Ill Patients: A Multicenter Observational Study in China[J].Chinese Medical Sciences Journal, 2021, 36(4): 257-264.

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Items	Early phase (n=502)	Later phase (n=490)	t or Z or χ²	P
Male [n (%)]	287 (57.2)	301 (61.4)	1.862	0.172
Age (yr, mean±SD)	61±18	59±17	1.849	0.064
APACHEⅡ	15 (11, 21)	17 (11, 23)	-0.924	0.270
SOFA [score, median (interquartile range)]	6 (4, 8)	6 (4, 8)	-0.662	0.508
Diagnosis [n (%)]
High risk surgery	183 (36.5)	187 (37.8)	0.310	0.578
Respiratory failure	130 (25.9)	152 (31.0)	3.200	0.074
Shock	84 (16.7)	66 (13.5)	2.058	0.151
Shock+Respiratory failure	39 (7.8)	29 (5.9)	1.330	0.249
Others^*	118 (23.5)	114 (23.3)	0.008	0.929
HR [bpm, median (interquartile range)]	92 (77, 114)	98 (79, 110)	-0.012	0.991
MAP [mmHg, median (interquartile range)]	88 (77, 102)	88 (80, 98)	-0.273	0.785
NE infusion [n, (%)]	103 (20.5)	115 (23.5)	0.725	0.124
MV [n, (%)]	264 (52.6)	279 (56.9)	1.893	0.169

Items	Early phase (n=502)	Later phase (n=490)	Z or χ²	P
Duration of examination [min, median (interquartile range)]	15 (11, 30)	15 (12, 30)	-1.495	0.135
FCU
Structure abnormality^*	92 (18.3)	94 (19.2)	0.120	0.730
Left ventricular systolic function
Normal	364 (72.5)	343 (70.0)	0.763	0.382
Moderately abnormal	120 (23.9)	132 (26.9)	1.205	0.272
Severely abnormal	18 (3.6)	15 (3.1)	0.212	0.645
IVC
Dilated and fixed	173 (34.5)	129 (26.3)	7.751	0.005
Moderate	240 (47.8)	276 (56.3)	7.208	0.007
Small and collapsed	89 (17.7)	85 (17.3)	0.025	0.874
RV dysfunction	7 (1.4)	9 (1.8)	0.306	0.580
LU
A profile	212 (42.2)	181(36.9)	2.903	0.088
A’ or B’+lung point	8 (1.6)	11(2.2)	0.560	0.454
B profile	35 (7.0)	29 (5.9)	0.456	0.499
Other profiles^*	247 (49.2)	269 (54.9)	3.222	0.073

Items	Early phase (n=502)	Later phase (n=490)	χ²	P
Patients with treatment change	245 (48.8)	240 (49.0)	0.003	0.956
One treatment change	153 (30.5)	149 (30.4)	0.001	0.991
More than one treatment change	92 (18.3)	91 (18.6)	0.010	0.921
Volume expansion	47 (9.4)	44 (9.0)	0.044	0.835
Negative fluid balance	166 (33.1)	139 (28.4)	2.573	0.109
Inotrope	28 (5.6)	39 (8.0)	2.233	0.135
Norepinephrine adjustment	37 (7.4)	22 (4.5)	3.679	0.055
Drainage of pericardial effusion	3 (0.6)	0	2.937	0.087
Ventilator adjustment	93 (18.5)	104 (21.2)	1.135	0.287
Drainage of pleural cavity	23 (4.6)	24 (4.9)	0.055	0.815
In need of other type of ultrasound examination	91 (18.1)	97 (19.8)	0.449	0.503
In need of CT	88 (17.5)	98 (20.0)	0.993	0.319
In need of CCO monitoring	39 (7.8)	26 (5.3)	2.456	0.117

Risk factors	OR	95%CI	P
Age	0.987	0.969-1.005	0.157
APAHCEⅡ	0.997	0.991-1.003	0.379
SOFA	1.034	0.946-1.130	0.465
Respiratory failure	2.357	1.284-4.326	0.006
Shock	1.733	0.896-3.353	0.103
Timing of examination	0.725	0.407-1.291	0.275

[1]	Cui Wang, Xiaodong Deng, Hongmin Zhang, Dawei Liu, Xiaoting Wang. Study on Image Acquisition of Transthoracic Echocardiography in Mechanically Ventilated ICU Patients [J]. Chinese Medical Sciences Journal, 2020, 35(4): 323-329.
[2]	Wei-yun Chen, Xue-rong Yu*, Jiao Zhang, Qing Yuan, Yu-guang Huang. Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion [J]. Chinese Medical Sciences Journal, 2016, 31(2): 83-88.

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