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Lung ultrasound to detect and monitor pulmonary congestion in patients with acute kidney injury in nephrology wards: a pilot study.

肺部超声检测和监测肾病病房急性肾损伤患者的肺淤血: 一项初步研究。

  • 影响因子:3.00
  • DOI:10.1007/s40620-019-00666-3
  • 作者列表:"Panuccio V","Tripepi R","Parlongo G","Mafrica A","Caridi G","Catalano F","Marino F","Tripepi G","Mallamaci F","Zoccali C
  • 发表时间:2020-04-01
Abstract

INTRODUCTION:Lung congestion and frank pulmonary edema are established complications of acute kidney injury (AKI) and early detection and monitoring of lung congestion may be useful for the clinical management of AKI patients. METHODS:We compared standardized clinical criteria (including lung crackles and peripheral edema grading) and simultaneous chest ultrasound (US) to detect lung congestion in a series of 39 inpatients with AKI. RESULTS:At baseline, twelve patients (31%) were clinically euvolemic and twelve presented clear-cur cardiovascular congestion (31%) by clinical criteria. Fifteen patients (38%) were hypovolemic. The median number of US-B lines in patients with cardiovascular congestion was much higher (50, inter-quartile range 27-99) than in euvolemic (14, IQR 11-37) and hypovolemic patients (7, IQR 3-16, P < 0.001). Remarkably, a substantial proportion of asymptomatic euvolemic (66%) and hypovolemic (46%) patients had lung congestion of moderate to severe degree (> 15 US-B lines) by lung US. Crackles severity and the number of US-B lines over time were inter-related (Spearman's ρ = 0.38, P < 0.01) but the agreement (Cohen k statistics) between the two metrics was unsatisfactory. Forty-eight percent of patients had lung congestion of moderate to severe degree by lung US and this estimate by far exceeded that by clinical criteria (32%). CONCLUSIONS:This pilot study shows that chest US has potential for the detection of lung congestion at a pre-clinical stage in AKI. The results of this pilot study form the basis for a clinical trial testing the usefulness of this technique for guiding lung congestion treatment in patients with AKI.

摘要

引言: 肺淤血和肺水肿是急性肾损伤 (AKI) 的公认并发症,早期发现和监测肺淤血可能有助于 AKI 患者的临床管理。 方法: 我们比较了 39 例 AKI 住院患者的标准化临床标准 (包括肺裂纹和外周水肿分级) 和同期胸部超声 (US),以检测肺淤血。 结果: 在基线时,根据临床标准,12 例患者 (31%) 临床血容量正常,12 例出现明显的心血管充血 (31%)。15 例 (38%) 为低血容量。心血管充血患者 US-B 线的中位数 (50,四分位距 27-99) 远高于正常血容量 (14,IQR 11-37) 和低血容量患者 (7,IQR 3-16,p <0.001)。值得注意的是,相当一部分无症状的正常血容量 (66%) 和低血容量 (46%) 患者存在肺 US 的中度至重度肺充血 (> 15 US-B 线)。随着时间的推移,爆裂声的严重程度和 US-B 线的数量相互关联 (Spearman's ρ = 0.38,p <0.01),但一致 (Cohen k 统计) 两个指标之间不令人满意。8% 的患者因肺部 US 而出现中重度肺充血,这一估计值远远超过临床标准 (32%)。 结论: 这项初步研究表明,胸部超声在 AKI 的临床前阶段有检测肺淤血的潜力。这项初步研究的结果构成了一项临床试验的基础,该试验测试了该技术对指导 AKI 患者肺淤血治疗的有用性。

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