JoVE Logo
Faculty Resource Center

Sign In

Summary

Abstract

Introduction

Protocol

Representative Results

Discussion

Acknowledgements

Materials

References

Medicine

成人床旁肺部超声:图像采集

Published: March 3rd, 2023

DOI:

10.3791/64722

1Department of Anesthesiology, Duke University School of Medicine, 2Department of Anesthesiology, Massachusetts General Hospital, 3Department of Surgery, Duke University School of Medicine, Duke University Health System, 4Department of Anesthesiology, Durham VA

肺部的即时超声(POCUS)可在快速变化的临床场景中提供快速答案。我们提出了一种用于急性护理环境的图像采集的高效且信息丰富的方案。

放射科医生进行的咨询超声传统上不用于肺部成像,因为肺部充满空气的性质通常会阻止肺实质的直接可视化。当显示肺实质时,超声通常会产生许多非解剖伪影。然而,在过去的几十年里,诊断即时超声(POCUS)从业者对这些伪影进行了研究,他们已经确定了在缩小心肺功能障碍鉴别诊断方面有价值的发现。例如,在出现呼吸困难的患者中,肺 POCUS 在诊断气胸、肺水肿、肺实变和胸腔积液方面优于胸部 X 线检查 (CXR)。尽管肺POCUS具有已知的诊断价值,但其在临床医学中的使用仍然存在差异,部分原因是医院对这种方式的培训仍然不一致。为了解决这一教育差距,本叙述性综述描述了成人的肺部POCUS图像采集,包括患者定位、换能器选择、探头放置、采集序列和图像优化。

在过去的几十年里,床边决策和治疗越来越多地通过即时超声(POCUS)得到加强。POCUS是由患者的主要治疗提供者使用超声波进行诊断或程序指导。这与咨询超声相反,在咨询超声中,超声检查由患者的主要治疗提供者要求,但由单独的专家团队进行1

本叙述性综述侧重于特定器官系统的诊断性POCUS:肺。肺部诊断性POCUS已被证明在急性护理环境中是有用的,可以在呼吸衰竭、休克、创伤、胸痛和其他情况下诊断可能危及生命的疾病2。此外,程序性肺POCUS用于引导经皮胸腔穿刺术3 和肺复张操作4中的针头放置。然而,尽管具有临床意义,但医生的肺部POCUS熟练程度是变量5,限制了这种方式的适当使用。本综述的目的是描述一种用于成人诊断性肺部POCUS的省时但全面的图像采集方案,并说明临床实践中常见的异常发现。本文描述的方法不适用于新生儿和小婴儿。有关该特定年龄组的肺POCUS成像技术和解释的信息,请读者参考特定文献67

文献中描述了多种成像方案,从 4 点到 28 点不等,具体取决于可用时....

Log in or to access full content. Learn more about your institution’s access to JoVE content here

在涉及人类参与者的研究中执行的所有程序均符合机构和/或国家研究委员会的道德标准以及1964年赫尔辛基宣言及其后来的修正案或类似的伦理标准。

1. 仪器设置和探头选择

注意:肺POCUS可以使用多个换能器进行,具体取决于需要回答的问题。

  1. 浅表肺部检查
    1. 为了评估具有浅表表现的异常(例如气胸或胸膜线异常),使用线性高?.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

肺部超声检查结果正常(视频 1、视频 2、视频 3、视频 4、视频 5、视频 6 和补充文件 1)
由于肺部空气与浅表组织之间的声阻抗存在明显差异,通常到达壁胸膜和内脏胸膜界面的所有超声能量都会立即反射回超声换能器。结果,在肺实质的深度,在超声机屏幕上看到的图像通常显示非解剖伪影:超声屏幕上的位置与体内该水平的解剖结构不对应的伪影16

Log in or to access full content. Learn more about your institution’s access to JoVE content here

诊断性POCUS是患者的主要治疗提供者在床边使用超声波来回答临床问题。最适合诊断性POCUS的问题是什么,本质上是定性的或二元的,需要比咨询超声服务更快地回答。

几个步骤对于图像采集至关重要。第一个是探针选择。作者建议使用扇形探针进行初步评估。这种类型的探头可以在大多数超声机器中轻松找到,它适用于浅层和深层结构的可视化,并且占地面积小,可以在肋?.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

没有。

....

Log in or to access full content. Learn more about your institution’s access to JoVE content here

NameCompanyCatalog NumberComments
Edge 1 ultrasound machineSonoSiten/aUsed to obtain two of the abnormal images/clips (Figures 11 and 12)
Affiniti ultrasound machinePhilipsn/aUsed to obtain all normal and all abnormal images/clips except for Figures 11 and 12

  1. Bronshteyn, Y. S., Blitz, J., Hashmi, N., Krishnan, S. Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing. International Anesthesiology Clinics. 60 (3), 1-7 (2022).
  2. Lichtenstein, D. A. Lung ultrasound in the critically ill. Annals of Intensive Care. 4 (1), (2014).
  3. Helgeson, S. A., Fritz, A. V., Tatari, M. M., Daniels, C. E., Diaz-Gomez, J. L. Reducing iatrogenic pneumothoraces: Using real-time ultrasound guidance for pleural procedures. Critical Care Medicine. 47 (7), 903-909 (2019).
  4. Tusman, G., Acosta, C. M., Costantini, M. Ultrasonography for the assessment of lung recruitment maneuvers. Critical Ultrasound Journal. 8 (1), (2016).
  5. McGinness, A., Lin-Martore, M., Addo, N., Shaahinfar, A. The unmet demand for point-of-care ultrasound among general pediatricians: A cross-sectional survey. BMC Medical Education. 22 (1), (2022).
  6. Liu, J., et al. Protocol and guidelines for point-of-care lung ultrasound in diagnosing neonatal pulmonary diseases based on international expert consensus. Journal of Visualized Experiments. (145), e58990 (2019).
  7. Liu, J., et al. Specification and guideline for technical aspects and scanning parameter settings of neonatal lung ultrasound examination. The Journal of Maternal-Fetal & Neonatal Medicine. 35 (5), 1003-1016 (2022).
  8. Volpicelli, G., et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Medicine. 38 (4), 577-591 (2012).
  9. Fox, W. C., Krishnamoorthy, V., Hashmi, N., Bronshteyn, Y. S. Pneumonia: Hiding in plain (film) sight. Journal of Cardiothoracic and Vascular Anesthesia. 34 (11), 3154-3157 (2020).
  10. Kok, B., et al. Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): A multicentre, observational study at the emergency department. BMJ Open. 11 (9), 048795 (2021).
  11. Kiamanesh, O., et al. Lung ultrasound for cardiologists in the time of COVID-19. The Canadian Journal of Cardiology. 36 (7), 1144-1147 (2020).
  12. Picano, E., Scali, M. C., Ciampi, Q., Lichtenstein, D. Lung ultrasound for the cardiologist. JACC. Cardiovascular Imaging. 11 (11), 1692-1705 (2018).
  13. Kisslo, J., vonRamm, O. T., Thurstone, F. L. Cardiac imaging using a phased array ultrasound system. II. Clinical technique and application. Circulation. 53 (2), 262-267 (1976).
  14. vonRamm, O. T., Thurstone, F. L. Cardiac imaging using a phased array ultrasound system. I. System design. Circulation. 53 (2), 258-262 (1976).
  15. . Count backwards from 10 Available from: https://www.countbackwardsfrom10.com (2023)
  16. Mojoli, F., Bouhemad, B., Mongodi, S., Lichtenstein, D. Lung ultrasound for critically ill patients. American Journal of Respiratory and Critical Care Medicine. 199 (6), 701-714 (2019).
  17. Volpicelli, G. Lung ultrasound B-lines in interstitial lung disease: moving from diagnosis to prognostic stratification. Chest. 158 (4), 1323-1324 (2020).
  18. Retief, J., Chopra, M. Pitfalls in the ultrasonographic diagnosis of pneumothorax. Journal of the Intensive Care Society. 18 (2), 143-145 (2017).
  19. Lichtenstein, D., Meziere, G., Biderman, P., Gepner, A. The comet-tail artifact: An ultrasound sign ruling out pneumothorax. Intensive Care Medicine. 25 (4), 383-388 (1999).
  20. Arbelot, C., et al. Lung ultrasound in emergency and critically ill patients: Number of supervised exams to reach basic competence. Anesthesiology. 132 (4), 899-907 (2020).
  21. Soldati, G., Demi, M. The use of lung ultrasound images for the differential diagnosis of pulmonary and cardiac interstitial pathology. Journal of Ultrasound. 20 (2), 91-96 (2017).
  22. Schrift, D., Barron, K., Arya, R., Choe, C. The use of POCUS to manage ICU patients with COVID-19. Journal of Ultrasound in Medicine. 40 (9), 1749-1761 (2021).
  23. Narasimhan, M., Koenig, S. J., Mayo, P. H. Advanced echocardiography for the critical care physician: part 2. Chest. 145 (1), 135-142 (2014).
  24. Balik, M., et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Medicine. 32 (2), 318 (2006).
  25. Zieleskiewicz, L., et al. Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Medicine. 46 (9), 1707-1713 (2020).
  26. Bronshteyn, Y. S., et al. Diagnostic point-of-care ultrasound: recommendations from an expert panel. Journal of Cardiothoracic and Vascular Anesthesia. 36 (1), 22-29 (2022).

Tags

JoVE 193

This article has been published

Video Coming Soon

JoVE Logo

Privacy

Terms of Use

Policies

Research

Education

ABOUT JoVE

Copyright © 2024 MyJoVE Corporation. All rights reserved