Name: point-of-care lung ultrasound in adults: image acquisition
Uploaded: 2023-03-03T14:45:00
Description: Watch this Scientific Journal Video about Point-of-Care Lung Ultrasound in Adults: Image Acquisition at JoVE.com

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。
<ol><li>浅表肺部检查<ol><li>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?...

<ol>
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Count backwards from 10 Available from: <a target="_blank" href="https://www.countbackwardsfrom10.com">https://www.countbackwardsfrom10.com</a> (2023)</li><li>Mojoli, F., Bouhemad, B., Mongodi, S., Lichtenstein, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+ultrasound+for+critically+ill+patients.">Lung ultrasound for critically ill patients.</a> American Journal of Respiratory and Critical Care Medicine. 199 (6), 701-714 (2019).</li><li>Volpicelli, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+ultrasound+B-lines+in+interstitial+lung+disease:+moving+from+diagnosis+to+prognostic+stratification.">Lung ultrasound B-lines in interstitial lung disease: moving from diagnosis to prognostic stratification.</a> Chest. 158 (4), 1323-1324 (2020).</li><li>Retief, J., Chopra, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pitfalls+in+the+ultrasonographic+diagnosis+of+pneumothorax.">Pitfalls in the ultrasonographic diagnosis of pneumothorax.</a> Journal of the Intensive Care Society. 18 (2), 143-145 (2017).</li><li>Lichtenstein, D., Meziere, G., Biderman, P., Gepner, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+comet-tail+artifact:+An+ultrasound+sign+ruling+out+pneumothorax.">The comet-tail artifact: An ultrasound sign ruling out pneumothorax.</a> Intensive Care Medicine. 25 (4), 383-388 (1999).</li><li>Arbelot, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+ultrasound+in+emergency+and+critically+ill+patients:+Number+of+supervised+exams+to+reach+basic+competence.">Lung ultrasound in emergency and critically ill patients: Number of supervised exams to reach basic competence.</a> Anesthesiology. 132 (4), 899-907 (2020).</li><li>Soldati, G., Demi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+lung+ultrasound+images+for+the+differential+diagnosis+of+pulmonary+and+cardiac+interstitial+pathology.">The use of lung ultrasound images for the differential diagnosis of pulmonary and cardiac interstitial pathology.</a> Journal of Ultrasound. 20 (2), 91-96 (2017).</li><li>Schrift, D., Barron, K., Arya, R., Choe, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+POCUS+to+manage+ICU+patients+with+COVID-19.">The use of POCUS to manage ICU patients with COVID-19.</a> Journal of Ultrasound in Medicine. 40 (9), 1749-1761 (2021).</li><li>Narasimhan, M., Koenig, S. J., Mayo, P. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advanced+echocardiography+for+the+critical+care+physician:+part+2.">Advanced echocardiography for the critical care physician: part 2.</a> Chest. 145 (1), 135-142 (2014).</li><li>Balik, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+estimation+of+volume+of+pleural+fluid+in+mechanically+ventilated+patients.">Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients.</a> Intensive Care Medicine. 32 (2), 318 (2006).</li><li>Zieleskiewicz, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+study+of+lung+ultrasound+and+chest+computed+tomography+scan+in+the+assessment+of+severity+of+confirmed+COVID-19+pneumonia.">Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia.</a> Intensive Care Medicine. 46 (9), 1707-1713 (2020).</li><li>Bronshteyn, Y. 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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?...

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6，7。
文献中描述了多种成像方案，从 4 点到 28 点不等，具体取决于可用时间以及考试试图回答的问题8.虽然当扫描更多点时，某些病理的诊断准确性可能会更高，但集中的六点协议在效率和诊断准确性之间提供了合理的权衡2，9，10，11，12。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Edge 1 ultrasound machine</td>
			<td>SonoSite</td>
			<td>n/a</td>
			<td>Used to obtain two of the abnormal images/clips (Figures 11 and 12)</td>
		</tr>
		<tr>
			<td>Affiniti ultrasound machine</td>
			<td>Philips</td>
			<td>n/a</td>
			<td>Used to obtain all normal and all abnormal images/clips except for Figures 11 and 12</td>
		</tr>
	</tbody>
</table>

point-of-care lung ultrasound in adults: image acquisition

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。

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。
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Watch this Scientific Journal Video about Point-of-Care Lung Ultrasound in Adults: Image Acquisition at JoVE.com

Point-of-Care Lung Ultrasound in Adults: Image Acquisition

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。

成人床旁肺部超声：图像采集

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally ...

该方案是一种简单但高收益的肺部超声图像采集方法，可评估每个半胸的三个区域以筛查复数和肺部病变。与完全省略后肺区的较短方案或耗时的较长方案相比，该技术有效地对肺的五个肺叶中的每一个进行采样。整个方案可以由繁忙的急性护理提供者在不到五分钟的时间内完成。首先，使用线性高频探头进行肺部POCUS。使用低频超声探头评估内脏胸膜和壁胸膜界面以外的任何深度。要预设机器，请选择腹部，选择不同的深度，然后选择禁用谐波成像，然后选择屏幕左侧的指示器。在称为亮度模式的二维灰度模式下执行大部分研究。在患者坐起或仰卧的情况下进行研究。将每个半胸分为三个区域，反映肺部的解剖分割。在左胸，将舌头视为右中叶的左侧类似物。将超声凝胶涂在换能器上。通过将探头放在锁骨中线第一至第三肋间隙来扫描右半胸。将探头定位在矢状旁方向，指示标记指向颅骨。现在，单击轴“并将轴居中在复数线上，以便在图像的边缘上可以看到颅骨和肋骨阴影。如果主导图案是具有大于或等于两条 B 线的 A 线，请减小深度，以便仅显示一条 A 线。如果有三条或更多 B 线，请增加深度，直到至少两条 A 线可见。接下来，选择总增益并调整增益，直到复数线和A线可见为明显的回波线，复数线和A线之间的空间为低回波线。然后，单击获取。要观察右中叶，请将探头放在第四至第五肋间隙的腋窝前线。将探头放置在矢状旁和冠状方向之间的中间，指示标记指向颅骨。如前所述设置轴、深度和总增益，然后单击获取。要对右下叶进行成像，请将探头放在腋窝中至后线，即第五至第七肋间隙。将探头放置在冠状平面上，指示标记指向颅骨。现在，单击轴并将轴居中放在隔膜上，以便同时可见子振膜和超振膜结构。单击深度“并增加深度，直到可见膈下脊柱。点击总增益“并增加增益，直到肝脏或脾脏出现轻微的超回声。接下来，扫描左血胸，并通过将探头放置在第一至第三肋间隙的锁骨中线来对左上叶成像。将探头定位在矢状旁方向，指示标记指向颅骨。如前所示设置轴、深度和整体增益并获取图像。要观察左上叶的舌骨，请将探头放在第四至第五肋间隙的腋窝前线。将探头放置在矢状旁和冠状方向之间的中间，指示标记指向颅骨。设置轴、深度和总增益，如图所示，同时对右上瓣进行成像并获取图像。类似地，通过将探头放置在第五至第七肋间隙的中至后腋线，并将探头定位在冠状平面上，指示标记指向颅骨，从而可视化左下叶。同样，设置轴、深度和整体增益，如右下瓣成像时所示并获取图像。B 型夹片显示与气胸一致的静态复数线。但是，M 模式跟踪显示被海滨模式间歇性中断的条形码。当尝试使用 M 模式筛查气胸时，通常会发生这种情况。当存在气胸时，M 型表现通常比 B 型表现更模糊。线性高频换能器显示 L1 视图，肺滑动正常，可能出现 B 线，R2 视图显示无以下任何一种情况。无肺滑动，无肺脉搏，无B线。缺乏这三项发现高度提示气胸。唯一被认为对气胸具有特异性的发现是肺穴位。肺点是指肺滑动进入，然后完全从静止的复数线退缩。静态复数线表示气胸的位置。每个肋间隙有一到两条细 B 线被认为在法线范围内。然而，三条或更多 B 线，或占据大部分间隙的大汇合 B 线被认为是病理性的。可见壁胸膜和内脏胸膜之间的消声间隙或低回声间隙，提示复数积液。在心周骤停情况下获得的患者的 R-3 视图显示异质性多发性积液伴有自由漂浮碎片。这是由于急性出血进入慢性右复数积液，形成右侧血胸。L3 视图显示肺实变碎征和动态支气管充气征的两种体征。切丝征是指在肺实质中间存在一条不规则的高回声线，垂直环下沉伪影从该线传播。动态支气管充气征是巩固中的点状圆形致变区域，在呼吸周期中移动。执行此过程时，调整每个视图非常重要，直到看到关键的预期结构。前视图、斜线、内侧视图的关键结构是复数线和肋骨。对于后侧位视图，关键结构如下：横膈膜、膈下脊柱、肝脏、斜线、脾脏和超膈肌间隙。该方案旨在快速缩小急性肺功能不全的鉴别诊断范围。证明该肺部超声方案合理的肺功能障碍类型包括以下任何一种：呼吸急促、呼吸困难、低氧血症和/或高碳酸血症。

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JoVE Journal

Medicine

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

快速点护理依诺肝素的抗凝血剂功效的测定全血中

There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the ...

科研

医学

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

下肢近端深静脉血栓形成的即时超声筛查

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

Troubleshooting FoCUS Image Acquisition: Patient Positioning, Transducer Manipulation, and Image Optimization

FoCUS 图像采集故障排除：患者定位、换能器操作和图像优化

Focused cardiac ultrasound (FoCUS) is a limited, clinician-performed application of echocardiography to add real-time information to patient care. These ...

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

床旁超声：预测困难气道的超声参数综述

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON ...

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h ...

Imaging the Abdominal Aorta with Point-of-Care Ultrasound

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta

Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta

腹主动脉床旁超声评估方法

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography ...

Gastric Ultrasound Technique for Mitigating Peri-Procedural Aspiration Risk

Gastric Point of Care Ultrasound in Adults: Image Acquisition and Interpretation

Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care (Video) | JoVE

成人胃旁超声：图像采集和解释

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical ...

Quantitative Autofluorescence (QAF) Image Acquisition

Quantitative Autofluorescence (QAF) Image Acquisition (Video) | JoVE 

定量自发荧光 （QAF） 图像采集

Ultrasound in Evaluating Diaphragm Dysfunction and Monitoring Treatment

Measuring Diaphragm Thickness and Function Using Point-of-Care Ultrasound

Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes (Video) | JoVE

使用床旁超声测量隔膜厚度和功能

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes ...