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 ...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.展开更多
目的探讨改良重症超声快速管理(modified critical care ultrasonic examination,M-CCUE)方案对非计划入ICU患者的评估价值,并分析其是否会影响医疗行为及预后判断。方法回顾性收集并分析2015年12月至2016年6月北京协和医院重症医学科...目的探讨改良重症超声快速管理(modified critical care ultrasonic examination,M-CCUE)方案对非计划入ICU患者的评估价值,并分析其是否会影响医疗行为及预后判断。方法回顾性收集并分析2015年12月至2016年6月北京协和医院重症医学科非计划收治患者的相关临床资料,包括血流动力学指标、器官及组织灌注指标和预后评价指标。所有入选患者在入室30 min内完成初始M-CCUE评估,根据M-CCUE评分系统予以评分(M-CCUE score,MCS)。分析MCS与预后的相关性及对治疗策略的影响。结果共计272例符合入选和排除标准的非计划入ICU患者纳入本研究,其中仅3例(1.1%,3/272)患者在M-CCUE评估方案中未发现异常,139例(51.1%,139/272)因评估结果改变了药物治疗方案,81例(29.8%,81/272)进行了有创检查或治疗。MCS与患者28 d死亡率(r=0.432,P=0.020)、48 h死亡率(r=0.594,P=0.008)、机械通气时间(r=0.454,P=0.040)、ICU住院时间(r=0.563,P=0.003)均呈正相关。多因素回归分析显示,年龄、急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、MCS和序贯性器官衰竭评分(sequential organ failure assessment,SOFA)是28 d死亡的独立危险因素,同时年龄、MCS和SOFA是48 h死亡的独立危险因素。结论 M-CCUE能够实现早期床旁心肺功能评估,其量化评估结果可改进临床治疗方案,预测患者预后。展开更多
文摘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.
文摘目的探讨改良重症超声快速管理(modified critical care ultrasonic examination,M-CCUE)方案对非计划入ICU患者的评估价值,并分析其是否会影响医疗行为及预后判断。方法回顾性收集并分析2015年12月至2016年6月北京协和医院重症医学科非计划收治患者的相关临床资料,包括血流动力学指标、器官及组织灌注指标和预后评价指标。所有入选患者在入室30 min内完成初始M-CCUE评估,根据M-CCUE评分系统予以评分(M-CCUE score,MCS)。分析MCS与预后的相关性及对治疗策略的影响。结果共计272例符合入选和排除标准的非计划入ICU患者纳入本研究,其中仅3例(1.1%,3/272)患者在M-CCUE评估方案中未发现异常,139例(51.1%,139/272)因评估结果改变了药物治疗方案,81例(29.8%,81/272)进行了有创检查或治疗。MCS与患者28 d死亡率(r=0.432,P=0.020)、48 h死亡率(r=0.594,P=0.008)、机械通气时间(r=0.454,P=0.040)、ICU住院时间(r=0.563,P=0.003)均呈正相关。多因素回归分析显示,年龄、急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、MCS和序贯性器官衰竭评分(sequential organ failure assessment,SOFA)是28 d死亡的独立危险因素,同时年龄、MCS和SOFA是48 h死亡的独立危险因素。结论 M-CCUE能够实现早期床旁心肺功能评估,其量化评估结果可改进临床治疗方案,预测患者预后。
