医学
氧合指数
吸入氧分数
平均气道压
充氧
持续气道正压
胎龄
呼吸窘迫
麻醉
支气管肺发育不良
重症监护
新生儿重症监护室
肺
动脉血
重症监护室
机械通风
内科学
重症监护医学
怀孕
儿科
阻塞性睡眠呼吸暂停
生物
遗传学
作者
Roselyne Brat,Nadya Yousef,Olivia Boyer,Stéphanie Reynaud,Shivani Shankar Aguilera,Danièle De Luca
出处
期刊:JAMA Pediatrics
[American Medical Association]
日期:2015-08-03
卷期号:169 (8): e151797-e151797
被引量:335
标识
DOI:10.1001/jamapediatrics.2015.1797
摘要
Importance
Lung ultrasonography (LUS) is a bedside technique useful to diagnose neonatal respiratory problems, but, to our knowledge, no data are available about its use for monitoring lung function or eventually guiding surfactant therapy. Objective
To determine the diagnostic accuracy of a neonatal-adapted LUS score to evaluate oxygenation and predict need for surfactant administration. Design, Setting, and Participants
Prospective diagnostic accuracy study following STARD (Standards for the Reporting of Diagnostic Accuracy Studies) guidelines at a tertiary level academic neonatal intensive care unit in 2014. All neonates admitted to the neonatal intensive care unit with signs of respiratory distress were eligible, and 130 neonates were enrolled. The LUS score was calculated in the first hours of life under continuous positive airway pressure. The transcutaneous partial pressure of oxygen (Ptco2) to fraction of inspired oxygen (Fio2) ratio, alveolar-arterial gradient, oxygenation index, and arterial to alveolar ratio were calculated within 30 minutes from LUS, using transcutaneous blood gas monitoring. Surfactant was administered according to 2013 European guidelines. Main Outcomes and Measures
Correlation between LUS score and indices of oxygenation and prediction of surfactant administration. Results
Among the 130 neonates in this study, the LUS score was significantly correlated with all indices of oxygenation, independent from gestational age (GA) (Ptco2to Fio2ratio: GA ≥34 weeks: ρ = −0.57; GA <34 weeks: ρ = −0.62;P < .001; alveolar-arterial gradient: GA ≥34 weeks: ρ = 0.62; GA <34 weeks: ρ = 0.59;P < .001; oxygenation index: GA ≥34 weeks: ρ = 0.63; GA <34 weeks: ρ = 0.69;P < .001; and arterial to alveolar ratio: GA ≥34 weeks: ρ = −0.60; GA <34 weeks: ρ = −0.56;P < .001). The LUS score predicted the need for surfactant better in preterm babies with a GA less than 34 weeks (area under the curve = 0.93; 95% CI, 0.86-0.99;P < .001) than in term and late-preterm neonates with a GA of 34 weeks or greater (area under the curve = 0.71; 95% CI, 0.54-0.90;P = .02); the areas under the curve for these 2 GA subgroups are significantly different (P = .02). In babies with a GA less than 34 weeks, a LUS score cutoff of 4 predicted surfactant administration with 100% sensitivity and 61% specificity, yielding a posttest probability of 72%. Conclusions and Relevance
The LUS score is well correlated with oxygenation status in both term and preterm neonates, and it shows good reliability to predict surfactant administration in preterm babies with a GA less than 34 weeks under continuous positive airway pressure.
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