OBJECTIVES: 

To determine the diagnostic accuracy of lung ultrasound signs for both the diagnosis of interstitial syndrome and for the discrimination of noncardiogenic interstitial syndrome (NCIS) from cardiogenic pulmonary edema (CPE) in a mixed ICU population.

DESIGN: 

A prospective diagnostic accuracy study with derivation and validation cohorts.

SETTING: 

Three academic mixed ICUs in the Netherlands.

PATIENTS: 

Consecutive adult ICU patients that received a lung ultrasound examination.

INTERVENTIONS: 

None.

MEASUREMENTS AND MAIN RESULT: 

The reference standard was the diagnosis of interstitial syndrome (NCIS or CPE) or noninterstitial syndromes (other pulmonary diagnoses and no pulmonary diagnoses) based on full post-hoc clinical chart review except lung ultrasound. The index test was a lung ultrasound examination performed and scored by a researcher blinded to clinical information. A total of 101 patients were included in the derivation and 122 in validation cohort. In the derivation cohort, patients with interstitial syndrome (n = 56) were reliably discriminated from other patients based on the presence of a B-pattern (defined as greater than or equal to 3 B-lines in one frame) with an accuracy of 94.7% (sensitivity, 90.9%; specificity, 91.1%). For discrimination of NCIS (n = 29) from CPE (n = 27), the presence of bilateral pleural line abnormalities (at least two: fragmented, thickened or irregular) had the highest diagnostic accuracy (94.6%; sensitivity, 89.3%; specificity, 100%). A diagnostic algorithm (Bedside Lung Ultrasound for Interstitial Syndrome Hierarchy protocol) using B-pattern and bilateral pleural abnormalities had an accuracy of 0.86 (95% CI, 0.77–0.95) for diagnosis and discrimination of interstitial syndromes. In the validation cohort, which included 122 patients with interstitial syndrome, bilateral pleural line abnormalities discriminated NCIS (n = 98) from CPE (n = 24) with a sensitivity of 31% (95% CI, 21–40%) and a specificity of 100% (95% CI, 86–100%).

CONCLUSIONS: 

Lung ultrasound can diagnose and discriminate interstitial syndromes in ICU patients with moderate-to-good accuracy. Pleural line abnormalities are highly specific for NCIS, but sensitivity is limited.

中文翻译：

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诊断和鉴别 ICU 患者间质综合征的肺部超声征象：两个队列的诊断准确性研究*

目标： 

确定混合 ICU 人群中肺部超声征象对诊断间质综合征和区分非心源性间质综合征 (NCIS) 与心源性肺水肿 (CPE) 的诊断准确性。

设计： 

一项具有推导和验证队列的前瞻性诊断准确性研究。

环境： 

荷兰的三个学术混合 ICU。

患者： 

接受肺部超声检查的连续成人 ICU 患者。

干预措施： 

没有任何。

测量和主要结果： 

参考标准是间质性综合征（NCIS 或 CPE）或非间质性综合征（其他肺部诊断和非肺部诊断）的诊断，基于除肺超声外的全面事后临床图表审查。指标测试是由对临床信息不知情的研究人员进行的肺部超声检查和评分。共有 101 名患者被纳入推导队列，122 名患者被纳入验证队列。在推导队列中，间质性综合征患者 ( n = 56) 根据是否存在 B 型（定义为一帧中大于或等于 3 条 B 线）可靠地与其他患者区分开来，准确率为 94.7 %（灵敏度，90.9%；特异性，91.1%）。用于区分 NCIS ( n = 29) 与 CPE ( n= 27)，双侧胸膜线异常（至少两个：碎片化、增厚或不规则）的存在具有最高的诊断准确性（94.6%；敏感性，89.3%；特异性，100%）。使用 B 型和双侧胸膜异常的诊断算法（用于间质性综合征层次结构的床边肺部超声诊断和鉴别间质性综合征的准确度为 0.86（95% CI，0.77–0.95）。在包括 122 名间质综合征患者的验证队列中，双侧胸膜线异常区分 NCIS ( n = 98) 和 CPE ( n = 24)，敏感性为 31% (95% CI, 21–40%)，特异性100%（95% CI，86–100%）。

结论： 

肺部超声可以诊断和区分 ICU 患者的间质综合征，准确性中等至良好。胸膜线异常对 NCIS 具有高度特异性，但敏感性有限。