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首页> 外文期刊>Anaesthesia and intensive care >Validation of the vascular pedicle width as a diagnostic aid in critically ill patients with pulmonary oedema by novice non-radiology physicians-in-training.
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Validation of the vascular pedicle width as a diagnostic aid in critically ill patients with pulmonary oedema by novice non-radiology physicians-in-training.

机译：初学者接受非放射学培训的医师验证了血管蒂宽度作为重症肺水肿患者诊断的辅助手段。

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Assessing intravascular volume status in the critically ill patient remains a challenge for intensivists, and the accuracy of such estimation based on bedside examination alone is reported to be nearly a coin toss. In this retrospective study we sought to validate a previously recommended chest radiographic vascular pedicle width (VPW) ≥70 mm for identifying cardiogenic pulmonary oedema (CPO). We additionally assessed whether novice physicians-in-training can reliably measure the VPW. The study included intensive care patients with an existing pulmonary artery catheter. Three independent raters performed measurements of VPW from chest radiographs obtained within three hours of pulmonary artery occlusion pressure measurements. In 80 patients enrolled, a VPW cut-off of ≥70 mm had a 55% sensitivity, 88% specificity, 81% positive predictive value, 69% negative predictive value and 73% accuracy for identifying patients with CPO. Receiver operating characteristic curve analysis showed an area under the curve of 0.72 (95% confidence interval 0.61 to 0.84) for VPW in discriminating CPO from non-cardiogenic pulmonary oedema. Kappa statistics for inter-rater reliability showed Kappa=0.41, 0.42 and 0.85 for each pair of the three raters. In conclusion, the previously accepted VPW cut-off of ≥70 mm is reasonably accurate in discriminating CPO from non-cardiogenic pulmonary oedema. VPW can be measured by physicians-in-training with a comparable performance to previous studies utilising expert radiologists.
机译：评估重症患者的血管内容积状态仍然是专科医生的一项挑战，据报道，仅基于床旁检查的这种估计的准确性几乎是掷硬币。在这项回顾性研究中，我们试图验证先前推荐的≥70 mm的胸部X线摄影血管蒂宽度（VPW），以识别心源性肺水肿（CPO）。我们还评估了培训新手医师是否可以可靠地测量VPW。该研究包括具有肺动脉导管的重症监护患者。由三名独立的评估者根据在肺动脉闭塞压力测量后三小时内获得的胸部X光照片进行VPW的测量。在入组的80例患者中，≥70 mm的VPW临界值在鉴别CPO患者中具有55％的敏感性，88％的特异性，81％的阳性预测值，69％的阴性预测值和73％的准确性。受试者工作特征曲线分析显示，在区分CPO和非心源性肺水肿时，VPW的曲线下面积为0.72（95％置信区间0.61至0.84）。评估者之间可靠性的Kapp统计显示，三个评估者中每对Kappa分别为0.41、0.42和0.85。总之，先前公认的≥70 mm的VPW临界值在区分CPO和非心源性肺水肿方面是相当准确的。 VPW可以由接受培训的医师进行测量，其性能与以前使用专家放射线医师的研究相当。

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