北协和重症超声培训：b超.docVIP

2011 SMART CONFERENCE May 27th, 2011 – Milan, Italy pleural New international guidelines on and lung ultrasound (PLUS conference) How they will change clinical practice The PNEUMOTHORAX Enrico Storti, MD USCME Global Education Chair, Winfocus BOD Chair, Winfocus Critical Ultrasound Director, ICU, Niguarda Ca’ Granda Hospital, Milan Italy Henry Ford Hospital Ultrasound University Board, Detroit - MI, USA Thanks to: Daniel Lichtenstein Gabriele Via Luca Neri ILC on Lung US – 2011 Statements Which kind of air is there beyond the pleura ? TISSUE-AIR INTERFACE lung Collapsed lung Normal Lung PNEUMOTHORAX ABSENCE OF THE LUNG BENEATH THE PLEURA (in the explored area) ? Absence of moving artifacts ? Absence of pathological artifacts arising from pleural-lung interface ? Presence of signs of transition to normal tissue-air interface (in more depending regions) PNEUMOTHORAX Normal Pattern M-MODE: the “STRATOSPHERE SIGN” Lichtenstein DA. AM J RESP CRIT CARE MED 1997. 1. 2. PLEURAL SLIDING (2D, M-Mode) B LINES (A lines alone) EXCLUSION CRITERIA 3. The “ LUNG POINT ”: I . inspiratory-syncronized change from pneumothorax pattern (no lung sliding, no B lines) to lung patterns (lung sliding and/or B lines) at a critical location on the chest wall; II. return to pneumothorax pattern at expiration CONFIRMATION CRITERION The “Lung Point” EXPIRATION INSPIRATION collapsed lung ? All or nothing pattern (whether the lung is in contact or not with chest wall) ? The more anterior, the smaller the pneumothorax (absent in complete pneumothorax) Adapted from: Lichtenstein DA. INT CARE MED 2000. Loculated Pneumothorax in Severe Late ARDS (RF. 39 yy) ANT VI Intercostal Space LONGITUDINAL SCAN LAT VI Intercostal Space Mapping PTX Extension “80% agreement on the retroparietal extension of the PTX between CT lung scan and lung US” (mean difference of 1.9 cm, range 0-4.5) Soldati G et al. CHEST 2008. Ultrasound - Aided PTX Drainage Pneumothorax in Thoracic Trauma (BS. 71 yy) ANT IV Intercostal