背景:为了根据现有证据和专家共识得出声明(作为意大利镇痛学会肺部超声工作组成员,麻醉,复苏,和重症监护,SIAARTI)关于使用肺部超声来管理入住重症监护病房的COVID-19患者。
方法:一组麻醉师和重症监护医师在COVID-19重症危重患者中使用肺部超声的专家采用了改良的德尔菲法,就十个临床问题达成共识,涉及肺部超声在以下方面的作用:COVID-19诊断和监测(有或没有有创机械通气),呼气末正压滴定,使用俯卧位,气胸或呼吸机相关性肺炎的早期诊断,有创机械通气的撤机过程,以及放射胸部成像的需要。
结果:专家组总共发表了20份声明。在第一轮投票中,20份声明中有18份达成了协议(得分为7-9;“适当”),而2份声明需要第二轮才能达成协议。在两次德尔福回合结束时,20份陈述的中位数为8.5[IQR8.9],协议百分比是100%。
结论:意大利镇痛学会肺部超声工作组,麻醉,复苏,和重症监护就入住ICU的COVID-19患者使用肺部超声发表了20项共识声明。这一专家共识强烈建议在危重COVID-19患者的临床治疗中整合肺部超声检查结果。
BACKGROUND: To produce statements based on the available evidence and an expert
consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit.
METHODS: A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a
consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging.
RESULTS: A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7-9; \"appropriate\") in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%.
CONCLUSIONS: The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20
consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert
consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.