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Medicina

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

Published: April 07, 2023
doi:
10.3791/64931
, , , , , , , ,
1Hemodynamic Consultation and Ultrasound in the Critically Ill Neonate,Hospital Infantil de México Federico Gómez (HIMFG), 2Neonatology Department,HIMFG, 3Neonatal Intensive Care Unit, Hospital de Ginecología y Obstetricia Número 4, Luis Castelazo Ayala,Instituto Mexicano del Seguro Social, 4Head of Intermediate Care,Instituto Nacional de Perinatología, 5Head of the Echocardiography Lab,HIMFG, 6Clinical Investigation Department,HIMFG

Summary

在这里，我们提出了一种方案，可用于新生儿重症监护室和产房，涉及三种情况：心脏骤停，血流动力学恶化或呼吸失代偿。该协议可以使用最先进的超声机器或经济实惠的手持设备执行;图像采集协议非常详细。

Abstract

常规即时超声 （POCUS） 在新生儿重症监护病房 （NICU） 中的使用正在增加，一些中心提倡提供 24 小时设备。2018 年，发布了危及生命急症的超声流程 （SAFE） 方案，该算法允许评估突然失代偿的新生儿，以识别异常收缩力、心包填塞、气胸和胸腔积液。在研究单元（提供新生儿血流动力学和POCUS咨询服务）中，该算法通过包括合并的核心步骤来支持有风险的新生儿，帮助临床医生管理心脏骤停，并添加视图以验证正确的插管。本文提出了一种方案，可用于新生儿重症监护病房（NICU）和产房（DR），涉及三种情况：心脏骤停，血流动力学恶化或呼吸失代偿。

该协议可以使用最先进的超声机器或经济实惠的手持设备执行;图像采集协议经过仔细详细说明。这种方法旨在作为及时诊断危及生命的情况的一般能力进行学习;该方法旨在节省时间，但不能替代多学科团队的全面和标准化的血流动力学和放射学分析，该团队可能不是普遍随叫随到，但需要参与该过程。从2019年1月至2022年7月，我们中心对25名需要修改SAFE方案的患者（2.3%）进行了1，045次血流动力学咨询/POCUS咨询，共进行了19次手术。在五起案件中，训练有素的待命人员解决了危及生命的情况。提供的临床实例表明将该技术纳入危重新生儿护理的重要性。

Introduction

超声波是一种工具，可以在患者的床边立即进行评估，而无需将他们转移到医院的另一个房间或楼层。它可以重复，简单，经济，精确，并且不发射电离辐射。超声越来越多地被急诊医生1、麻醉师2和重症监护医生3 用于在患者床边获得解剖学和功能图像。它是一种实用工具，被一些作者认为是体格检查的第五大支柱，是人类感官的 延伸4（检查，触诊，叩诊，听诊和超声）5。

2018 年，SAFE 协议（用于危及生命的急症的首字母缩略词超声图算法）发布，该协议允许评估突发失代偿（呼吸和/或血流动力学）的新生儿，以识别收缩力、心包积液伴心包填塞 （PCE/CT）、气胸 （PTX） 和胸腔积液 （PE）的改变6.我们单位是三级转诊医院，大多数婴儿需要机械通气和中心导管;在这种情况下，通过评估危重新生儿的合并核心步骤8，调整心脏骤停的辅助7，服用钙和葡萄糖以及添加超声视图以验证插管来修改SAFE方案。自 2017 年以来，新生儿重症监护病房 （NICU） 配备了血流动力学咨询 （HC） 和 POCUS 团队，配备了专用设备。

与成人相比，大多数新生儿心脏骤停病例是由于呼吸系统原因，导致无脉电活动（PEA）或心脏停搏。超声可能是传统复苏技能的宝贵辅助工具，用于评估插管、通气和心率 （HR）9，并排除低血容量、PCE/CT 和张力 PTX。在新生儿复苏期间发现心电图具有误导性，因为一些新生儿可能患有PEA10，11，12。

该方法的总体目标是调整引用的文献，以创建一种超声图算法，该算法可应用于 NICU 和 DR 中，涉及三种情况：心脏骤停、血流动力学恶化或呼吸失代偿。这允许重症监护团队扩大体格检查范围，以提供正确插管的及时诊断，包括 PEA 或心脏停搏、异常收缩力、PCE/CT、PTX 或 PE 的诊断，使用高端超声设备 （HEUE） 或经济实惠的手持设备 （HHD）。该算法改编自 SAFE 协议，既适用于配备 NICU 专用机器的三级护理中心，也适用于配备价格合理的便携式设备的 DR 和二级护理中心。这种方法被设计为一种通用能力，以获得对危及生命的情况的适当诊断;该方法旨在节省时间，但不能替代由多学科团队进行的全面、标准化的血流动力学和放射学分析，后者是必不可少的，但并不总是普遍可用。

图1描述了该方案：一种改进的超声图算法，用于危重新生儿中危及生命的紧急情况。此过程可以使用 HEUE 或 HHD 执行，具体取决于医疗保健中心的资源。在这种方法中，POCUS团队被视为主治团队的佐剂;患者管理，特别是在新生儿复苏期间，应根据最新的国际复苏联络委员会 （ILCOR） 建议13 和当地指南进行，而超声医师作为额外成员提供帮助。

Protocol

该协议得到了该机构人类研究伦理委员会的批准;获取和发布匿名图像已获得书面同意。切勿用传统的操作（例如听诊）代替超声图像（它们可以由不同的操作员同时或交替完成）。危重新生儿的综合核心步骤是一系列快速的支持行动，在POCUS团队评估患者时需要记住这些行动。始终让 POCUS 团队的第二名成员固定气管插管 （ETT）。使扫描适应患者的需求，而不会干扰复苏操作。 <p class="jove_title"…

Representative Results

通过“眼球”检查心脏功能可用于定性评估整体心脏收缩功能。任何对心脏功能受损的怀疑都应进行紧急 HC 和小儿心脏病学检查，以评估先天性心脏病 （CHD）。必须根据病理生理学开始治疗，并且应根据全面的解剖学和功能超声心动图研究27进行整合和修改治疗。如果怀疑导管依赖性 CDH，必须开始使用前列腺素，并安排儿科心脏病会诊。在研究中心，提供儿科心脏病学和新生?…

Discussion

与儿童和成人相比，大多数急性恶化/心脏骤停病例是由于新生儿的呼吸原因。最初的SAFE方案在我们的三级转诊护理新生儿中心进行了修改，因为该单位需要几名留置导管的通气患者。该议定书已根据低收入和中等收入国家使用的不同情景和设备进行了调整。作为一个拥有新生儿血流动力学和POCUS计划的机构，在共和国不同州举办LUS研讨会后，我们注意到需要整合超声以加强新生儿护理。

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Declarações

The authors have nothing to disclose.

Acknowledgements

我们感谢Nadya Yousef博士，Daniele De Luca博士，Francesco Raimondi博士，Javier Rodriguez Fanjul博士，Almudena Alonso-Ojembarrena博士，Shazia Bhombal博士，Patrick McNamara博士，Amish Jain博士，Ashraf Kharrat博士，新生儿血流动力学研究中心，Yasser Elsayed博士，Muzafar Gani博士和POCUSNEO小组的支持和反馈。

Materials

Conductivity gel Ultra/Phonic, Pharmaceutical innovations, New Jersey, United States 36-1001-25
Handheld linear probe, 10.0 MHz Konted, Beijing, China C10L handheld device
 Hockey stick probe 8–18 MHz, L8-18I-SC Probe GE Medical Systems, Milwaukee, WI, United States H40452LZ high-end ultrasound equipment
iPad Air 2 Apple Inc MGWM2CL/A electronic tablet
Phased array probe 6-12 MHz, 12S-D Phased Array Probe GE Medical Systems, Milwaukee, WI, United States H45021RT high-end ultrasound equipment
Vivid E90 v203 Console Package GE Medical Systems, Milwaukee, WI, United States H8018EB Vivid E90 w/OLED monitor v203 Console
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Tags

Sonographic AssessmentLife-threatening EmergenciesNeonatal Intensive Care UnitNewbornUltrasoundAirway ManagementOxygen AdministrationCardiopulmonary MonitoringLinear Array ProbeThyroidEndotracheal TubeLung UltrasoundPleural SlidingParenchymal SignsLung PulsePhased Array ProbeCardiac UltrasoundLiverRight AtriumSubcostal Long Axis

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Ibarra-Ríos, D., Serpa-Maldonado, E. V., Mantilla-Uresti, J. G., Guillén-Torres, R., Aguilar-Martínez, N., Sánchez-Cruz, A., Morales-Barquet, D. A., Becerra-Becerra, R., Márquez-González, H. A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn. J. Vis. Exp. (194), e64931, doi:10.3791/64931 (2023).
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