Rouby J J, Puybasset L, Cluzel P, Richecoeur J, Lu Q, Grenier P
Réanimation Chirurgicale Pierre Viars, Department of Anesthesiology, Hôpital de la Pitié-Salpetrière, University Pierre et Marie Curie, Paris, France.
Intensive Care Med. 2000 Aug;26(8):1046-56. doi: 10.1007/s001340051317.
(a) To assess whether differences in lung morphology observed in patients with adult respiratory distress syndrome (ARDS) are associated with differences in cardiorespiratory parameters, lung mechanics, and outcome. (b) To propose a new ARDS Severity Score to identify patients with a high mortality risk.
Prospective study over a 53-month period.
Fourteen-bed surgical intensive care unit of a university hospital.
Seventy-one consecutive patients with early ARDS.
Cardiorespiratory parameters were measured using a Swan-Ganz catheter, the pressure-volume (PV) curve was measured using the gross syringe method, and fast spiral computed tomography (CT) was performed. Patients with diffuse attenuations (n = 16) differed from patients with lobar attenuations (n = 26) regarding: (a) mortality rate (75% vs. 42%, p = 0.05), (b) incidence of primary ARDS (82% vs. 50%, p = 0.03), (c) respiratory compliance (47 +/- 12 vs. 64 +/- 16 ml per cmH2O(-1) p = 0.04), and (d) lower inflexion point (8.4 +/- 2.0 vs. 4.6 +/- 2.0 cmH2O, p = 0.001). A third group of patients with patchy attenuations (n = 29) had a mortality rate of 41 %, a respiratory compliance of 56 +/- 18 ml per cmH2O(-1) and a lower inflexion point of 6.3 +/- 2.7 cmH2O. The bedside chest radiograph accurately assessed lung morphology in only 42% of the patients. In contrast to the scores based on the bedside chest radiograph, a new ARDS Severity Score based on CT lung morphology and cardiorespiratory parameters identified a subgroup of patients with a high mortality rate (> or = 60%).
In patients with ARDS, differences in lung morphology are associated with differences in outcome and lung mechanics. A new ARDS Severity Score based on CT lung morphology and cardiorespiratory parameters accurately identified patients with the most severe forms of ARDS and a mortality rate above 60%.
(a)评估成人呼吸窘迫综合征（ARDS）患者肺部形态的差异是否与心肺参数、肺力学及预后的差异相关。(b)提出一种新的ARDS严重程度评分系统以识别高死亡风险患者。
为期53个月的前瞻性研究。
一所大学医院的拥有14张床位的外科重症监护病房。
71例连续的早期ARDS患者。
使用Swan-Ganz导管测量心肺参数，采用粗注射器法测量压力-容积（PV）曲线，并进行快速螺旋计算机断层扫描（CT）。弥漫性肺衰减患者（n = 16）与肺叶性肺衰减患者（n = 26）在以下方面存在差异：(a)死亡率（75%对42%，p = 0.05），(b)原发性ARDS的发生率（82%对50%，p = 0.03），(c)呼吸顺应性（47±12对64±16 ml/cmH₂O⁻¹，p = 0.04），以及(d)低位拐点（8.4±2.0对4.6±2.0 cmH₂O，p = 0.001）。第三组斑片状肺衰减患者（n = 29）的死亡率为41%，呼吸顺应性为56±18 ml/cmH₂O⁻¹，低位拐点为6.3±2.7 cmH₂O。床旁胸部X线片仅在42%的患者中准确评估了肺部形态。与基于床旁胸部X线片的评分不同，一种基于CT肺部形态和心肺参数的新的ARDS严重程度评分系统识别出了一个高死亡率（≥60%）的患者亚组。
在ARDS患者中，肺部形态的差异与预后及肺力学的差异相关。一种基于CT肺部形态和心肺参数的新的ARDS严重程度评分系统准确地识别出了最严重形式的ARDS患者及死亡率高于60%的患者。
