Kuzkov Vsevolod V, Kirov Mikhail Y, Sovershaev Mikhail A, Kuklin Vladimir N, Suborov Evgeny V, Waerhaug Kristine, Bjertnaes Lars J
Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation.
Crit Care Med. 2006 Jun;34(6):1647-53. doi: 10.1097/01.CCM.0000218817.24208.2E.
To find out if the extravascular lung water index (EVLWI) and the derived permeability indexes determined by the single transpulmonary thermodilution technique are associated with markers of acute lung injury in human septic shock.
Prospective, observational study.
Mixed intensive care unit of a 900-bed university hospital.
Thirty-eight consecutive adult patients with septic shock and acute lung injury.
None.
The variables were assessed over a 72-hr period and included hemodynamics, EVLWI, and pulmonary vascular permeability indexes determined with the single indicator transpulmonary thermodilution technique, lung compliance, oxygenation ratio (Pao2/Fio2), lung injury score, cell counts, and the plasma concentration of endothelin-1. At day 1, EVLWI was elevated (>or=7 mL/kg) in 28 (74%) patients and correlated with lung compliance (r=-.48, p=.002), Pao2/Fio2 (r=-.50, p=.001), lung injury score (r=.46, p=.004), roentgenogram quadrants (r=.39, p=.02), and platelet count (r=-.43, p=.007). At day 3, EVLWI correlated with compliance (r=-.51, p=.002), Pao2/Fio2 (r=-.49, p = .006), and lung injury score (r=.53, p=.003). At day 3, EVLWI and pulmonary vascular permeability indexes were higher in nonsurvivors (p<.05). The plasma concentration of endothelin-1 (mean+/-sd) was significantly higher in patients with elevated EVLWI (>or=7 mL/kg) (3.85+/-1.40 vs. 2.07+/-0.38 pg/mL, respectively). Twenty-two (59%) patients died before day 28.
In human septic shock, EVLWI demonstrated moderate correlation with markers of acute lung injury, such as lung compliance, oxygenation ratio, roentgenogram quadrants, and lung injury score. In nonsurvivors, EVLWI and permeability indexes were significantly increased at day 3. Thus, EVLWI might be of value as an indicator of prognosis and severity of sepsis-induced acute lung injury.
探究血管外肺水指数（EVLWI）以及通过单指示剂经肺热稀释技术测定的衍生通透性指数是否与人类感染性休克中的急性肺损伤标志物相关。
前瞻性观察性研究。
一家拥有900张床位的大学医院的混合重症监护病房。
38例连续性成年感染性休克合并急性肺损伤患者。
无。
在72小时内对各项变量进行评估，包括血流动力学、EVLWI、用单指示剂经肺热稀释技术测定的肺血管通透性指数、肺顺应性、氧合指数（Pao2/Fio2）、肺损伤评分、细胞计数以及内皮素-1的血浆浓度。在第1天，28例（74%）患者的EVLWI升高（≥7 mL/kg），且与肺顺应性（r = -0.48，p = 0.002）、Pao2/Fio2（r = -0.50，p = 0.001）、肺损伤评分（r = 0.46，p = 0.004）、X线胸片象限（r = 0.39，p = 0.02）和血小板计数（r = -0.43，p = 0.007）相关。在第3天，EVLWI与肺顺应性（r = -0.51，p = 0.002）、Pao2/Fio2（r = -0.49，p = 0.006）和肺损伤评分（r = 0.53，p = 0.003）相关。在第3天，非存活者的EVLWI和肺血管通透性指数更高（p < 0.05）。EVLWI升高（≥7 mL/kg）的患者血浆内皮素-1浓度（均值±标准差）显著更高（分别为3.85±1.40与2.07±0.38 pg/mL）。22例（59%）患者在第28天前死亡。
在人类感染性休克中，EVLWI与急性肺损伤标志物如肺顺应性、氧合指数、X线胸片象限和肺损伤评分呈中度相关。在非存活者中，第3天的EVLWI和通透性指数显著升高。因此，EVLWI可能作为脓毒症诱导的急性肺损伤预后和严重程度的一个指标具有价值。
