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脓毒症相关急性呼吸窘迫综合征中的血管外肺水:使用预测体重进行指数化可改善与疾病严重程度和生存率的相关性。

Extravascular lung water in sepsis-associated acute respiratory distress syndrome: indexing with predicted body weight improves correlation with severity of illness and survival.

作者信息

Phillips Charles R, Chesnutt Mark S, Smith Stephen M

机构信息

Division of Pulmonary and Critical Care Medicine and Center for Intensive Care Research, Oregon Health and Science University, Portland, OR, USA.

出版信息

Crit Care Med. 2008 Jan;36(1):69-73. doi: 10.1097/01.CCM.0000295314.01232.BE.

Abstract

OBJECTIVES

To determine whether extravascular lung water predicts survival in patients with early acute respiratory distress syndrome, to determine the relationship between extravascular lung water and other markers of lung injury, and to examine if indexing extravascular lung water with predicted body weight (EVLWp) strengthens its discriminative power.

DESIGN

Extravascular lung water and other markers of lung injury were measured prospectively in 19 patients with sepsis-induced acute respiratory distress syndrome for 3 days.

SETTING

The intensive care units of an academic tertiary referral hospital.

MEASUREMENTS AND MAIN RESULTS

Lung injury score, Sequential Organ Failure Assessment score, dead space-tidal volume fraction (Vd/Vt), and EVLWp were all significantly higher on day 1 in nonsurvivors compared with survivors (lung injury score, 2.8 +/- 0.34 vs. 1.9 +/- 0.50; p = .004) (Sequential Organ Failure Assessment score, 13 +/- 3.4 vs. 7.7 +/- 0.8; p = .006) (Vd/Vt, 0.68 +/- 0.07 vs. 0.58 +/- 0.07; p = .009) (EVLWp, 20.6 +/- 4.6 vs. 11.6 +/- 1.9 mL/kg; p = .002). EVLWp correlated with Sequential Organ Failure Assessment score, lung injury score, Vd/Vt, and PaO2/FIO2. The receiver operator characteristic curve analysis indicated that EVLWp, Vd/Vt, and extravascular lung water (p = .0005, .009, and .013, respectively) but not PaO2/FIO2 (p = .311) discriminate between survivors and nonsurvivors. Three-day average EVLWp >16 mL/kg predicted in-hospital mortality with 100% specificity and 86% sensitivity.

CONCLUSIONS

Increased extravascular lung water is a feature of early acute respiratory distress syndrome and predicts survival. Indexing extravascular lung water to predicted body weight, instead of actual body weight, improves the predictive value of extravascular lung water for survival and correlation with markers of disease severity.

摘要

目的

确定血管外肺水是否可预测早期急性呼吸窘迫综合征患者的生存率,确定血管外肺水与其他肺损伤标志物之间的关系,并检验用预测体重对血管外肺水进行指数化(EVLWp)是否能增强其鉴别能力。

设计

对19例脓毒症诱发的急性呼吸窘迫综合征患者进行为期3天的前瞻性血管外肺水及其他肺损伤标志物测量。

地点

一所学术性三级转诊医院的重症监护病房。

测量指标及主要结果

与存活患者相比,非存活患者在第1天的肺损伤评分、序贯器官衰竭评估评分、死腔潮气量分数(Vd/Vt)和EVLWp均显著更高(肺损伤评分,2.8±0.34对1.9±0.50;p = 0.004)(序贯器官衰竭评估评分,13±3.4对7.7±0.8;p = 0.006)(Vd/Vt,0.68±0.07对0.58±0.07;p = 0.009)(EVLWp,20.6±4.6对11.6±1.9 mL/kg;p = 0.002)。EVLWp与序贯器官衰竭评估评分、肺损伤评分、Vd/Vt及PaO2/FIO2相关。受试者工作特征曲线分析表明,EVLWp、Vd/Vt和血管外肺水(分别为p = 0.0005、0.009和0.013)可区分存活者与非存活者,而PaO2/FIO2(p = 0.311)则不能。3天平均EVLWp>16 mL/kg预测院内死亡率的特异性为100%,敏感性为86%。

结论

血管外肺水增加是早期急性呼吸窘迫综合征的一个特征,可预测生存率。用预测体重而非实际体重对血管外肺水进行指数化,可提高血管外肺水对生存率的预测价值及其与疾病严重程度标志物的相关性。

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