Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK.
Crit Care Med. 2010 Jan;38(1):114-20. doi: 10.1097/CCM.0b013e3181b43050.
Acute lung injury and the acute respiratory distress syndrome are characterized by noncardiogenic pulmonary edema, which can be assessed by measurement of extravascular lung water. Traditionally, extravascular lung water has been indexed to actual body weight (mL/kg). Because lung size is dependent on height rather than weight, we hypothesized indexing to predicted body weight may be a better predictor of mortality in acute lung injury/acute respiratory distress syndrome.
Prospective observational cohort study.
A tertiary referral intensive care unit.
Patients were recruited within 48 hrs of fulfilling the American European Consensus Conference definition of acute lung injury/acute respiratory distress syndrome.
None.
Demographics, severity of illness scores, and respiratory parameters were collected. Extravascular lung water was measured using the PiCCO system. This was indexed to actual and predicted body weight. Statistically significant predictors of mortality identified using single regressor logistic regression and additional variables known to be associated with outcome were entered into a multiple logistic regression analysis. Receiver operator characteristic curves were generated. Forty-four patients were recruited (septic 34%). Using single regressor logistic regression, six variables were statistically significantly related to mortality: Acute Physiology and Chronic Health Evaluation II, PaO2, PaO2/Fio2 ratio, oxygenation index, actual extravascular lung water, and predicted extravascular lung water. In multiple logistic regression analysis, predicted extravascular lung water but not actual extravascular lung water was a predictor of mortality with an odds ratio of 4.3 (95% confidence interval, 1.5-12.9) per sd. Although the area under the curve for predicted extravascular lung water (0.8; confidence interval, 0.65-0.94) was larger than for actual extravascular lung water (0.72; confidence interval, 0.53-0.91), this was not statistically significant (p = .12). A baseline predicted extravascular lung water value of 16 mL/kg predicted intensive care unit mortality with a sensitivity of 0.75 (confidence interval, 0.47-0.91) and specificity of 0.78 (confidence interval, 0.61-0.89).
Early measurement of predicted extravascular lung water is a better predictor than actual extravascular lung water to identify patients at risk for death in acute lung injury/acute respiratory distress syndrome.
急性肺损伤和急性呼吸窘迫综合征的特征是无心源性肺水肿，可以通过测量血管外肺水来评估。传统上，血管外肺水以实际体重（mL/kg）为指标。由于肺的大小取决于身高而不是体重，我们假设以预测体重为指标可能是急性肺损伤/急性呼吸窘迫综合征死亡率的更好预测指标。
前瞻性观察队列研究。
三级转诊重症监护病房。
患者在符合急性肺损伤/急性呼吸窘迫综合征美国欧洲共识会议定义后 48 小时内入组。
无。
收集了人口统计学、疾病严重程度评分和呼吸参数。使用 PiCCO 系统测量血管外肺水。将其与实际体重和预测体重进行了比较。使用单回归逻辑回归识别有统计学意义的死亡率预测指标，并将已知与预后相关的其他变量纳入多逻辑回归分析。生成了接收者操作特征曲线。共招募了 44 名患者（脓毒症 34%）。使用单回归逻辑回归，有六个变量与死亡率有统计学显著关系：急性生理学和慢性健康评估 II、PaO2、PaO2/Fio2 比值、氧合指数、实际血管外肺水和预测血管外肺水。在多逻辑回归分析中，预测血管外肺水而不是实际血管外肺水是死亡率的预测指标，其优势比为每标准差 4.3（95%置信区间，1.5-12.9）。尽管预测血管外肺水的曲线下面积（0.8；置信区间，0.65-0.94）大于实际血管外肺水（0.72；置信区间，0.53-0.91），但差异无统计学意义（p =.12）。预测血管外肺水基线值为 16 mL/kg 可预测重症监护病房死亡率，其敏感性为 0.75（置信区间，0.47-0.91），特异性为 0.78（置信区间，0.61-0.89）。
早期测量预测血管外肺水比实际血管外肺水更能预测急性肺损伤/急性呼吸窘迫综合征患者死亡风险。
