Mutz N, Neumann M, Hörmann C, Koller W, Putensen C, Putz G, Benzer H
Universitätsklinik für Anaesthesie und Allgemeine Intensivmedizin, Innsbruck.
Anaesthesist. 1990 Oct;39(10):535-9.
In patients with multiple injuries, the development of permeability edema can be assumed. However, no uniform shape of this fluid accumulation can be found even in the presence of severe injuries. Based on the first clinical observations, our aim was to search for correlations between the development of extravascular lung water (EVLW) and the individual injury pattern in severely traumatized ICU patients. PATIENTS and METHODS. Our investigations were performed in 48 artificially ventilated ICU patients. According to the prevailing injury pattern patients were divided into three groups: group A: 18 patients (mean age: 32 years, mean Injury Severity Score (ISS) = 29) with isolated thoracic trauma; group B: 10 patients (mean age: 27 years, mean ISS = 42) with severe multiple trauma but without any thoracic injury; group C: 20 patients (mean age: 33 years, mean ISS = 43) with severe multiple trauma and concomitant thoracic trauma. In all patients (group A, B, C), EVLW was determined by means of a double indicator method on a daily basis from the patient's admission to the ICU (day of trauma) until day 10. Additionally, the hemodynamic parameters (heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and cardiac index) were determined at the same time. RESULTS. As shown in Fig 1, EVLW was slightly elevated on day 1. However, on day 2 EVLW decreased within normal values and remained in that range until the end of the observation period. On day 3 a slight and fleeting increase of EVLW, but within normal range, can be seen. In group B (Fig.2), EVLW can be observed within normal range within a period of 4 days. Starting from day 5 until day 7 a marked increase (p greater than 0.01) in EVLW can be seen. From that maximum point EVLW development reverses slightly until day 10--however, without returning to the normal range. In group C, a marked biphasic pattern can be seen due to EVLW maximum values on post-traumatic days 3 and 7. However, in this group the EVLW was in the pathological range during the whole observation period. No statistically significant differences could be seen, when looking at hemodynamic variables. CONCLUSION. Isolated thoracic trauma will not lead to a marked pathological elevation of EVLW within the lungs. Moreover, EVLW decreases rapidly within a short time period. Based on our results, it seems that severe extrathoracic injuries will intensify microvascular injury in the initial period, as shown in our patients in group C. Increase of EVLW at a later time (day 7), as observed in groups B and C, is possibly the expression of a mediator and activator-induced "septiformal" injury of the microvascular endothelium. This may be caused by the underlying massive peripheral soft-tissue trauma. Specific elevations of EVLW subsequent to the individual injury pattern can indicate that that process has begun and is responsible for the origin of the microvascular injuries.
对于多发伤患者，可以推测会发生通透性水肿。然而，即使存在严重损伤，也无法发现这种液体蓄积的统一形态。基于最初的临床观察，我们的目的是寻找重症创伤ICU患者血管外肺水（EVLW）的发展与个体损伤模式之间的相关性。患者与方法。我们对48例接受人工通气的ICU患者进行了研究。根据主要损伤模式，将患者分为三组：A组：18例（平均年龄：32岁，平均损伤严重度评分（ISS）=29），为单纯胸部创伤；B组：10例（平均年龄：27岁，平均ISS=42），为严重多发伤但无任何胸部损伤；C组：20例（平均年龄：33岁，平均ISS=43），为严重多发伤并伴有胸部创伤。在所有患者（A、B、C组）中，从患者入住ICU（创伤日）至第10天，每天通过双指示剂法测定EVLW。此外，同时测定血流动力学参数（心率、平均动脉压、平均肺动脉压、肺毛细血管楔压和心脏指数）。结果。如图1所示，第1天EVLW略有升高。然而，第2天EVLW降至正常范围内，并在观察期结束前一直保持在该范围内。第3天可见EVLW有轻微且短暂的升高，但仍在正常范围内。在B组（图2）中，4天内EVLW可在正常范围内观察到。从第5天开始至第7天，可见EVLW显著升高（p>0.01）。从该最高点开始，EVLW的发展在第
