Department of Intensive Care, Ziekenhuis Netwerk Antwerpen, Campus ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerpen 6, Belgium.
II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
Ann Intensive Care. 2012 Jul 5;2(Suppl 1 Diagnosis and management of intra-abdominal hyperten):S1. doi: 10.1186/2110-5820-2-S1-S1. eCollection 2012.
Capillary leak in critically ill patients leads to interstitial edema. Fluid overload is independently associated with poor prognosis. Bedside measurement of intra-abdominal pressure (IAP), extravascular lung water index (EVLWI), fluid balance, and capillary leak index (CLI) may provide a valuable prognostic tool in mechanically ventilated patients.
We performed an observational study of 123 mechanically ventilated patients with extended hemodynamic monitoring, analyzing process-of-care variables for the first week of ICU admission. The primary outcome parameter was 28-day mortality. ΔmaxEVLWI indicated the maximum difference between EVLWI measurements during ICU stay. Patients with a ΔmaxEVLWI <-2 mL/kg were called 'responders'. CLI was defined as C-reactive protein (milligrams per deciliter) over albumin (grams per liter) ratio and conservative late fluid management (CLFM) as even-to-negative fluid balance on at least two consecutive days.
CLI had a biphasic course. ΔmaxEVLWI was lower if CLFM was achieved and in survivors (-2.4 ± 4.8 vs 1.0 ± 5.5 mL/kg, p = 0.001; -3.3 ± 3.8 vs 2.5 ± 5.3 mL/kg, p = 0.001, respectively). No CLFM achievement was associated with increased CLI and IAPmean on day 3 and higher risk to be nonresponder (odds ratio (OR) 2.76, p = 0.046; OR 1.28, p = 0.011; OR 5.52, p = 0.001, respectively). Responders had more ventilator-free days during the first week (2.5 ± 2.3 vs 1.5 ± 2.3, p = 0.023). Not achieving CLFM and being nonresponder were strong independent predictors of mortality (OR 9.34, p = 0.001 and OR 7.14, p = 0.001, respectively).
There seems to be an important correlation between CLI, EVLWI kinetics, IAP, and fluid balance in mechanically ventilated patients, associated with organ dysfunction and poor prognosis. In this context, we introduce the global increased permeability syndrome.
危重病患者的毛细血管渗漏会导致间质水肿。液体超负荷与预后不良独立相关。床边测量腹腔内压（IAP）、血管外肺水指数（EVLWI）、液体平衡和毛细血管渗漏指数（CLI），可能为机械通气患者提供有价值的预后工具。
我们对 123 例接受扩展血流动力学监测的机械通气患者进行了一项观察性研究，分析了 ICU 入住第一周的治疗过程变量。主要结局参数为 28 天死亡率。ΔmaxEVLWI 表示 ICU 期间 EVLWI 测量的最大差异。ΔmaxEVLWI＜-2 mL/kg 的患者称为“应答者”。CLI 定义为 C 反应蛋白（毫克/分升）与白蛋白（克/升）比值，保守的晚期液体管理（CLFM）为至少连续两天的液体平衡为零或负。
CLI 呈双相性。如果实现 CLFM，ΔmaxEVLWI 较低（-2.4±4.8 与 1.0±5.5 mL/kg，p=0.001；-3.3±3.8 与 2.5±5.3 mL/kg，p=0.001），幸存者也是如此。未实现 CLFM 与第 3 天 CLI 和 IAPmean 增加以及成为非应答者的风险增加相关（比值比（OR）2.76，p=0.046；OR 1.28，p=0.011；OR 5.52，p=0.001）。应答者在第一周内有更多的无呼吸机天数（2.5±2.3 与 1.5±2.3，p=0.023）。未实现 CLFM 和非应答者是死亡率的独立强预测因素（OR 9.34，p=0.001 和 OR 7.14，p=0.001）。
机械通气患者 CLI、EVLWI 动力学、IAP 和液体平衡之间似乎存在重要的相关性，与器官功能障碍和预后不良相关。在这种情况下，我们引入了整体通透性综合征。
