Department of Intensive Care, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen 6, Belgium.
Ann Intensive Care. 2012 Jul 5;2 Suppl 1(Suppl 1):S15. doi: 10.1186/2110-5820-2-S1-S15.
Achievement of a negative fluid balance in patients with capillary leak is associated with improved outcome. We investigated the effects of a multi-modal restrictive fluid strategy aiming for negative fluid balance in patients with acute lung injury (ALI).
In this retrospective matched case-control study, we included 114 mechanically ventilated (MV) patients with ALI. We compared outcomes between a group of 57 patients receiving PAL-treatment (PAL group) and a matched control group, abstracted from a historical cohort. PAL-treatment combines high levels of positive end-expiratory pressure, small volume resuscitation with hyperoncotic albumin, and fluid removal with furosemide (Lasix®) or ultrafiltration. Effects on extravascular lung water index (EVLWI), intra-abdominal pressure (IAP), organ function, and vasopressor therapy were recorded during 1 week. The primary outcome parameter was 28-day mortality.
At baseline, no significant intergroup differences were found, except for lower PaO2/FIO2 and increased IAP in the PAL group (174.5 ± 84.5 vs 256.5 ± 152.7, p = 0.001; 10.0 ± 4.2 vs 8.0 ± 3.7 mmHg, p = 0.013, respectively). After 1 week, PAL-treated patients had a greater reduction of EVLWI, IAP, and cumulative fluid balance (-4.2 ± 5.6 vs -1.1 ± 3.7 mL/kg, p = 0.006; -0.4 ± 3.6 vs 1.8 ± 3.8 mmHg, p = 0.007; -1,451 ± 7,761 vs 8,027 ± 5,254 mL, p < 0.001). Repercussions on cardiovascular and renal function were limited. PAL-treated patients required fewer days of intensive care unit admission and days on MV (23.6 ± 15 vs 37.1 ± 19.9 days, p = 0.006; 14.6 ± 10.7 vs 25.5 ± 20.2 days, respectively) and had a lower 28-day mortality (28.1% vs 49.1%, p = 0.034).
PAL-treatment in patients with ALI is associated with a negative fluid balance, a reduction of EVLWI and IAP, and improved clinical outcomes without compromising organ function.
在毛细血管渗漏患者中实现负液体平衡与改善结局相关。我们研究了旨在实现急性肺损伤（ALI）患者负液体平衡的多模式限制液体策略的效果。
在这项回顾性匹配病例对照研究中，我们纳入了 114 例接受机械通气（MV）的 ALI 患者。我们比较了接受 PAL 治疗的 57 例患者（PAL 组）和从历史队列中提取的匹配对照组的结局。PAL 治疗结合高水平呼气末正压、小容量复苏与高渗白蛋白、呋塞米（Lasix®）或超滤进行液体清除。在 1 周内记录血管外肺水指数（EVLWI）、腹腔内压（IAP）、器官功能和血管加压剂治疗的效果。主要结局参数为 28 天死亡率。
在基线时，两组间除了 PAL 组的 PaO2/FIO2 更低和 IAP 更高（174.5 ± 84.5 与 256.5 ± 152.7，p = 0.001；10.0 ± 4.2 与 8.0 ± 3.7 mmHg，p = 0.013）外，无显著的组间差异。1 周后，PAL 治疗组的 EVLWI、IAP 和累积液体平衡的降低更显著（-4.2 ± 5.6 与-1.1 ± 3.7 mL/kg，p = 0.006；-0.4 ± 3.6 与 1.8 ± 3.8 mmHg，p = 0.007；-1451 ± 7761 与 8027 ± 5254 mL，p < 0.001）。对心血管和肾功能的影响有限。PAL 治疗组需要入住重症监护病房的天数和 MV 的天数更少（23.6 ± 15 与 37.1 ± 19.9 天，p = 0.006；14.6 ± 10.7 与 25.5 ± 20.2 天，分别），28 天死亡率更低（28.1%与 49.1%，p = 0.034）。
在 ALI 患者中，PAL 治疗与负液体平衡、EVLWI 和 IAP 降低以及改善的临床结局相关，而不影响器官功能。
Zotero 插件
