AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de Réanimation Médicale, Le Kremlin-Bicêtre, France.
Crit Care Med. 2013 Feb;41(2):472-80. doi: 10.1097/CCM.0b013e31826ab377.
Acute respiratory distress syndrome might be associated with an increase in extravascular lung water index and pulmonary vascular permeability index, which can be measured by transpulmonary thermodilution. We tested whether extravascular lung water index and pulmonary vascular permeability index are independent prognostic factors in patients with acute respiratory distress syndrome.
Retrospective study.
Medical intensive care unit.
Two hundred consecutive acute respiratory distress syndrome patients (age = 57 ± 17, Simplified Acute Physiology Score II = 57 ± 20, overall day-28 mortality = 54%).
Extravascular lung water index and pulmonary vascular permeability index were collected (PiCCO device, Pulsion Medical Systems) at each day of the acute respiratory distress syndrome episode.
The maximum values of extravascular lung water index and pulmonary vascular permeability index recorded during the acute respiratory distress syndrome episode (maximum value of extravascular lung water index and maximum value of pulmonary vascular permeability index, respectively) were significantly higher in nonsurvivors than in survivors at day-28 (mean ± SD: 24 ± 10 mL/kg vs. 19 ± 7 mL/kg of predicted body weight, p < 0.001 [t-test] for maximum value of extravascular lung water index and median [interquartile range]: 4.4 [3.3-6.1] vs. 3.5 [2.8-4.4], p = 0.001 for maximum value of pulmonary vascular permeability index, Wilcoxon's test). In multivariate analyses, maximum value of extravascular lung water index or maximum value of pulmonary vascular permeability index, Simplified Acute Physiology Score II, maximum blood lactate, mean positive end-expiratory pressure, mean cumulative fluid balance, and the minimal ratio of arterial oxygen pressure over the inspired oxygen fraction were all independently associated with day-28 mortality. A maximum value of extravascular lung water index >21 mL/kg predicted day-28 mortality with a sensitivity of (mean [95% confidence interval]) 54% (44-63)% and a specificity of 73% (63-82)%. The mortality rate was 70% in patients with a maximum value of extravascular lung water index >21 mL/kg and 43% in the remaining patients (p = 0.0003). A maximum value of pulmonary vascular permeability index >3.8 predicted day-28 mortality with a sensitivity of (mean [95% confidence interval]) 67% (57-76)% and a specificity of 65% (54-75)%. The mortality rate was 69% in patients with a maximum value of pulmonary vascular permeability index >3.8 and 37% in the group with a maximum value of pulmonary vascular permeability index ≤ 3.8 (p < 0.0001).
Extravascular lung water index and pulmonary vascular permeability index measured by transpulmonary thermodilution are independent risk factors of day-28 mortality in patients with acute respiratory distress syndrome.
急性呼吸窘迫综合征可能与肺血管外水指数和肺血管通透性指数的增加有关，这些指数可通过经肺温度稀释法测量。我们测试了肺血管外水指数和肺血管通透性指数是否为急性呼吸窘迫综合征患者的独立预后因素。
回顾性研究。
医疗重症监护病房。
200 例连续急性呼吸窘迫综合征患者（年龄=57±17，简化急性生理学评分 II = 57±20，整体第 28 天死亡率=54%）。
在急性呼吸窘迫综合征发作期间，每天采集肺血管外水指数和肺血管通透性指数（Pulsion 医疗系统公司的 PiCCO 设备）。
与第 28 天存活者相比，急性呼吸窘迫综合征发作期间记录的肺血管外水指数和肺血管通透性指数的最大值（肺血管外水指数最大值和肺血管通透性指数最大值）在非幸存者中显著更高（平均值±SD：24±10 mL/kg 与 19±7 mL/kg 预测体重，p<0.001[检验]肺血管外水指数最大值，中位数[四分位距]：4.4[3.3-6.1]与 3.5[2.8-4.4]，p=0.001 肺血管通透性指数最大值，Wilcoxon 检验）。在多变量分析中，肺血管外水指数最大值或肺血管通透性指数最大值、简化急性生理学评分 II、最大血乳酸、平均呼气末正压、平均累积液体平衡和动脉氧分压与吸入氧分数的最小比值均与第 28 天死亡率独立相关。肺血管外水指数最大值>21 mL/kg 预测第 28 天死亡率的敏感性为（平均值[95%置信区间]）54%（44%-63%），特异性为 73%（63%-82%）。肺血管外水指数最大值>21 mL/kg 的患者死亡率为 70%，其余患者为 43%（p=0.0003）。肺血管通透性指数最大值>3.8 预测第 28 天死亡率的敏感性为（平均值[95%置信区间]）67%（57%-76%），特异性为 65%（54%-75%）。肺血管通透性指数最大值>3.8 的患者死亡率为 69%，而肺血管通透性指数最大值≤3.8 的患者死亡率为 37%（p<0.0001）。
经肺温度稀释法测量的肺血管外水指数和肺血管通透性指数是急性呼吸窘迫综合征患者第 28 天死亡率的独立危险因素。
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