Burnham Ellen L, Hyzy Robert C, Paine Robert, Kelly Aine M, Quint Leslie E, Lynch David, Curran-Everett Douglas, Moss Marc, Standiford Theodore J
From the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
Chest. 2014 Nov;146(5):1196-1204. doi: 10.1378/chest.13-2708.
In ARDS, the extent of fibroproliferative activity on chest high-resolution CT (HRCT) scan has been reported to correlate with poorer short-term outcomes and pulmonary-associated quality of life. However, clinical factors associated with HRCT scan fibroproliferation are incompletely characterized. We questioned if lung compliance assessed at the bedside would be associated with fibroproliferation on HRCT scans obtained during the resolution phase of ARDS.
We used data from a published randomized, controlled clinical trial in ARDS. All patients were cared for using a low tidal volume strategy. Demographic data and ventilator parameters were examined in association with radiologic scores from chest HRCT scans obtained 14 days after diagnosis.
Data from 82 patients with ARDS were analyzed. Average static respiratory compliance over the first 14 days after diagnosis was inversely associated with chest HRCT scan reticulation (ρ = -0.46); this relationship persisted in multivariable analysis including APACHE (Acute Physiology and Chronic Health Evaluation) II scores, initial Pao2/Fio2, pneumonia diagnosis, and ventilator days. Average static respiratory compliance was also lower among patients with bronchiectasis at day 14 (P = .007). Initial static respiratory compliance obtained within the first day after ARDS diagnosis was correlated inversely with the presence of HRCT scan reticulation (ρ = -0.38) and was lower among patients who demonstrated bronchiectasis on the day 14 HRCT scan (P = .008).
In patients with ARDS, diminished lung compliance measured bedside was associated with radiologic fibroproliferation 14 days post diagnosis. Establishing factors that predispose to development of excessive fibroproliferation with subsequent confirmation by chest HRCT scan represents a promising strategy to identify patients with ARDS at risk for poorer clinical outcomes.
在急性呼吸窘迫综合征（ARDS）中，据报道胸部高分辨率CT（HRCT）扫描显示的纤维增生活动程度与较差的短期预后及肺部相关生活质量相关。然而，与HRCT扫描纤维增生相关的临床因素尚未完全明确。我们想知道在床边评估的肺顺应性是否与ARDS缓解期获得的HRCT扫描上的纤维增生有关。
我们使用了一项已发表的ARDS随机对照临床试验的数据。所有患者均采用低潮气量策略进行治疗。将人口统计学数据和呼吸机参数与诊断后14天获得的胸部HRCT扫描的放射学评分相关联进行检查。
分析了82例ARDS患者的数据。诊断后前14天的平均静态呼吸顺应性与胸部HRCT扫描的网状改变呈负相关（ρ = -0.46）；在包括急性生理与慢性健康状况评分系统（APACHE）II评分、初始动脉血氧分压/吸入氧分数值（Pao2/Fio2）、肺炎诊断和机械通气天数的多变量分析中，这种关系仍然存在。在第14天，支气管扩张患者的平均静态呼吸顺应性也较低（P = .007）。ARDS诊断后第一天内获得的初始静态呼吸顺应性与HRCT扫描网状改变的存在呈负相关（ρ = -0.38），并且在第14天HRCT扫描显示支气管扩张的患者中较低（P = .008）。
在ARDS患者中，床边测量的肺顺应性降低与诊断后14天的放射学纤维增生有关。确定易导致过度纤维增生并随后通过胸部HRCT扫描证实的因素，是识别有临床预后较差风险的ARDS患者的一种有前景的策略。
