Ye Shunan, Li Qiujie, Yuan Shiying, Shu Huaqing, Yuan Yin
Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).
Department of Anesthesiology, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland).
Med Sci Monit. 2015 Jul 12;21:2008-20. doi: 10.12659/MSM.892734.
Early goal-directed therapy (EGDT) is used to reduce mortality from septic shock and could be used in early fluid resuscitation of acute respiratory distress syndrome (ARDS). The aim of the present study was to assess the effects of restrictive (RFR) and nonrestrictive fluid resuscitation (NRFR) on hemodynamics, oxygenation, pulmonary function, tissue perfusion, and inflammation in piglets with pulmonary or extrapulmonary ARDS (ARDSp and ARDSexp).
Chinese miniature piglets (6-8 weeks; 15 ± 1 kg) were randomly divided into 2 groups (n=12/group) for establishing ARDSp and ARDSexp models, and were further divided into 2 subgroups (n=6/subgroup) for performing RFR and NRFR. Piglets were anesthetized and hemodynamic, pulmonary, and oxygenation indicators were collected at different time points for 6 hours. The goal of EGDT was set for PiCCO parameters (mean arterial pressure (MAP), urine output and cardiac index (CI), and central venous oxygen saturation (ScvO2).
Piglets under RFR had lower urine output compared with NRFR, as well as lower total fluid volume (P<0.05). EVLW was decreased in ARDSp+RFR and NRFR, as well as in ARDSexp+RFR, but EVLW increased in ARDSexp+NRFR (P<0.05). PaO2/FiO2 decreased in ARDSp using both methods, but was higher with RFR (P<0.05), and was increased in ARDSexp+RFR. Other pulmonary indicators were comparable. The anti-inflammatory cytokines IL-10 and LXA4 were increased in ARDSexp after RFR (P<0.05), but not in the other groups.
RFR led to better oxygenation in ARDSp and ARDSexp compared with NRFR, but fluid restriction improved oxygenation in ARDSexp only.
早期目标导向治疗（EGDT）用于降低感染性休克的死亡率，也可用于急性呼吸窘迫综合征（ARDS）的早期液体复苏。本研究旨在评估限制性液体复苏（RFR）和非限制性液体复苏（NRFR）对肺源性或肺外源性ARDS（ARDSp和ARDSexp）仔猪血流动力学、氧合、肺功能、组织灌注及炎症的影响。
中国小型仔猪（6 - 8周龄；体重15±1 kg）随机分为2组（每组n = 12）以建立ARDSp和ARDSexp模型，每组再进一步分为2个亚组（每组n = 6）以进行RFR和NRFR。对仔猪进行麻醉，并在6小时内的不同时间点收集血流动力学、肺和氧合指标。EGDT的目标设定为脉波指示剂连续心输出量监测（PiCCO）参数（平均动脉压（MAP）、尿量、心脏指数（CI）和中心静脉血氧饱和度（ScvO2））。
与NRFR相比，RFR组仔猪尿量更低，总液体量也更低（P < 0.05）。ARDSp + RFR和NRFR组以及ARDSexp + RFR组的血管外肺水（EVLW）均降低，但ARDSexp + NRFR组的EVLW升高（P < 0.05）。两种方法用于ARDSp时动脉血氧分压/吸入氧分数值（PaO2/FiO2）均降低，但RFR时更高（P < 0.05），ARDSexp + RFR组的该指标升高。其他肺指标相当。RFR后ARDSexp组的抗炎细胞因子白细胞介素 - 10（IL - 10）和脂氧素A4（LXA4）升高（P < 0.05），但其他组未升高。
与NRFR相比，RFR使ARDSp和ARDSexp的氧合情况更好，但液体限制仅改善了ARDSexp的氧合。
