Werner Matthias, Wernly Bernhard, Lichtenauer Michael, Franz Marcus, Kabisch Bjoern, Muessig Johanna M, Masyuk Maryna, Schulze Paul Christian, Hoppe Uta C, Kelm Malte, Lauten Alexander, Jung Christian
Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany.
Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
Wien Klin Wochenschr. 2019 Jul;131(13-14):321-328. doi: 10.1007/s00508-019-1501-x. Epub 2019 May 8.
Pulse index continuous cardiac output (PiCCO) is used for hemodynamic assessment. This study describes real world extravascular lung water index (EVLWI) measurements at three time points and relates them to other hemodynamic parameters and mortality in critically ill patients admitted to a medical intensive care unit (ICU).
A total of 198 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis. Patients were admitted for various diseases such as sepsis (n = 22), myocardial infarction (n = 53), pulmonary embolism (n = 3), cardiopulmonary resuscitation (n = 15), acute heart failure (AHF; n = 21) and pneumonia (n = 25).
Patients included in this analysis were severely ill as represented by the high simplified acute physiology score 2 (SAPS2, 42 ± 18) and acute physiology and chronic health evaluation score 2 (APACHE2' 22 ± 9). Real-world values at three time points are provided. Intra-ICU mortality rates did not differ between the EVLWI > 7 vs. the ELVWI < 7 groups (15% vs. 13%; p = 0.82) and no association between hemodynamic measurements obtained by PiCCO with long-term mortality could be shown.
There were no associations of any PiCCO measurements with mortality most probably due to selection bias towards severely ill patients. Future prospective studies with predefined inclusion criteria and treatment algorithms are necessary to evaluate the value of PiCCO for prediction of mortality against simple clinical tools such as jugular venous pressure, edema and auscultation.
脉搏指示连续心输出量（PiCCO）用于血流动力学评估。本研究描述了在三个时间点的实际血管外肺水指数（EVLWI）测量值，并将其与入住内科重症监护病房（ICU）的危重症患者的其他血流动力学参数及死亡率相关联。
本回顾性分析纳入了2004年2月至2010年12月期间入住一所三级医科大学附属医院的198例患者。患者因各种疾病入院，如脓毒症（n = 22）、心肌梗死（n = 53）、肺栓塞（n = 3）、心肺复苏（n = 15）、急性心力衰竭（AHF；n = 21）和肺炎（n = 25）。
本分析纳入的患者病情严重，简化急性生理学评分2（SAPS2，42±18）和急性生理学与慢性健康状况评估评分2（APACHE2，22±9）较高。给出了三个时间点的实际测量值。EVLWI>7组与ELVWI<7组的ICU内死亡率无差异（15%对13%；p = 0.82），且未显示PiCCO获得的血流动力学测量值与长期死亡率之间存在关联。
任何PiCCO测量值与死亡率均无关联，这很可能是由于对重症患者存在选择偏倚。未来有必要进行具有预定义纳入标准和治疗算法的前瞻性研究，以评估PiCCO相对于颈静脉压、水肿和听诊等简单临床工具在预测死亡率方面的价值。
