Lardet Florian, Monnet Xavier, Teboul Jean-Louis, Shi Rui, Lai Christopher, Fossé Quentin, Moretto Francesca, Gobé Thibaut, Jelinski Ludwik, Combet Margot, Pavot Arthur, Guérin Laurent, Pham Tài
Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche CARMAS, Hôpitaux Universitaires Paris-Saclay, AP-HP, 94270 Le Kremlin-Bicêtre, France.
Département d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, AP-HP, Sorbonne Université, 75020 Paris, France.
J Clin Med. 2023 Mar 3;12(5):2028. doi: 10.3390/jcm12052028.
During acute respiratory distress syndrome (ARDS), the increase in pulmonary vascular permeability and lung water induced by pulmonary inflammation may be related to altered lung compliance. A better understanding of the interactions between respiratory mechanics variables and lung water or capillary permeability would allow a more personalized monitoring and adaptation of therapies for patients with ARDS. Therefore, our main objective was to investigate the relationship between extravascular lung water (EVLW) and/or pulmonary vascular permeability index (PVPI) and respiratory mechanic variables in patients with COVID-19-induced ARDS. This is a retrospective observational study from prospectively collected data in a cohort of 107 critically ill patients with COVID-19-induced ARDS from March 2020 to May 2021. We analyzed relationships between variables using repeated measurements correlations. We found no clinically relevant correlations between EVLW and the respiratory mechanics variables (driving pressure (correlation coefficient [CI 95%]: 0.017 [-0.064; 0.098]), plateau pressure (0.123 [0.043; 0.202]), respiratory system compliance (-0.003 [-0.084; 0.079]) or positive end-expiratory pressure (0.203 [0.126; 0.278])). Similarly, there were no relevant correlations between PVPI and these same respiratory mechanics variables (0.051 [-0.131; 0.035], 0.059 [-0.022; 0.140], 0.072 [-0.090; 0.153] and 0.22 [0.141; 0.293], respectively). In a cohort of patients with COVID-19-induced ARDS, EVLW and PVPI values are independent from respiratory system compliance and driving pressure. Optimal monitoring of these patients should combine both respiratory and TPTD variables.
在急性呼吸窘迫综合征（ARDS）期间，肺部炎症引起的肺血管通透性增加和肺水增多可能与肺顺应性改变有关。更好地理解呼吸力学变量与肺水或毛细血管通透性之间的相互作用，将有助于对ARDS患者进行更个性化的监测和调整治疗方案。因此，我们的主要目的是研究新型冠状病毒肺炎（COVID-19）所致ARDS患者血管外肺水（EVLW）和/或肺血管通透性指数（PVPI）与呼吸力学变量之间的关系。这是一项回顾性观察研究，数据前瞻性收集自2020年3月至2021年5月的107例COVID-19所致ARDS重症患者队列。我们使用重复测量相关性分析变量之间的关系。我们发现EVLW与呼吸力学变量（驱动压（相关系数[95%置信区间]：0.017[-0.064；0.098]）、平台压（0.123[0.043；0.202]）、呼吸系统顺应性（-0.003[-0.084；0.079]）或呼气末正压（0.203[0.126；0.278]））之间无临床相关相关性。同样，PVPI与这些相同的呼吸力学变量之间也无相关相关性（分别为0.051[-0.131；0.035]、0.059[-0.022；0.140]、0.072[-0.090；0.153]和0.22[0.141；0.293]）。在COVID-19所致ARDS患者队列中，EVLW和PVPI值与呼吸系统顺应性和驱动压无关。对这些患者的最佳监测应同时结合呼吸和脉搏指示连续心输出量（TPTD）变量。
