Fein A M, Goldberg S K, Walkenstein M D, Dershaw B, Braitman L, Lippmann M L
Am Rev Respir Dis. 1984 Jun;129(6):1006-9. doi: 10.1164/arrd.1984.129.6.1006.
The ability to differentiate cardiac from permeability edema on the basis of clinical and radiographic criteria was studied in 70 ICU patients in whom subsequent pulmonary artery catheterization (PAC) was performed. Our study demonstrated that the clinical assessment of permeability pulmonary edema was correct in 17 of 20 patients (85%). In contrast, of the 50 patients initially suspected of having cardiac edema, only 31 (62%) were predicted correctly (p less than 0.05). Complications relating to catheterization occurred in 25% of patients, with 3 deaths. We conclude that the diagnosis of cardiogenic pulmonary edema, based on clinical criteria alone, is often inaccurate in the intensive care setting. The failure of patients to respond to initial therapy should mandate pulmonary artery catheterization, despite the attendant risks. Furthermore, even though the clinical diagnosis is correct in 85% of patients with permeability pulmonary edema, PAC data may be necessary for optimal management.
在70例随后接受肺动脉导管插入术（PAC）的重症监护病房（ICU）患者中，研究了根据临床和影像学标准区分心源性水肿与通透性水肿的能力。我们的研究表明，20例通透性肺水肿患者中有17例（85%）临床评估正确。相比之下，最初怀疑有心源性水肿的50例患者中，只有31例（62%）预测正确（p<0.05）。25%的患者发生了与导管插入术相关的并发症，有3例死亡。我们得出结论，在重症监护环境中，仅基于临床标准的心源性肺水肿诊断通常不准确。尽管存在相关风险，但患者对初始治疗无反应时应进行肺动脉导管插入术。此外，即使85%的通透性肺水肿患者临床诊断正确，PAC数据对于优化治疗可能也是必要的。
