Groeneveld A B, Raijmakers P G, Teule G J, Thijs L G
Medical Intensive Care Unit, Free University Hospital, Amsterdam, The Netherlands.
Crit Care Med. 1996 Sep;24(9):1467-72. doi: 10.1097/00003246-199609000-00007.
To establish the value of the 67Gallium (Ga) pulmonary leak index, a marker of increased permeability edema of the lungs, in assessing the severity and course of the adult respiratory distress syndrome (ARDS).
Prospective observational study.
Medical intensive care unit of a university hospital.
Seventeen consecutive, mechanically-ventilated ARDS patients. Eleven patients (recovering from ARDS) improved, as defined by the ability to taper the level of positive end-expiratory pressure (PEEP) to 0 cm H2O at a median of 7 days after admission. Ten patients survived. Six patients did not recover and died a median of 3.5 days after admission.
None.
The pulmonary leak index (i.e., upper limit of normal 14.1 x 10(-3)/min) was measured within 72 hrs after admission, and repeated within 48 hrs at the time of recovery in recovering patients. At admission and recovery, respiratory variables were recorded and a lung injury score was calculated. At admission, the pulmonary leak index was increased in each patient to 32.3 (range 15.6 to 52.4) and 28.7 (range 26.0 to 40.8) x 10(-3)/min in recovering and nonrecovering patients, respectively (NS). Groups did not differ with respect to the oxygenation ratio, the level of PEEP, radiographic abnormalities, and the lung injury score. At recovery, the pulmonary leak index in recovering patients had decreased in each patient and had normalized in four patients, averaging 15.2 (range 5.6 to 25.9) x 10(-3)/min, concomitantly with an increased oxygenation ratio, less radiographic abnormalities, and a decreased lung injury score (p < .01 vs. admission). For pooled recovering and nonrecovering patient data, the pulmonary leak index directly related to the lung injury score (p < .005).
The 67Ga pulmonary leak index may be a clinically useful tool to quantify the severity and course of ARDS, since clinical recovery from the syndrome may be characterized by amelioration of increased microvascular permeability.
确定67镓（Ga）肺渗漏指数（一种肺通透性水肿增加的标志物）在评估成人呼吸窘迫综合征（ARDS）严重程度和病程中的价值。
前瞻性观察性研究。
一所大学医院的医学重症监护病房。
17例连续接受机械通气的ARDS患者。11例患者（从ARDS中恢复）病情改善，定义为在入院后中位时间7天能够将呼气末正压（PEEP）水平逐渐降至0 cm H2O。10例患者存活。6例患者未恢复，在入院后中位时间3.5天死亡。
无。
在入院后72小时内测量肺渗漏指数（即正常上限为14.1×10⁻³/分钟），恢复患者在恢复时48小时内重复测量。在入院时和恢复时，记录呼吸变量并计算肺损伤评分。入院时，恢复患者和未恢复患者的肺渗漏指数分别增加至32.3（范围15.6至52.4）和28.7（范围26.0至40.8）×10⁻³/分钟（无显著性差异）。两组在氧合比、PEEP水平、影像学异常和肺损伤评分方面无差异。恢复时，恢复患者的肺渗漏指数在每位患者中均下降，4例患者恢复正常，平均为15.2（范围5.6至25.9）×10⁻³/分钟，同时氧合比增加、影像学异常减少、肺损伤评分降低（与入院时相比，p < 0.01）。对于恢复患者和未恢复患者的汇总数据，肺渗漏指数与肺损伤评分直接相关（p < 0.005）。
67Ga肺渗漏指数可能是一种临床上有用的工具，用于量化ARDS的严重程度和病程，因为该综合征的临床恢复可能以微血管通透性增加的改善为特征。
