High values of the pulmonary artery wedge pressure in patients with acute lung injury and acute respiratory distress syndrome
High values of the pulmonary artery wedge pressure in patients with acute lung injury and acute respiratory distress syndrome
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DOI：
10.1007/s00134-002-1354-y
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发表时间：
2002-08-01
影响因子：
38.9
通讯作者：
Stewart, TE
中科院分区：
文献类型：
--
作者：
Ferguson, ND;Meade, MO;Stewart, TE
目的：探讨急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）患者肺动脉楔压（PAWP）升高的发生率及严重程度。此外，检查临床变量对高PAWP（>18 mmHg）的影响以及PAWP升高对死亡率的影响。设计和患者：对120例ARDS患者或高危患者进行事后分析，这些患者入组了一项压力和容量限制通气的随机对照试验。患有充血性心力衰竭或处于充血性心力衰竭高风险的患者被从原始研究中排除。设置：8个三级重症监护病房。测量和结果：由主治医生酌情插入肺动脉导管，如果存在PAWP，则每8小时采集一次。在120例受试者中，71例（59%）植入了肺动脉导管（随机化时44例，之后27例）。患者的平均最大PAWP阅读为22.5 mmHg（95% CI 21.2-23.8），平均中位数为16.6 mmHg（95% CI 15.6-17.5）。符合ARDS标准的患者更有可能发展为高PAWP。在多变量逐步logistic回归模型中，PAWP持续升高（中位数> 18 mmHg）是校正基线差异后死亡率的强预测因子（OR估计值6.82; 95% CI 1.66-37.81）。结论：我们得出结论，在这组患者中，PAWP高于18 mmHg是常见的。要求PAWP ≤ 18 mmHg可能会对以ARDS为入选/排除标准或终点的临床试验产生负面影响。
Objective: To determine the incidence and severity of pulmonary artery wedge pressure (PAWP) elevation in patients with ALI/ARDS. In addition, to examine the effects of clinical variables on the presence of a high PAWP (>18 mmHg) and the effect of an elevated PAWP on mortality. Design and patients: Post hoc analysis of 120 patients with or at high risk of ARDS, enrolled in a randomized controlled trial of pressure-and volume-limited ventilation. Patients with or at high risk of congestive heart failure were excluded from the original study. Setting: Eight tertiary intensive care units. Measurements and results: Pulmonary artery catheters were inserted at the discretion of the attending physician, and PAWP was collected every 8 h when present. Of 120 subjects 71 (59%) had a pulmonary artery catheter (44 at randomization, 27 later). The mean maximum PAWP reading among patients was 22.5 mmHg (95% CI 21.2-23.8) and mean median was 16.6 mmHg (95% CI 15.6-17.5). Patients who met standard criteria for ARDS were more likely to develop a high PAWP. In a multivariate stepwise logistic regression model a persistently elevated PAWP (median > 18 mmHg) was a strong predictor of mortality after correction for baseline differences (OR estimate 6.82; 95% CI 1.66-37.81). Conclusions: We conclude that in this group of patients a PAWP higher than 18 mmHg is common. Mandating a PAWP of 18 mmHg or less may negatively impact clinical trials in which ARDS is an inclusion/exclusion criteria or an endpoint.