Indices of hypoxemia in patients with acute respiratory distress syndrome: reliability, validity, and clinical usefulness.
Indices of hypoxemia in patients with acute respiratory distress syndrome: reliability, validity, and clinical usefulness.
复制标题
急性呼吸窘迫综合征患者低氧血症指标：可靠性、有效性和临床实用性。
DOI：
10.1097/00003246-199701000-00005
复制
发表时间：
1997
影响因子：
8.8
通讯作者：
T. Raffin
中科院分区：
文献类型：
--
作者：
M. Gould;S. Ruoss;N. Rizk;R. Doyle;T. Raffin
我们对急性呼吸窘迫综合征(ARDS)的认识随着时间的推移而演变，不仅涉及到肺损伤的细胞方面和低氧血症的生理机制，而且涉及到该综合征的定义和治疗。在本期《重症监护医学》中，Gowda博士和KLocke博士[1]就ARDS患者气体交换生理的患者间变异性提供了有用的提醒，并对常用的低氧血症指标的可靠性提出了警告。他们的警告对ARDS的定义，以及临床试验患者的选择和分层都有影响。他们的结论也促使人们思考这些指标在ARDS患者临床治疗中的有限效用。在ARDS的最初描述中，肺内分流来自肺泡灌洗被认为是低氧血症的唯一生理原因[2，3]。通风/灌流不均匀的可能作用在后面进行了推测[4]。使用惰性气体消除技术，Dantzker和他的同事[5]证明，在他们研究的16名ARDS患者中，有一半患者存在显著的肺内分流。Gowda博士和KLocke博士的工作[1]进一步探索了这种患者间生理学差异的后果。具体地说，Gowda博士和KLocke博士证明：a)PaO2/FiO2比率(和其他“基于张力的”指数)在不同的FiO2值之间变化，特别是在明显的通风/灌流不均匀的患者中，但在高分流分数的患者中也是如此；b)PaO2/FiO2比率在通常的临床条件下仍然是最可靠的气体交换异常指标；(C)被认为是评估肺氧合的金标准的静脉混合液(基于含量的指数)也可能随着FIO2的变化而变化，这种变化的程度与呼吸/灌流失衡的程度成正比。这些结论增加了关于这一主题的已有的大量文献。
Our understanding of the acute respiratory distress syndrome (ARDS) has evolved over time, not only with respect to the cellular aspects of lung injury and the physiologic mechanisms of hypoxemia, but also regarding the syndrome's definition and treatment. In this issue of Critical Care Medicine, Drs. Gowda and Klocke [1] offer both a useful reminder about interpatient variabilities in the physiology of gas exchange in ARDS patients, and a warning about the reliability of commonly used indices of hypoxemia. Their warning has implications for the definition of ARDS, and for the selection and stratification of patients for clinical trials. Their conclusions also prompt reflection about the limited usefulness of such indices in the clinical management of ARDS patients.In the initial descriptions of ARDS, intrapulmonary shunting from alveolar flooding was thought to be the sole physiologic cause of hypoxemia [2, 3]. The possible contribution of ventilation/perfusion inequality was postulated later [4]. Using the inert gas elimination technique, Dantzker and colleagues [5] documented that significant ventilation/perfusion inequality accompanied intrapulmonary shunting in half of the 16 ARDS patients they studied. The work of Drs. Gowda and Klocke [1] further explores the consequences of this interpatient variation in physiology. Specifically, Drs. Gowda and Klocke demonstrate that: a) the PaO 2/FIO 2 ratio (and other" tension-based" indices) varies across different FIO 2 values, especially in patients with significant ventilation/perfusion inequality, but also in patients with high shunt fractions; b) the PaO 2/FIO 2 ratio is nevertheless the most reliable index of abnormal gas exchange under usual clinical conditions; and (c) the measured venous admixture (a" content-based" index), which is thought to be the gold standard for assessing pulmonary oxygenation, also may vary with alterations in FIO 2, and the degree of this variation is proportional to the degree of ventilation/perfusion imbalance. These conclusions add to an already extensive literature on the subject.
DOI：
10.1164/ajrccm.152.6.8520742
发表时间：
1995-12-01
影响因子：
24.7
作者：
DOYLE, RL;SZAFLARSKI, N;MATTHAY, MA
通讯作者：
MATTHAY, MA