High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury
High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury
复制标题
DOI：
10.1378/chest.128.5.3098
复制
发表时间：
2005-11-01
期刊：
影响因子：
9.6
通讯作者：
Rartieri, VM
中科院分区：
文献类型：
--
作者：
Sakr, Y;Vincent, JL;Rartieri, VM
研究目的：最近的数据表明，治疗策略可以影响急性肺损伤（ALI）和ARDS的结局。我们检验了感染/败血症和使用比ARDS网络（ARDSnet）研究中应用的更高潮气量的假设（> 7.4 mL/kg预测体重）会使ALI/ARDS患者的结局恶化。设计：国际队列，观察性研究。设置：198个欧洲ICU参与急性病患者败血症发生率研究。患者或参与者：在2002年5月1日至2002年5月15日期间，所有3，147名成年患者均入住其中一个参与的ICU。干预措施：无。测量和结果：患者随访至死亡、出院或60天。在3,147例患者中，393例（12.5%）发生了ALI/ARDS。急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）患者的ICU和住院死亡率高于非ALI/ARDS患者（分别为38.9%vs15.6%和45.5%vs21.0%; p < 0.001）。以ICU结局为因变量的多变量logistic回归分析显示，死亡率的独立风险如下：癌症的存在、使用的潮气量高于ARDSnet研究使用的潮气量、多器官功能障碍的程度和较高的平均液体平衡。脓毒症，脓毒性休克，氧合在发病的ALI/ARDS没有独立的相关性较高的mortality rates.Conclusions：除了合并症和器官功能障碍，高潮气量和积极的液体平衡与一个更糟糕的结果从ALI/ARDS。
Study objectives: Recent data have suggested that ventilatory strategy could influence outcomes from acute lung injury (ALI) and ARDS. We tested the hypothesis that infection/sepsis and use of higher tidal volumes than those applied in the ARDS Network (ARDSnet) study (> 7.4 mL/kg of predicted body weight) would worsen outcome in patients with ALI/ARDS.Design: International cohort, observational study.Setting: One hundred ninety-eight European ICUs participating in the Sepsis Occurrence in Acutely Ill Patients study.Patients or participants: All 3,147 adult patients admitted to one of the participating ICUs between May 1, 2002, and May 15, 2002.Interventions: None.Measurements and results: Patients were followed up until death, hospital discharge, or for 60 days. Of the 3,147 patients, 393 patients (12.5%) had ALI/ARDS. ICU and hospital mortality was higher in patients with ALI/ARDS than those without ALI/ARDS (38.9% vs 15.6% and 45.5% vs 21.0%, respectively; p < 0.001). A multivariable logistic regression analysis with ICU outcome as the dependent factor showed that the independent risks for mortality were, as follows: presence of cancer, use of tidal volumes higher than those used by the ARDSnet study, degree of multiorgan dysfunction, and higher mean fluid balance. Sepsis, septic shock, and oxygenation at the onset of ALI/ARDS were not independently associated with higher mortality rates.Conclusions: In addition to comorbidities and organ dysfunction, high tidal volumes and positive fluid balance are associated with a worse outcome from ALI/ARDS.