Prognostic value of extravascular lung water in critically ill patients
Prognostic value of extravascular lung water in critically ill patients
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DOI：
10.1378/chest.122.6.2080
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发表时间：
2002-12-01
期刊：
影响因子：
9.6
通讯作者：
Meier-Hellmann, A
中科院分区：
文献类型：
--
作者：
Sakka, SG;Klein, M;Meier-Hellmann, A
目的：血管外肺水（EVLW）的测量作为肺功能评估的临床工具已被发现比氧合参数或放射学技术更合适。在这项研究中，我们分析了EVLW在危重患者中的预后价值。设计：回顾性分析。设置：一所大学医院的手术ICU。测量和结果：我们回顾性分析了373例危重患者（133名女性和240名男性患者;年龄范围，10至89岁;平均+/- SD年龄，53 +/- 19岁），这些患者在1996年至2000年期间在我们的ICU接受治疗。所有患者均采用经尿道双指示剂（热染料）稀释技术进行血流动力学监测。每例患者均接受股动脉鞘管，通过该鞘管将带有集成热敏电阻和光纤的4F柔性导管推进到动脉下主动脉中，使用计算机系统计算EVLW。对于每次测量，将15至17 mL冷却的2%吲哚菁绿色注入中央静脉。在我们的研究结果中，死亡者（n = 186）的最大EVLW显著高于存活者（n = 187）[中位数分别为14.3 mL/kg vs 10.2 mL/kg; p < 0.001]。在单变量logistic回归模型中，基线EVLW（r（2）= 0.024，p = 0.003）以及简化急性生理学评分（SAPS）II（r（2）= 0.135，p < 0.0001）和APACHE（急性生理学和慢性健康评估）II评分（r（2）= 0.050，p < 0.0001）是死亡率的重要预测因子。如果SAPS II和APACHE II评分相结合，r（2）增加到0.136，但与单独的SAPS II相比改善不显著。增加基线EVLW进一步增加r（2）至0.149（p = 0.021的改善），表明EVLW有助于独立预后。结论：EVLW与生存相关（即，非幸存者有显着较高的EVLW值比幸存者），是一个独立的预后预测因子。
Objective: Measurement of extravascular lung water (EVLW) as a clinical tool for the assessment of pulmonary function has been found to be more appropriate than oxygenation parameters or radiographic techniques. In this study, we analyzed the prognostic value of EVLW in Critically ill patients.Design: Retrospective analysis.Setting: Operative ICU of a university hospital.Measurements and results: We retrospectively, analyzed 373 critically ill patients (133 female and 240 male patients; age range, 10 to 89 years; mean +/- SD age, 53 +/- 19 years) who were treated in our ICU between 1996 and 2000. All these patients were hemodynamically monitored by the transpulmonary double-indicator (thermo-dye) dilution technique. Each patient received a femoral artery sheath through which a 4F flexible catheter with an integrated thermistor and fiberoptic was advanced into the infradiaphragmatic aorta, EVLW was calculated using a computer system. For each measurement, 15 to 17 mL of cooled 2% indocyanine green were injected central venously. In our results, maximum EVLW was significantly higher in nonsurvivors (n = 186) than in survivors (n = 187) [median, 14.3 mL/kg vs 10.2 mL/kg, respectively; p < 0.001]. In univariate logistic regression models, EVLW (r(2) = 0.024, p = 0.003) at baseline as well as simplified acute physiology score (SAPS) II (r(2) = 0.135, p < 0.0001) and APACHE (acute physiology and chronic health evaluation) II scores (r(2) = 0.050, p < 0.0001) were significant predictors of mortality. If SAPS II and APACHE II scores are combined, r(2) increases to 0.136, but the improvement over SAPS II alone is not significant. The addition of baseline EVLW further increases r(2) to 0.149 (p = 0.021 for the improvement), indicating that EVLW contributes independently to prognosis.Conclusion: EVLW correlated well with survival (ie, nonsurvivors had significantly higher EVLW values than survivors) and is an independent predictor of prognosis.