Aiming for a negative fluid balance in patients with acute lung injury and increased intra-abdominal pressure: a pilot study looking at the effects of PAL-treatment.
Aiming for a negative fluid balance in patients with acute lung injury and increased intra-abdominal pressure: a pilot study looking at the effects of PAL-treatment.
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DOI：
10.1186/2110-5820-2-s1-s15
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发表时间：
2012-07-05
影响因子：
8.1
通讯作者：
Malbrain ML
中科院分区：
文献类型：
--
作者：
Cordemans C;De Laet I;Van Regenmortel N;Schoonheydt K;Dits H;Martin G;Huber W;Malbrain ML
毛细血管渗漏患者实现负液体平衡与改善结局相关。我们研究了针对急性肺损伤（ALI）患者的负液体平衡的多模式限制性液体策略的效果。在这项回顾性配对病例对照研究中，我们纳入了114例机械通气（MV）的ALI患者。我们比较了一组57例接受PAL治疗的患者（PAL组）和一个匹配的对照组之间的结果，这些患者来自一个历史队列。PAL治疗结合了高水平的呼气末正压、高渗白蛋白的小容量复苏以及呋塞米（Lasix®）或超滤的液体清除。在1周内记录对血管外肺水指数（EVLWI）、腹内压（IAP）、器官功能和血管加压治疗的影响。主要结局参数为28天死亡率。基线时，除PAL组PaO 2/FIO 2较低和IAP升高（分别为174.5 ± 84.5 vs 256.5 ± 152.7，p = 0.001; 10.0 ± 4.2 vs 8.0 ± 3.7 mmHg，p = 0.013）外，未发现组间显著差异。1周后，PAL治疗患者的EVLWI、IAP和累积液体平衡降低幅度更大（-4.2 ± 5.6 vs -1.1 ± 3.7 mL/kg，p = 0.006; -0.4 ± 3.6 vs 1.8 ± 3.8 mmHg，p = 0.007;-1，451 ± 7，761 vs 8，027 ± 5，254 mL，p < 0.001）。对心血管和肾功能的抑制有限。PAL治疗的患者需要更少的重症监护室住院天数和MV天数（分别为23.6 ± 15 vs 37.1 ± 19.9天，p = 0.006; 14.6 ± 10.7 vs 25.5 ± 20.2天），28天死亡率较低（28.1% vs 49.1%，p = 0.034）。ALI患者的PAL治疗与负液体平衡、EVLWI和IAP减少以及临床结局改善相关，而不影响器官功能。
Achievement of a negative fluid balance in patients with capillary leak is associated with improved outcome. We investigated the effects of a multi-modal restrictive fluid strategy aiming for negative fluid balance in patients with acute lung injury (ALI). In this retrospective matched case-control study, we included 114 mechanically ventilated (MV) patients with ALI. We compared outcomes between a group of 57 patients receiving PAL-treatment (PAL group) and a matched control group, abstracted from a historical cohort. PAL-treatment combines high levels of positive end-expiratory pressure, small volume resuscitation with hyperoncotic albumin, and fluid removal with furosemide (Lasix®) or ultrafiltration. Effects on extravascular lung water index (EVLWI), intra-abdominal pressure (IAP), organ function, and vasopressor therapy were recorded during 1 week. The primary outcome parameter was 28-day mortality. At baseline, no significant intergroup differences were found, except for lower PaO2/FIO2 and increased IAP in the PAL group (174.5 ± 84.5 vs 256.5 ± 152.7, p = 0.001; 10.0 ± 4.2 vs 8.0 ± 3.7 mmHg, p = 0.013, respectively). After 1 week, PAL-treated patients had a greater reduction of EVLWI, IAP, and cumulative fluid balance (-4.2 ± 5.6 vs -1.1 ± 3.7 mL/kg, p = 0.006; -0.4 ± 3.6 vs 1.8 ± 3.8 mmHg, p = 0.007; -1,451 ± 7,761 vs 8,027 ± 5,254 mL, p < 0.001). Repercussions on cardiovascular and renal function were limited. PAL-treated patients required fewer days of intensive care unit admission and days on MV (23.6 ± 15 vs 37.1 ± 19.9 days, p = 0.006; 14.6 ± 10.7 vs 25.5 ± 20.2 days, respectively) and had a lower 28-day mortality (28.1% vs 49.1%, p = 0.034). PAL-treatment in patients with ALI is associated with a negative fluid balance, a reduction of EVLWI and IAP, and improved clinical outcomes without compromising organ function.