Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS.
Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS.
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DOI：
10.1136/thoraxjnl-2017-211280
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发表时间：
2018-09
期刊：
影响因子：
10
通讯作者：
Ware LB
中科院分区：
文献类型：
--
作者：
Warren MA;Zhao Z;Koyama T;Bastarache JA;Shaver CM;Semler MW;Rice TW;Matthay MA;Calfee CS;Ware LB
目前还没有准确的、非侵入性的测量方法来估计ARDS中肺水肿的程度。我们开发了肺水肿放射学评估（RALE）评分来评估胸片上肺泡混浊的范围和密度。在首先比较RALE评分与器官供体肺水肿的重量评估后，我们评估了ARDS患者的RALE评分与氧合和临床结局的关系。我们比较了来自72名器官供体的X线片与切除肺重量（衍生队列）以及来自ARDSNet液体和导管治疗试验（验证队列）中174名ARDS患者的X线片与临床数据。为了计算RALE，对每个放射学象限的实变程度（0-4）和浑浊密度（1-3）进行评分。将四个象限中每个象限的固结和密度评分的乘积相加（最大评分=48）。两名独立评审员之间的RALE评分一致性极佳（类内相关系数=0.93，95% CI：0.91-0.95）。在供体中，采购前RALE评分与身高调整后的肺总重量相关（ρ=0.59，p<0.001）。在ARDS患者中，较高的RALE评分与较低的PaO 2/FiO 2和较差的生存率独立相关。与自由液体管理相比，保守液体管理在3天内显著降低了RALE评分。RALE评分可用于评估肺水肿的程度和ARDS的严重程度，通过利用已经在每个ARDS患者中常规、安全和廉价地获得的信息。这种新的非侵入性的措施应该是有用的评估ARDS的严重程度和监测对治疗的反应。
There is no accurate, non-invasive measurement to estimate the degree of pulmonary edema in ARDS. We developed the Radiographic Assessment of Lung Edema (RALE) score to evaluate the extent and density of alveolar opacities on chest radiographs. After first comparing the RALE score to gravimetric assessment of pulmonary edema in organ donors, we then evaluated the RALE score in ARDS patients for its relationship to oxygenation and clinical outcomes. We compared radiographs with excised lung weights from 72 organ donors (derivation cohort) and radiographs with clinical data from 174 ARDS patients in the ARDSNet Fluid and Catheter Treatment Trial (validation cohort). To calculate RALE, each radiographic quadrant was scored for extent of consolidation (0–4) and density of opacification (1–3). The product of the consolidation and density scores for each of the four quadrants was summed (maximum score=48). Agreement between two independent reviewers for RALE score was excellent (intra-class correlation coefficient=0.93, 95% CI:0.91–0.95). In donors, pre-procurement RALE score correlated with height-adjusted total lung weight (ρ=0.59, p<0.001). In ARDS patients, higher RALE scores were independently associated with lower PaO2/FiO2 and worse survival. Conservative fluid management significantly decreased RALE score over 3 days compared to liberal fluid management. The RALE score can be used to assess both the extent of pulmonary edema and the severity of ARDS, by utilizing information that is already obtained routinely, safely, and inexpensively in every ARDS patient. This novel non-invasive measure should be useful for assessing ARDS severity and monitoring response to therapy.
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影响因子：
9.6
作者：
HALPERIN, BD;FEELEY, TW;BLANK, NE
通讯作者：
BLANK, NE
影响因子：
2.1
作者：
Ware, Lorraine B.;Neyrinck, Arne;Matthay, Michael A.
通讯作者：
Matthay, Michael A.
影响因子：
158.5
作者：
Papazian, Laurent;Forel, Jean-Marie;Roch, Antoine
通讯作者：
Roch, Antoine
DOI：
10.1111/ajt.12564
发表时间：
2014-03
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Ware LB;Landeck M;Koyama T;Zhao Z;Singer J;Kern R;Neidlinger N;Nguyen J;Johnson E;Janz DR;Bernard GR;Lee JW;Matthay MA;California Transplant Donor Network
通讯作者：
California Transplant Donor Network
影响因子：
2.5
作者：
Wallet, Florent;Delannoy, Bertrand;Guerin, Claude
通讯作者：
Guerin, Claude