Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease - Different syndromes?
Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease - Different syndromes?
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DOI：
10.1164/ajrccm.158.1.9708031
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发表时间：
1998-07-01
影响因子：
24.7
通讯作者：
Lissoni, A
中科院分区：
文献类型：
--
作者：
Gattinoni, L;Pelosi, P;Lissoni, A
探讨肺源性急性呼吸窘迫综合征（ARDS（p））与肺外源性急性呼吸窘迫综合征（ARDS（p））在呼吸力学方面的差异在0、5、10、10、20、20、30、40、50、50、60、70、80、80、90、100、100、10、15 cm H2O呼气末正压（PEEP）12例（P），9例（exp）。在零呼气末压（ZEEP），Est，rs和EELV在两组患者中相似。然而，ARDS组的Est，L明显高于ARDS（exp）组（20.2 +/- 5.4 vs 13.8 +/- 5.0 cm H2O/L，p < 0.05），而ARDS（exp）组的Est，w异常增加（12.1 +/- 3.8 vs 5.2 +/- 1.9 cm H2O/L，p < 0.05）。急性呼吸窘迫综合征（ARDS）组IAP（exp）高于急性呼吸窘迫综合征（p）组（22.2 ± 6.0 vs 8.5 ± 2.9 cm H2O，p < 0.01），IAP与Est，w显著相关（p < 0.01）。将PEEP增加到15 cm H2O导致ARDS中的Est，rs增加（p）（从25.4 +/- 6.2到31.2 +/- 11.3 cm H2O/L，p < 0.01），而ARDS中的Est，rs减少（exp）（从25.9 +/- 5.4到21.4 +/- 55.5 cm H2O/L，p < 0.01）。在15 cm H2O PEEP时，ARDS（p）和ARDS（exp）的估计募集分别为-0.031 +/- 0.092 vs 0.293 +/- 0.241 L（p < 0.01）。观察到的不同呼吸力学和对PEEP的反应与ARDS（p）中实变的普遍性一致，而与ARDS（exp）中普遍水肿和肺泡萎陷相反。
To assess the possible differences in respiratory mechanics between the acute respiratory distress syndrome (ARDS) originating from pulmonary disease (ARDS(p)) and that originating from extrapulmonary disease (ARDS(exp)) we measured the total respiratory system (Est, rs), chest wall (Est, w) and lung (Est, L) elastance, the intra-abdominal pressure (IAP), and the end-expiratory lung volume (EELV) at 0, 5, 10, and 15 cm H2O positive end-expiratory pressure (PEEP) in 12 patients with ARDS(P) and nine with ARDS(exp). At zero end-expiratory pressure (ZEEP), Est,rs and EELV were similar in both groups of patients. The Est, L, however, was markedly higher in the ARDS, group than in the ARDS(exp) group (20.2 +/- 5.4 versus 13.8 +/- 5.0 cm H2O/L, p < 0.05), whereas Est, w was abnormally increased in the ARDS(exp) group (12.1 +/- 3.8 versus 5.2 +/- 1.9 cm H2O/L, p < 0.05). The IAP was higher in ARDS(exp) than in ARDS(p) (22.2 +/- 6.0 versus 8.5 +/- 2.9 cm H2O, p < 0.01), and it significantly correlated with Est, w (p < 0.01). Increasing PEEP to 15 cm H2O caused an increase of Est, rs in ARDS(p) (from 25.4 +/- 6.2 to 31.2 +/- 11.3 cm H2O/L, p < 0.01) and a decrease in ARDS(exp), (from 25.9 +/- 5.4 to 21.4 +/- 55.5 cm H2O/L, p < 0.01). The estimated recruitment at 15 cm H2O PEEP was -0.031 +/- 0.092 versus 0.293 +/- 0.241 L in ARDS(p) and ARDS(exp), respectively (p < 0.01). The different respiratory mechanics and response to PEEP observed are consistent with a prevalence of consolidation in ARDS(p) as opposed to prevalent edema and alveolar collapse in ARDS(exp).