Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury
Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury
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DOI：
10.1097/00003246-200210000-00001
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发表时间：
2002-10-01
影响因子：
8.8
通讯作者：
Bernard, GR
中科院分区：
文献类型：
--
作者：
Martin, GS;Mangialardi, RJ;Bernard, GR
目的：低蛋白血症、液体潴留和体重增加与重症患者的急性肺损伤和死亡率的发生有关，但没有因果关系的证据。我们设计了一项临床试验来确定急性肺损伤低蛋白血症患者的利尿和胶体替代是否会改善肺生理学。设计：前瞻性、随机、双盲、安慰剂对照试验。设置：两所大学医院的所有成人重症监护室。患者：37例急性肺损伤和血清总蛋白低于或等于5.0 g/dL的机械通气患者。干预。五天的方案，25克的人血清白蛋白，每8小时连续输注呋塞米，或双安慰剂，针对利尿，减肥，和血清总protein. Measures和主要结果：测量结果包括体重的变化，血清总蛋白，液体平衡，血流动力学，呼吸系统的顺应性，和氧合。两组的基线特征相似（治疗组，n = 19;对照组，n = 18），创伤是急性肺损伤的主要原因。5天内的利尿和体重减轻（治疗组增加5.3 kg，p = .04）伴随着治疗组24小时内Pao（2）/Fio（2）比值的改善（从171至236，p = .02）。呼吸力学无变化。随着时间的推移，治疗组的平均动脉压从80 mmHg升高至88 mmHg（p = 0.10），心率从110次/min降低至95次/min（p = 0.008）。死亡率没有观察到差异，重症监护措施有良好的趋势。白蛋白和速尿治疗可改善急性肺损伤低蛋白血症患者的液体平衡、氧合和血流动力学。确定这种简单疗法对成本，结果和其他患者人群的影响需要进一步研究。
Objective: Hypoproteinemia, fluid retention, and weight gain are associated with development of acute lung injury and mortality in critically ill patients, without proof of cause and effect. We designed a clinical trial to determine whether diuresis and colloid replacement in hypoproteinemic patients with acute lung injury would improve pulmonary physiology.Design: Prospective, randomized, double-blind, placebo-controlled trial.Setting: All adult intensive care units from two university hospitals.Patients: Thirty-seven mechanically-ventilated patients with acute lung injury and serum total protein less than or equal to5.0 g/dL.Interventions. Five-day protocolized regimen of 25 g of human serum albumin every 8 hrs with continuous infusion furosemide, or dual placebo, targeted to diuresis, weight loss, and serum total protein.Measurements and Main Results: Measured outcomes included change in weight, serum total protein, fluid balance, hemodynamics, respiratory system compliance, and oxygenation. Baseline characteristics were similar between groups (treatment, n = 19; control, n = 18), with trauma being the major cause of acute lung injury. Diuresis and weight loss over 5 days (5.3 kg more in the treatment group, p = .04) was accompanied by improvements in the Pao(2)/Fio(2) ratio in the treatment group within 24 hrs (from 171 to 236, p = .02). Respiratory mechanics were unchanged. Mean arterial pressure increased from 80 to 88 mm Hg (p = .10), and heart rate decreased from 110 to 95 beats/min (p = .008) over time in the treatment group. No difference in mortality was observed, with favorable trends in measures of intensive care.Conclusions. Albumin and furosemide therapy improves fluid balance, oxygenation, and hemodynamics in hypoproteinemic patients with acute lung injury. Determining the effect of this simple therapy on cost, outcomes, and other patient populations requires further study.