Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS Severity Score
Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS Severity Score
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DOI：
10.1007/s001340051317
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发表时间：
2000-08-01
影响因子：
38.9
通讯作者：
Grenier, P
中科院分区：
文献类型：
--
作者：
Rouby, JJ;Puybasset, L;Grenier, P
目的：(a)评估成人呼吸窘迫综合征（ARDS）患者肺形态的差异是否与心肺参数、肺力学和预后的差异相关。(b)提出新的ARDS严重程度评分，以识别高死亡风险患者。设计：为期53个月的前瞻性研究。环境：大学医院有14个床位的外科重症监护室。患者和参与者：71例早期ARDS患者。测量结果：采用Swan-Ganz导管测量心肺参数，采用大体注射器法测量压力-容积（PV）曲线，并进行快速螺旋计算机断层扫描（CT）。弥漫性衰减患者（n = 16）与大叶性衰减患者（n = 26）在以下方面存在差异：(a)死亡率（75%对42%，p = 0.05）， (b)原发性ARDS发生率（82%对50%，p = 0.03）， (c)呼吸顺应性(47 +/- 12 vs 64 +/- 16 mi / cmH(2)O(-1) p = 0.04), (d)下临界点（8.4 +/- 2.0 vs 4.6 +/- 2.0 cmH(2)O, p = 0.001）。第三组出现不均匀减弱的患者（n = 29）死亡率为41%，呼吸顺应性为56 +/- 18 ml / cmH(2)O(-1)，较低的拐点为6.3 +/- 2.7 cmH(2)O。床边胸片准确地评估了只有42%的患者的肺形态。与基于床边胸片的评分相比，基于CT肺形态和心肺参数的新的ARDS严重程度评分确定了高死亡率（大于或等于60%）的患者亚组。结论：在ARDS患者中，肺形态的差异与预后和肺力学的差异有关。基于CT肺形态和心肺参数的新的ARDS严重程度评分准确地识别出最严重的ARDS形式和死亡率超过60%的患者。
Objectives: (a) To assess whether differences in lung morphology observed in patients with adult respiratory distress syndrome (ARDS) are associated with differences in cardiorespiratory parameters, lung mechanics, and outcome. (b) To propose a new ARDS Severity Score to identify patients with a high mortality risk.Design: Prospective study over a 53-month period.Setting: Fourteen-bed surgical intensive care unit of a university hospital.Patients and participants: Seventy-one consecutive patients with early ARDS.Measurements ann results: Cardiorespiratory parameters were measured using a Swan-Ganz catheter, the pressure-volume (PV) curve was measured using the gross syringe method, and fast spiral computed tomography (CT) was performed. Patients with diffuse attenuations (n = 16) differed from patients with lobar attenuations (n = 26) regarding: (a) mortality rate (75 % vs. 42 %, p = 0.05), (b) incidence of primary ARDS (82 % vs. 50 %, p = 0.03), (c) respiratory compliance (47 +/- 12 vs. 64 +/- 16 mi per cmH(2)O(-1) p = 0.04), and (d) lower inflexion point (8.4 +/- 2.0 vs. 4.6 +/- 2.0 cmH(2)O, p = 0.001). A third group of patients with patchy attenuations (n = 29) had a mortality rate of 41 %, a respiratory compliance of 56 +/- 18 ml per cmH(2)O(-1) and a lower inflexion point of 6.3 +/- 2.7 cmH(2)O. The bedside chest radiograph accurately assessed lung morphology in only 42 % of the patients. In contrast to the scores based on the bedside chest radiograph, a new ARDS Severity Score based on CT lung morphology and cardiorespiratory parameters identified a subgroup of patients with a high mortality rate (greater than or equal to 60 %).Conclusions: In patients with ARDS, differences in lung morphology are associated with differences in outcome and lung mechanics. A new ARDS Severity Score based on CT lung morphology and cardiorespiratory parameters accurately identified patients with the most severe forms of ARDS and a mortality rate above 60 %.