TRIAL OF PULMONARY ARTERY CATHETER VS CENTRAL VENOUS CATHETER FOR ARDS

肺动脉导管与中心静脉导管治疗 ARDS 的试验

• 批准号: 7376263
• 负责人: BENNETT P DEBOISBLANC
• 金额: $ 2.12万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7376263
• 关键词: TRIAL; PULMONARY; ARTERY; CATHETER; VS

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The pulmonary arterial catheter (PAC) was introduced for clinincal use in 1970 to provide diagnostic and monitoring information not available from other clinical sources. The PAC provides a wealth of direct and indirect information about circulatory, and respiratory systems and intravascular fluid volume over time. The PAC allows measurement of central venous and pulmonary arterial pressure, pulmonary artery occlusion pressure (PAOP or "wedge pressure"), mixed venous blood gases, and indicator-dilution cardiac output. This data is quantitative and since it is, more information, such as systemic and pulmonary vascular resistance can be derived. The accuracy of these measurements is high in well-trained and qualified hands, but is subject to proper placement of the catheter, calibration of transducers and user interpretation of waveforms and data. PAC data properly interpreted help to assess the right and left ventricle function, intracardiac shunts, pulmonary ventilatory function and intra-vascular fluid status. A pulmonary arterial catheter that is properly maintained allows for ongoing monitoring, which may provide early information regarding trends towards improvement or deterioration in response to therapeutic intervention. The PAC catheter is used commonly in patients with acute lung injury (ALI) and its most severe subset, the acute respiratory distress syndrome (ARDS). ALI is a clinical problem of significant magnitude in terms of incidence (150,000 patients per year), mortality (30-60% in most series) and cost (in part due to long stays in intensive care). In patients with ALI, the PAC has been employed widely both to confirm the diagnosis as well as to optimize hemodynamic management. Theoretically, measurement of the PAOP and cardiac output may make it possible for physicians to maintain pulmonary vascular pressures at a lower level, thus reducing the quantity of pulmonary edema that may develop in the presence of increases in lung vascular permeability. Also, maintaining a lower pulmonary capillary pressure may prevent or minimize damage ("stress failure") to the capillary wall. The measurement of pulmonary arterial pressure and cardiac output may make it possible for physicians to administer vasoactive agents more skillfully in order to optimize cardiac output, maintain or improve renal function, and increase systemic blood pressure and blood flow to vital organs. On the other hand, it is possible that the measurement of central venous pressure along with a central venous catheter (CVC) is adequate to optimize hemodynamics in patients with ALI.

该子项目是利用 NIH/NCRR 资助的中心拨款提供的资源的众多研究子项目之一。子项目和研究者 (PI) 可能已从另一个 NIH 来源获得主要资金，因此可以在其他 CRISP 条目中得到体现。列出的机构是中心的机构，不一定是研究者的机构。肺动脉导管 (PAC) 于 1970 年引入临床使用，以提供其他临床来源无法提供的诊断和监测信息。 PAC 提供了大量有关循环系统、呼吸系统以及血管内液量随时间变化的直接和间接信息。 PAC 可以测量中心静脉压和肺动脉压、肺动脉闭塞压（PAOP 或“楔压”）、混合静脉血气和指标稀释心输出量。该数据是定量的，因此可以得出更多信息，例如全身和肺血管阻力。这些测量的准确性对于训练有素且合格的人员来说是很高的，但取决于导管的正确放置、传感器的校准以及用户对波形和数据的解释。正确解读 PAC 数据有助于评估左右心室功能、心内分流、肺通气功能和血管内液体状态。正确维护的肺动脉导管可以进行持续监测，这可以提供有关响应治疗干预的改善或恶化趋势的早期信息。 PAC 导管通常用于急性肺损伤 (ALI) 及其最严重的亚型急性呼吸窘迫综合征 (ARDS) 患者。 ALI 是一个在发病率（每年 150,000 名患者）、死亡率（大多数系列中为 30-60%）和费用（部分由于长期住院重症监护）方面具有重要意义的临床问题。在 ALI 患者中，PAC 已被广泛用于确认诊断和优化血流动力学管理。 理论上，PAOP和心输出量的测量可以使医生将肺血管压力维持在较低水平，从而减少肺血管通透性增加时可能发生的肺水肿的数量。而且，维持较低的肺毛细血管压力可以防止或最小化对毛细血管壁的损伤（“应力衰竭”）。肺动脉压和心输出量的测量可以使医生能够更熟练地施用血管活性药物，以优化心输出量，维持或改善肾功能，并增加全身血压和重要器官的血流量。另一方面，通过中心静脉导管 (CVC) 测量中心静脉压可能足以优化 ALI 患者的血流动力学。