TRIAL OF PULMONARY ARTERY CATHETER VS CENTRAL VENOUS CATHETER FOR ARDS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。肺动脉导管(PAC)于1970年被引入临床使用，以提供其他临床来源无法提供的诊断和监测信息。PAC提供了关于循环系统、呼吸系统和血管内液体量随时间变化的丰富的直接和间接信息。PAC可以测量中心静脉和肺动脉压、肺动脉阻断压(PAOP或“楔压”)、混合静脉血气和指示器稀释心输出量。这些数据是定量的，因此可以得出更多的信息，如全身和肺血管阻力。这些测量的准确性在训练有素和合格的手中很高，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。正确解释PAC数据有助于评估右、左心功能、心内分流、肺呼吸功能和血管内液体状态。适当维护的肺动脉导管可以进行持续监测，这可以提供有关治疗干预反应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在发病率(每年15万名患者)、死亡率(大多数病例中为30%-60%)和费用(部分原因是长期住在重症监护病房)方面是一个重大的临床问题。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。从理论上讲，测量PAOP和心输出量可能使医生能够将肺血管压力维持在较低水平，从而减少在肺血管通透性增加时可能出现的肺水肿量。此外，保持较低的肺毛细血管压力可以防止或最大限度地减少对毛细血管壁的损害(“应力失效”)。测量肺动脉压和心输出量可能使医生有可能更熟练地使用血管活性药物，以优化心输出量，维持或改善肾功能，并增加全身血压和流向重要器官的血流量。另一方面，使用中心静脉导管(CVC)测量中心静脉压足以优化ALI患者的血流动力学。

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.