The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome

被引：104

作者：

Kushimoto, Shigeki ^{[1
]}

Taira, Yasuhiko ^{[2
]}

Kitazawa, Yasuhide ^{[3
]}

Okuchi, Kazuo ^{[4
]}

Sakamoto, Teruo ^{[5
]}

Ishikura, Hiroyasu ^{[6
]}

Endo, Tomoyuki ^{[7
]}

Yamanouchi, Satoshi ^{[1
]}

Tagami, Takashi ^{[8
,9
]}

Yamaguchi, Junko ^{[10
]}

Yoshikawa, Kazuhide ^{[11
]}

Sugita, Manabu ^{[12
]}

Kase, Yoichi ^{[13
]}

Kanemura, Takashi ^{[14
]}

Takahashi, Hiroyuki ^{[15
]}

Kuroki, Yuichi ^{[16
]}

Izumino, Hiroo ^{[17
]}

Rinka, Hiroshi ^{[18
]}

Seo, Ryutarou ^{[19
]}

Takatori, Makoto ^{[20
]}

Kaneko, Tadashi ^{[21
]}

Nakamura, Toshiaki ^{[22
]}

Irahara, Takayuki ^{[23
]}

Saito, Nobuyuki ^{[24
]}

Watanabe, Akihiro ^{[8
]}

机构：

[1] Tohoku Univ, Grad Sch Med, Div Emergency Med, Aoba Ku, Sendai, Miyagi 9808574, Japan

[2] St Marianna Univ, Sch Med, Dept Emergency & Crit Care Med, Kawasaki, Kanagawa 2168511, Japan

[3] Kansai Med Univ, Dept Emergency & Crit Care Med, Moriguchi, Osaka 5708506, Japan

[4] Nara Med Univ, Dept Emergency & Crit Care Med, Kashihara, Nara 6348521, Japan

[5] Kurume Univ, Sch Med, Dept Emergency & Crit Care Med, Kurume, Fukuoka 8300011, Japan

[6] Fukuoka Univ, Fac Med, Dept Emergency & Crit Care Med, Jonan Ku, Fukuoka 8140180, Japan

[7] Tohoku Univ Hosp, Adv Emergency & Crit Care Ctr, Aoba Ku, Sendai, Miyagi 9808574, Japan

[8] Nippon Med Coll Hosp, Dept Emergency & Crit Care Med, Bunkyo Ku, Tokyo 1138603, Japan

[9] Aidu Chuo Hosp, Dept Emergency & Crit Care Med, Aiduwakamatsu, Fukushima 9658611, Japan

[10] Nihon Univ, Sch Med, Dept Acute Med, Div Emergency & Crit Care Med,Itabashi Ku, Tokyo 1738610, Japan

[11] Tokyo Med & Dent Univ Hosp, Shock Trauma & Emergency Med Ctr, Bunkyo Ku, Tokyo 1138519, Japan

[12] Juntendo Univ, Nerima Hosp, Dept Emergency & Crit Care Med, Nerima Ku, Tokyo 1778521, Japan

[13] Jikei Univ, Sch Med, Dept Crit Care Med, Minato Ku, Tokyo 1058471, Japan

[14] Natl Hosp, Org Disaster Med Ctr, Tachikawa, Tokyo 1900014, Japan

[15] Saiseikai Yokohamashi Tobu Hosp, Dept Intens Care Med, Tsurumi Ku, Yokohama, Kanagawa 2308765, Japan

[16] Social Insurance Chukyo Hosp, Dept Emergency & Crit Care Med, Minami Ku, Nagoya, Aichi 4578510, Japan

[17] Kansai Med Univ, Takii Hosp, Adv Emergency & Crit Care Ctr, Moriguchi, Osaka 5708507, Japan

[18] Osaka City Gen Hosp, Emergency & Crit Care Med Ctr, Miyakojima, Osaka 5340021, Japan

[19] Gen Hosp, Kobe City Med Ctr, Dept Anesthesia, Chuo Ku, Kobe, Hyogo 6500046, Japan

[20] Hiroshima City Hosp, Dept Anesthesia & Intens Care, Naka Ku, Hiroshima 7308518, Japan

[21] Yamaguchi Univ, Adv Med Emergency & Crit Care Ctr, Ube, Yamaguchi 7558505, Japan

[22] Nagasaki Univ Hosp, Intens Care Unit, Nagasaki 8528501, Japan

[23] Tama Nagayama Hosp, Nippon Med Sch, Dept Emergency & Crit Care Med, Tama, Tokyo 2068512, Japan

[24] Chiba Hokusoh Hosp, Nippon Med Sch, Dept Emergency & Crit Care Med, Inzai, Chiba 2701694, Japan

来源：

CRITICAL CARE | 2012年 / 16卷 / 06期

关键词：

PREDICTED BODY-WEIGHT; SINGLE TRANSPULMONARY THERMODILUTION; EUROPEAN CONSENSUS CONFERENCE; INDICATOR DILUTION TECHNIQUE; END-EXPIRATORY PRESSURE; CRITICALLY-ILL; ARTERY CATHETER; TRIAL COORDINATION; RELEVANT OUTCOMES; CRITICAL-CARE;

D O I：

10.1186/cc11898

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is characterized by features other than increased pulmonary vascular permeability. Pulmonary vascular permeability combined with increased extravascular lung water content has been considered a quantitative diagnostic criterion of ALI/ARDS. This prospective, multi- institutional, observational study aimed to clarify the clinical pathophysiological features of ALI/ARDS and establish its quantitative diagnostic criteria. Methods: The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO(2) ratio <= 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals. Pulmonary edema was defined as EVLWI >= 10 ml/kg. Three experts retrospectively determined the pathophysiological features of respiratory insufficiency by considering the patients' history, clinical presentation, chest computed tomography and radiography, echocardiography, EVLWI and brain natriuretic peptide level, and the time course of all preceding findings under systemic and respiratory therapy. Results: Patients were divided into the following three categories on the basis of the pathophysiological diagnostic differentiation of respiratory insufficiency: ALI/ARDS, cardiogenic edema, and pleural effusion with atelectasis, which were noted in 207 patients, 26 patients, and 33 patients, respectively. EVLWI was greater in ALI/ARDS and cardiogenic edema patients than in patients with pleural effusion with atelectasis (18.5 +/- 6.8, 14.4 +/- 4.0, and 8.3 +/- 2.1, respectively; P < 0.01). PVPI was higher in ALI/ARDS patients than in cardiogenic edema or pleural effusion with atelectasis patients (3.2 +/- 1.4, 2.0 +/- 0.8, and 1.6 +/- 0.5; P < 0.01). In ALI/ARDS patients, EVLWI increased with increasing pulmonary vascular permeability (r = 0.729, P < 0.01) and was weakly correlated with intrathoracic blood volume (r = 0.236, P < 0.01). EVLWI was weakly correlated with the PaO2/FiO(2) ratio in the ALI/ARDS and cardiogenic edema patients. A PVPI value of 2.6 to 2.85 provided a definitive diagnosis of ALI/ARDS (specificity, 0.90 to 0.95), and a value < 1.7 ruled out an ALI/ARDS diagnosis (specificity, 0.95). Conclusion: PVPI may be a useful quantitative diagnostic tool for ARDS in patients with hypoxemic respiratory failure and radiographic infiltrates.

引用

页数：15

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