AIM: To investigate extravascular lung water indexed to predicted body weight(EVLWIp) and actual body weight(EVLWIa) on outcome of patients with severe sepsis.METHODS: Transpulmonary thermodilution was prospectively u...AIM: To investigate extravascular lung water indexed to predicted body weight(EVLWIp) and actual body weight(EVLWIa) on outcome of patients with severe sepsis.METHODS: Transpulmonary thermodilution was prospectively used to measure cardiovascular hemodynamics, EVLWIp and EVLWIa via an arterial catheter placed in each patient within 48 h of meeting the criteria for severe sepsis from a medical intensive care unit(ICU) at a university affiliated hospital. Survival was the single dependent variable. In order to examine and compare the predictive power of EVLWIp, EVLWIa and other clinically significant factors in predicting the inhospital survival status of severe sepsis patients in the medical ICU, a receiver operating characteristic(ROC) curve method to analyze the significant variables and the area under the ROC curve(AUC) of the variables, P value and 95%CI were calculated.RESULTS: In total, 33 patients were studied. In the ROC curve method analyses, EVLWIp(the AUC: 0.849; P = 0.001, 95%CI: 0.72-0.98) was as predictive for inhospital survival rate as variables with EVLWIa(AUC, 0.829; P = 0.001, 95%CI: 0.68-0.98). The proportion of patients surviving with a low EVLW(EVLWI < 10 m L/kg) was better than that of patients with a higher EVLW, whether indexed by actual(HR = 0.2; P = 0.0002, 95%CI: 0.06-0.42) or predicted body weight(HR = 0.13; P < 0.0001, 95%CI: 0.05-0.35) during their hospital stay with the Kaplan-Meier method(76% vs 12.5%, respectively).CONCLUSION: This investigation proposed that EVLWIp is as good a predictor as EVLWIa to predict inhospital survival rate among severe sepsis patients in the medical ICU.展开更多
The effect of high frequency oscillatory ventilation（HFOV） at early stage on hemodynamic parameters, extravascular lung water（EVLW）, lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extr...The effect of high frequency oscillatory ventilation（HFOV） at early stage on hemodynamic parameters, extravascular lung water（EVLW）, lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome（ARDS） was explored. Central vein pressure（CVP） and pulse indicator continuous cardiac output（Pi CCO） were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS（ARDSp） and extrapulmonary ARDS（ARDSexp） models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index（EVLWI）, EVLW/intratroracic blood volume（ITBV） and pulmonary vascular permeability index（PVPI） were measured before and after modeling（T0 and T1）, and T2（1 h）, T3（2 h）, T4（3 h） and T5（4 h） after HFOV. CC16 and s ICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group（P〈0.05）. The EVLWI in ARDSp group was increased at T1（P=0.008）, and sustained continuously within 2 h（P=0.679, P=0.216）, but decreased at T4（P=0.007） and T5（P=0.037）. The EVLWI in ARDSexp group was also increased at T1（P=0.003）, but significantly decreased at T3（P=0.002） and T4（P=0.019）. PVPI was increased after modeling in both two groups（P=0.004, P=0.012）, but there was no significant change within 4 h（T5） under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI（P=0.13）, ΔPVPI（P=0.28） and ΔEVLW/ITBV between the two groups（P=0.63）. The significant decreases in both CC16 and s ICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.展开更多
基金Supported by Grants from Taiwan National Science Council,No.NSC-100-2314-B-182A-054Chang Gung Memorial Hospital,Nos.CMRPG3B0831,CMRPG3B0832 and CMRPG3A0562
文摘AIM: To investigate extravascular lung water indexed to predicted body weight(EVLWIp) and actual body weight(EVLWIa) on outcome of patients with severe sepsis.METHODS: Transpulmonary thermodilution was prospectively used to measure cardiovascular hemodynamics, EVLWIp and EVLWIa via an arterial catheter placed in each patient within 48 h of meeting the criteria for severe sepsis from a medical intensive care unit(ICU) at a university affiliated hospital. Survival was the single dependent variable. In order to examine and compare the predictive power of EVLWIp, EVLWIa and other clinically significant factors in predicting the inhospital survival status of severe sepsis patients in the medical ICU, a receiver operating characteristic(ROC) curve method to analyze the significant variables and the area under the ROC curve(AUC) of the variables, P value and 95%CI were calculated.RESULTS: In total, 33 patients were studied. In the ROC curve method analyses, EVLWIp(the AUC: 0.849; P = 0.001, 95%CI: 0.72-0.98) was as predictive for inhospital survival rate as variables with EVLWIa(AUC, 0.829; P = 0.001, 95%CI: 0.68-0.98). The proportion of patients surviving with a low EVLW(EVLWI < 10 m L/kg) was better than that of patients with a higher EVLW, whether indexed by actual(HR = 0.2; P = 0.0002, 95%CI: 0.06-0.42) or predicted body weight(HR = 0.13; P < 0.0001, 95%CI: 0.05-0.35) during their hospital stay with the Kaplan-Meier method(76% vs 12.5%, respectively).CONCLUSION: This investigation proposed that EVLWIp is as good a predictor as EVLWIa to predict inhospital survival rate among severe sepsis patients in the medical ICU.
文摘The effect of high frequency oscillatory ventilation（HFOV） at early stage on hemodynamic parameters, extravascular lung water（EVLW）, lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome（ARDS） was explored. Central vein pressure（CVP） and pulse indicator continuous cardiac output（Pi CCO） were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS（ARDSp） and extrapulmonary ARDS（ARDSexp） models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index（EVLWI）, EVLW/intratroracic blood volume（ITBV） and pulmonary vascular permeability index（PVPI） were measured before and after modeling（T0 and T1）, and T2（1 h）, T3（2 h）, T4（3 h） and T5（4 h） after HFOV. CC16 and s ICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group（P〈0.05）. The EVLWI in ARDSp group was increased at T1（P=0.008）, and sustained continuously within 2 h（P=0.679, P=0.216）, but decreased at T4（P=0.007） and T5（P=0.037）. The EVLWI in ARDSexp group was also increased at T1（P=0.003）, but significantly decreased at T3（P=0.002） and T4（P=0.019）. PVPI was increased after modeling in both two groups（P=0.004, P=0.012）, but there was no significant change within 4 h（T5） under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI（P=0.13）, ΔPVPI（P=0.28） and ΔEVLW/ITBV between the two groups（P=0.63）. The significant decreases in both CC16 and s ICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.
