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
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- 作者：Shigeki Kushimoto (1)
Yasuhiko Taira (2)
Yasuhide Kitazawa (3)
Kazuo Okuchi (4)
Teruo Sakamoto (5)
Hiroyasu Ishikura (6)
Tomoyuki Endo (7)
Satoshi Yamanouchi (1)
Takashi Tagami (8) (9)
Junko Yamaguchi (10)
Kazuhide Yoshikawa (11)
Manabu Sugita (12)
Yoichi Kase (13)
Takashi Kanemura (14)
Hiroyuki Takahashi (15)
Yuichi Kuroki (16)
Hiroo Izumino (17)
Hiroshi Rinka (18)
Ryutarou Seo (19)
Makoto Takatori (20)
Tadashi Kaneko (21)
Toshiaki Nakamura (22)
Takayuki Irahara (23)
Nobuyuki Saito (24)
Akihiro Watanabe (8) - 刊名：Critical Care
- 出版年：2012
- 出版时间：December 2012
- 年：2012
- 卷：16
- 期：6
- 全文大小：
- 作者单位：Shigeki Kushimoto (1)
Yasuhiko Taira (2)
Yasuhide Kitazawa (3)
Kazuo Okuchi (4)
Teruo Sakamoto (5)
Hiroyasu Ishikura (6)
Tomoyuki Endo (7)
Satoshi Yamanouchi (1)
Takashi Tagami (8) (9)
Junko Yamaguchi (10)
Kazuhide Yoshikawa (11)
Manabu Sugita (12)
Yoichi Kase (13)
Takashi Kanemura (14)
Hiroyuki Takahashi (15)
Yuichi Kuroki (16)
Hiroo Izumino (17)
Hiroshi Rinka (18)
Ryutarou Seo (19)
Makoto Takatori (20)
Tadashi Kaneko (21)
Toshiaki Nakamura (22)
Takayuki Irahara (23)
Nobuyuki Saito (24)
Akihiro Watanabe (8)
1. Division of Emergency Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
2. Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
3. Department of Emergency and Critical Care Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka, 570-8506, Japan
4. Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shinjo-cho, Kashihara, Nara, 634-8521, Japan
5. Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan
6. Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka 814-0180, Japan
7. Advanced Emergency and Critical Care Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
8. Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
9. Department of Emergency and Critical Care Medicine, Aidu Chuo Hospital, 1-1 Tsuruga, Aiduwakamatsu, Fukushima, 965-8611, Japan
10. Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
11. Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
12. Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
13. Department of Critical Care Medicine, Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
14. Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa-shi, Tokyo, 190-0014, Japan
15. Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosumiyosi, Tsurumi-ku, Yokohama City, Kanagawa 230-8765, Japan
16. Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya City, Aichi, 457-8510, Japan
17. Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, 10-15 Fumizono-machi, Moriguchi Cty, Osaka, 570-8507, Japan
18. Emergency and Critical Care Medical Center, Osaka City General Hospital, 2-13-22, Miyakojima Hondori, Miyakojima, Osaka, 534-0021, Japan
19. Department of Anesthesia, Kobe City Medical Center General Hospital, 2-2-1 Minatojimaminamimachi, Chuo-ku, Kobe City, Hyogo, 650-0046, Japan
20. Department of Anesthesia and Intensive Care, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima-shi, Hiroshima, 730-8518, Japan
21. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
22. Intensive Care Unit, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
23. Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan
24. Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-shi, Chiba, 270-1694, Japan - ISSN：1364-8535
文摘
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/FiO2 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/FiO2 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. Trial registration UMIN-CTR ID UMIN000003627