Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition
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- 作者：Shigeki Kushimoto (1)
Tomoyuki Endo (2)
Satoshi Yamanouchi (1)
Teruo Sakamoto (3)
Hiroyasu Ishikura (4)
Yasuhide Kitazawa (5)
Yasuhiko Taira (6)
Kazuo Okuchi (7)
Takashi Tagami (8)
Akihiro Watanabe (8)
Junko Yamaguchi (9)
Kazuhide Yoshikawa (10)
Manabu Sugita (11)
Yoichi Kase (12)
Takashi Kanemura (13)
Hiroyuki Takahashi (14)
Yuuichi Kuroki (15)
Hiroo Izumino (16)
Hiroshi Rinka (17)
Ryutarou Seo (18)
Makoto Takatori (19)
Tadashi Kaneko (20)
Toshiaki Nakamura (21)
Takayuki Irahara (22)
Nobuyuki Saito (23) - 刊名：Critical Care
- 出版年：2013
- 出版时间：August 2013
- 年：2013
- 卷：17
- 期：4
- 全文大小：
- 作者单位：Shigeki Kushimoto (1)
Tomoyuki Endo (2)
Satoshi Yamanouchi (1)
Teruo Sakamoto (3)
Hiroyasu Ishikura (4)
Yasuhide Kitazawa (5)
Yasuhiko Taira (6)
Kazuo Okuchi (7)
Takashi Tagami (8)
Akihiro Watanabe (8)
Junko Yamaguchi (9)
Kazuhide Yoshikawa (10)
Manabu Sugita (11)
Yoichi Kase (12)
Takashi Kanemura (13)
Hiroyuki Takahashi (14)
Yuuichi Kuroki (15)
Hiroo Izumino (16)
Hiroshi Rinka (17)
Ryutarou Seo (18)
Makoto Takatori (19)
Tadashi Kaneko (20)
Toshiaki Nakamura (21)
Takayuki Irahara (22)
Nobuyuki Saito (23)
1. Division of Emergency Medicine, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
2. Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
3. Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan
4. Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
5. Department of Emergency and Critical Care Medicine, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka, 573-1191, Japan
6. Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
7. Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, 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, Nihon University School of Medicine Itabashi Hospital, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
10. Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
11. Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
12. Critical Care Medicine, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tochigi, 105 8461, Japan
13. Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
14. Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-8765, Japan
15. Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, 1-1-10. Sanjyo, Minami-ku, Nagoya, Aichi, 457-8510, Japan
16. Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, 10-15, Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
17. Emergency and Critical Care Medical Center, Osaka City General Hospital, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
18. Intensive Care Unit, Kobe City Medical Center General Hospital, 4-6, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
19. Department of Anesthesia and Intensive Care, Hiroshima City Hospital, 7-33 Motomachi Naka-ku, Hiroshima-shi, Hiroshima, 730-8518, Japan
20. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1, Minamikogushi, Ube-ku, Yamaguchi, 755-8505, Japan
21. Intensive Care Unit, Nagasaki University Hospital, 1-14 Bunkyo-machi, Nagasaki-ku Nagasaki, 852-8521, Japan
22. Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan
23. Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusou Hospital, 1715 Kamagari, Inzai-shi, Chiba, 270-1694, Japan - ISSN：1364-8535
文摘
Introduction The Berlin definition divides acute respiratory distress syndrome (ARDS) into three severity categories. The relationship between these categories and pulmonary microvascular permeability as well as extravascular lung water content, which is the hallmark of lung pathophysiology, remains to be elucidated. The aim of this study was to evaluate the relationship between extravascular lung water, pulmonary vascular permeability, and the severity categories as defined by the Berlin definition, and to confirm the associated predictive validity for severity. Methods The extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) were measured using a transpulmonary thermodilution method for three consecutive days in 195 patients with an EVLWi of ≥10 mL/kg and who fulfilled the Berlin definition of ARDS. Collectively, these patients were seen at 23 ICUs. Using the Berlin definition, patients were classified into three categories: mild, moderate, and severe. Results Compared to patients with mild ARDS, patients with moderate and severe ARDS had higher acute physiology and chronic health evaluation II and sequential organ failure assessment scores on the day of enrollment. Patients with severe ARDS had higher EVLWi (mild, 16.1; moderate, 17.2; severe, 19.1; P <0.05) and PVPI (2.7; 3.0; 3.2; P <0.05). When categories were defined by the minimum PaO2/FIO2 ratio observed during the study period, the 28-day mortality rate increased with severity categories: moderate, odds ratio: 3.125 relative to mild; and severe, odds ratio: 4.167 relative to mild. On independent evaluation of 495 measurements from 195 patients over three days, negative and moderate correlations were observed between EVLWi and the PaO2/FIO2 ratio (r = -0.355, P<0.001) as well as between PVPI and the PaO2/FIO2 ratio (r = -0.345, P <0.001). ARDS severity was associated with an increase in EVLWi with the categories (mild, 14.7; moderate, 16.2; severe, 20.0; P <0.001) in all data sets. The value of PVPI followed the same pattern (2.6; 2.7; 3.5; P <0.001). Conclusions Severity categories of ARDS described by the Berlin definition have good predictive validity and may be associated with increased extravascular lung water and pulmonary vascular permeability. Trial registration UMIN-CTR ID UMIN000003627