PICCO指导的食管癌术后ARDS患者容量管理
摘要
目的:急性呼吸窘迫综合征(ARDS)是重症患者发生呼吸衰竭的主要原因。目前认为感染、创伤、休克、大量输血、大量输液后的过度炎症反应是导致ARDS的根本原因。过度的炎症反应损伤肺泡上皮和内皮细胞导致肺毛细血管通透性增加,富含蛋白的水肿液进入肺间质甚至肺泡,形成肺水肿。
肺血管内皮通透性(PPI)增加是ARDS重要病理生理特点。PPI增加又导致血管外肺水(EVLW)增加,肺水肿的严重程度与ARDS预后密切相关。因此如何对ARDS患者进行容量管理尤为重要。然而ARDS最佳的容量管理仍未明确,研究显示对于创伤导致的ALI/ARDS病人液体正平衡使危重患者病死率明显增加,液体负平衡与感染性休克患者病死率的降低显著相关,因此推荐容量管理目标为保证心输出量基础上的最低肺动脉楔压(PAWP)。但是,最近的临床研究证实利用压力(CVP和PAWP)反映容量的方法是不准确的。胸腔内血容量(ITBV)/全新舒张末容积(GEDV)是反映危重病患者循环血容量更好的指标。
脉搏指示剂心排血量(PICCO)可直接提供两个重要的血流动力学信息—EVLW和心脏前负荷(ITBV/GEDV),本研究以PICCO指导ARDS容量管理,保证容量充足的基础上尽量减少血管外肺水的产生,早期达到液体负平衡,以期改善预后。
方法:食管癌术后ARDS患者24例,随机分为2组:①CVP监测治疗组:根据CVP及尿量,心率、平均动脉压等传统临床表现给与开放性液体管理;②PICCO监测治疗组:根据PICCO监测血流动力学数据结合患者尿量、心率,平均动脉压等临床表现给与限制性液体管理;记录前7天每天液体入量,出量,液体平衡,血管外肺水指数(EVLWI)变化,氧合指数(PaO2/FiO2),机械通气时间,ICU住院时间,观察28天死亡率。
数据统计分析采用SPSS13.0版软件包进行;数据均以均数±标准差(mean±s)表示,两组均数的比较行两组独立样本t检验,多个样本均数间比较采用单因素方差分析,两样本率的比较采用卡方检验,EVLWI与GEDVI、ITBVI、PVPI、LIS、PaO2/FiO2、CI、SVRI及CVP相关性分析应用直线相关分析。P<0.05为差异有统计学意义。
结果
1两组28天死亡率比较无差异(18%VS18%,P>0.05)。PICCO组与CVP组入选后7天累计液体入量分别为(27851.8±4578.6ml VS 33247±4524.2ml, P<0.05);累计7天液体净平衡两组比较(PICCO组4584±3615ml;CVP组8402±4248ml,P<0.05);达到液体负平衡(>500ml)的时间分别为(PICCO组4.17±1.64d;CVP组6.75±2.63d,P<0.01);PICCO组较CVP组显著改善了第5天的氧合指数(248±21 VS 200±22,P<0.05),缩短了机械通气天数(6.1±1.6d VS 8.0±2.4d,P<0.05)及ICU住院天数(8.4±2.5d VS 10.5±2.2d, P<0.05);PICCO组较CVP组未增加休克及急性肾功能衰竭的发生率。机械通气天数与达到液体负平衡的时间存在正相关性(r=0.61,P<0.01);中心静脉压均值CVP组较PICCO组高(13±0.7mmHg VS 9±0.5mmHg,P<0.05)。
2 EVLWI与其他指标的相关性
EVLWI与ITBVI存在正相关性(r=0.512,P<0.01);EVLWI与GEDVI存在正相关性(r=0.573,P<0.05);EVLWI变化与液体平衡改变存在正相关性(r=0.439,P<0.05);EVLWI与肺血管通透指数(PVPI)(r=0.767,P<0.01)以及肺损伤评分(LIS)(r=0.613,P<0.01)存在正相关性。EVLWI与氧合指数整体存在负相关性(r=0.48,P<0.01),EVLWI越高,氧合指数越差(r=0.65,P<0.01);EVLWI与CI、SVRI及CVP不存在直接相关性(P>0.05);CVP与GEDVI、ITBVI亦无相关性。
3实验室指标
监测1、3、5天pH值、BE值、Cr、BUN变化PICCO组与CVP组各时间点组间比较均无差异。但ALB水平PICCO组较CVP组改善显著,第5天PICCO组高于CVP组(24.74±2.51 VS 1.68±3.06,P<0.05)。
结论:PICCO监测血流动力学指导ARDS限制性液体管理较CVP监测下的传统液体管理有好的临床结果。虽然没有改善患者的死亡率,但PICCO组能够减少容量负荷,减轻肺水肿的发生,缩短机械通气时间及ICU住院时间,且不增加肺外脏器的损伤。
Objective: The acute respiratory distress syndrome(ARDS)is the major cause of acute respiratory failure in the critically ill patient.Currently,it is believed that ARDS result from the extensive and excessive inflammatory reaction in the lung due to serious strikes such as serious infection,trauma, shock,massive blood transfusion,high-dose infusion.Excessive inflammatory injury the alveolar epithelial and endothelial barriers of the lung and increse pulmonary capillary permeability,which brings about protein rich fliud accumulated in alveolar and interstitial and than causes pulmonary edema further.
Increase in pumonary vascular endothelial permeability(PPI)incresae is an important pathophysiological feature of ARDS,which would lead to increase in extravascular lung water(EVLW)and that increased the severity of pumonary edema,which is closely related to the prognosis of ARDS.Unfortunately there is still a controversy that how to keep a fliud balance in this patient population.Recent data indicated that consistent positive fluid gain was associated with a worse outcome in patients with ARDS or after major surgery and a negative fluid balane was correlation with the mortality decrease of septic shock patients.Recommendated fluid management goal is the lowest possible pulmonary wedge pressure consistent with an adequate cardiac output.However,recent clinical studies confirmed that it was not accurate to reflect cardic volume by pressure(CVP and PAWP).May be Intrathoracic Blood Volume(ITBV)/Global End Diastolic Volume(GEDV)was a better indicater of circulation blood volume in critical ill patient.
Pulse indicator cardiac output (PICCO) would provide two important haemodynamics information-EVLW and cardic preload(ITBV/GEDV).In this study,PICCO was used to guide ARDS capacity management in order to ensure adequate capacity on the basis of minimizing extravasclar lung water and achieve an early negative fluid balance for improvement of patients’prognosis.
Methods:Twenty-four patients with ARDS after esophagectomy were randomly divided into 2 groups(n=12each):①C VP monitoring-treated group,in which the traditional liberty fliud management strategy was given according to the CVP,urine output,heart rate and mean arterial pressure;②PICCO monitoring-treated group,in which a restrictive fliud management was given according to the PICCO monitoring of hemodynamic data in conbination with urine output,heart rate,mean arterial pressure.Then the amount of liqud into and out volume,fliud balance,extravascular lung water index(EVLWI)changes and oxygenation index(PaO2/FiO2)were record during study days 1 to 7,ventilator days,length of stay and the 28-days mortality were record too.
Statistical analysis was performed using SPSS 13.0 software package. Data were expressed as mean±SD;Compared two-sample using Student’s t-tests.The means of each group were analysed with ANOVA;Compared two-sample rate use chi-square test;The relationship bettween EVLWI with GEDVI,ITBVI,PVPI,LIS,PaO2/FiO2 ratio,CI,SVRI and CVP were analyzed by linea correlation analysis.A statistical significant was P-value<0.05.
Results:
1 No statistical difference developed to the overall 28-day mortality beteen the two groups(18.0%VS18.0%,P>0.05).The mean cumulative fluid input during 1 to 7 day was 27851.8±4578.6ml in PICCO group and 33247±4524.2 ml in cvp group,respectively(P<0.05).The net balance of the two groups of liquid was 4584.0±3615.0ml in the PICCO group,and 8402.0±4248.0ml in the cvp group(P<0.05)during the first seven days;The time by which a nagative fliuld balance(>500mL)was achieved was earlier in the PICCO group than in the cvp group(4.17±1.64d VS 6.75±2.63d,P=0.009);The oxygenation index of Day 5 was better in the PICCO group than in cvp group(248±21 VS 200±22, P<0.05).The PICCO group reduce the number of ventilator days (6.1±1.6d VS 8.0±2.4d,P<0.05) and ICU length of stay(8.4±2.5d VS 10.5±2.2d,P<0.05). The shock and acute kidney falure incidenc was not increased in the PICCO group than in the cvp group.There was a positive correlation between ventilator days and the achievement of negative fluid balance of the time(r=0.61,P<0.01);The mean CVP was high in CVP group compared with PICCO group(13±0.7mmHg VS 9±0.5mmHg,P<0.05).
2 Correlation with extravascular lung water index(EVLWI)
There was a positive correlation between EVLWI and ITBVI(r=0.512, P<0.01);EVLWI was well correlated with the GEDVI(r=0.573,P<0.05);The change in EVLWI has positive correlation with the change in fliud balance (r=0.439,P<0.05);EVLWI was also well correlated with the pumonary vascular endothelial permeability index(PVPI)(r=0.767,P<0.01)and lung injury score(LIS)(r=0.613,P<0.01);EVLWI was negative correlation with oxygenation index(r=0.48,P<0.01).There was a signifacant correlation between the highest EVLWI and the lowest PaO2/FiO2 ratio(r=0.65,P<0.01);There was no correlation between EVLWI with CI, SVRI,and CVP(P>0.05); There was also no correlation between CVP and GEDVI or ITBVI,either.
3 Lab Index
There was no statistical difference in pH value,acid-base status,serum urea nitrogen levels and serum creatinine levels between the PICCO group and the CVP group at each time point.But the ALB level was improved significantly in PICCO group compared with CVP group.The ALB level was 24.74±2.51g/l in PICCO group and 21.68±3.06g/l in CVP group at day 5,P<0.05.
Conclusions:Conservative-strategy with PICCO seystem moniter hemodynamic of patients with ARDS after esophagectomy has better outcome compared to liberal-strategy with CVP.Though there was no reduction in overall mortality, PICCO group can reduce the volume overload, reduce the incidence of acute pulmonary edema, improved the oxygenation index and decreased the number of ventilator days and ICU length of stay,without increse the extrapulmonary organ damage.
肺血管内皮通透性(PPI)增加是ARDS重要病理生理特点。PPI增加又导致血管外肺水(EVLW)增加,肺水肿的严重程度与ARDS预后密切相关。因此如何对ARDS患者进行容量管理尤为重要。然而ARDS最佳的容量管理仍未明确,研究显示对于创伤导致的ALI/ARDS病人液体正平衡使危重患者病死率明显增加,液体负平衡与感染性休克患者病死率的降低显著相关,因此推荐容量管理目标为保证心输出量基础上的最低肺动脉楔压(PAWP)。但是,最近的临床研究证实利用压力(CVP和PAWP)反映容量的方法是不准确的。胸腔内血容量(ITBV)/全新舒张末容积(GEDV)是反映危重病患者循环血容量更好的指标。
脉搏指示剂心排血量(PICCO)可直接提供两个重要的血流动力学信息—EVLW和心脏前负荷(ITBV/GEDV),本研究以PICCO指导ARDS容量管理,保证容量充足的基础上尽量减少血管外肺水的产生,早期达到液体负平衡,以期改善预后。
方法:食管癌术后ARDS患者24例,随机分为2组:①CVP监测治疗组:根据CVP及尿量,心率、平均动脉压等传统临床表现给与开放性液体管理;②PICCO监测治疗组:根据PICCO监测血流动力学数据结合患者尿量、心率,平均动脉压等临床表现给与限制性液体管理;记录前7天每天液体入量,出量,液体平衡,血管外肺水指数(EVLWI)变化,氧合指数(PaO2/FiO2),机械通气时间,ICU住院时间,观察28天死亡率。
数据统计分析采用SPSS13.0版软件包进行;数据均以均数±标准差(mean±s)表示,两组均数的比较行两组独立样本t检验,多个样本均数间比较采用单因素方差分析,两样本率的比较采用卡方检验,EVLWI与GEDVI、ITBVI、PVPI、LIS、PaO2/FiO2、CI、SVRI及CVP相关性分析应用直线相关分析。P<0.05为差异有统计学意义。
结果
1两组28天死亡率比较无差异(18%VS18%,P>0.05)。PICCO组与CVP组入选后7天累计液体入量分别为(27851.8±4578.6ml VS 33247±4524.2ml, P<0.05);累计7天液体净平衡两组比较(PICCO组4584±3615ml;CVP组8402±4248ml,P<0.05);达到液体负平衡(>500ml)的时间分别为(PICCO组4.17±1.64d;CVP组6.75±2.63d,P<0.01);PICCO组较CVP组显著改善了第5天的氧合指数(248±21 VS 200±22,P<0.05),缩短了机械通气天数(6.1±1.6d VS 8.0±2.4d,P<0.05)及ICU住院天数(8.4±2.5d VS 10.5±2.2d, P<0.05);PICCO组较CVP组未增加休克及急性肾功能衰竭的发生率。机械通气天数与达到液体负平衡的时间存在正相关性(r=0.61,P<0.01);中心静脉压均值CVP组较PICCO组高(13±0.7mmHg VS 9±0.5mmHg,P<0.05)。
2 EVLWI与其他指标的相关性
EVLWI与ITBVI存在正相关性(r=0.512,P<0.01);EVLWI与GEDVI存在正相关性(r=0.573,P<0.05);EVLWI变化与液体平衡改变存在正相关性(r=0.439,P<0.05);EVLWI与肺血管通透指数(PVPI)(r=0.767,P<0.01)以及肺损伤评分(LIS)(r=0.613,P<0.01)存在正相关性。EVLWI与氧合指数整体存在负相关性(r=0.48,P<0.01),EVLWI越高,氧合指数越差(r=0.65,P<0.01);EVLWI与CI、SVRI及CVP不存在直接相关性(P>0.05);CVP与GEDVI、ITBVI亦无相关性。
3实验室指标
监测1、3、5天pH值、BE值、Cr、BUN变化PICCO组与CVP组各时间点组间比较均无差异。但ALB水平PICCO组较CVP组改善显著,第5天PICCO组高于CVP组(24.74±2.51 VS 1.68±3.06,P<0.05)。
结论:PICCO监测血流动力学指导ARDS限制性液体管理较CVP监测下的传统液体管理有好的临床结果。虽然没有改善患者的死亡率,但PICCO组能够减少容量负荷,减轻肺水肿的发生,缩短机械通气时间及ICU住院时间,且不增加肺外脏器的损伤。
Objective: The acute respiratory distress syndrome(ARDS)is the major cause of acute respiratory failure in the critically ill patient.Currently,it is believed that ARDS result from the extensive and excessive inflammatory reaction in the lung due to serious strikes such as serious infection,trauma, shock,massive blood transfusion,high-dose infusion.Excessive inflammatory injury the alveolar epithelial and endothelial barriers of the lung and increse pulmonary capillary permeability,which brings about protein rich fliud accumulated in alveolar and interstitial and than causes pulmonary edema further.
Increase in pumonary vascular endothelial permeability(PPI)incresae is an important pathophysiological feature of ARDS,which would lead to increase in extravascular lung water(EVLW)and that increased the severity of pumonary edema,which is closely related to the prognosis of ARDS.Unfortunately there is still a controversy that how to keep a fliud balance in this patient population.Recent data indicated that consistent positive fluid gain was associated with a worse outcome in patients with ARDS or after major surgery and a negative fluid balane was correlation with the mortality decrease of septic shock patients.Recommendated fluid management goal is the lowest possible pulmonary wedge pressure consistent with an adequate cardiac output.However,recent clinical studies confirmed that it was not accurate to reflect cardic volume by pressure(CVP and PAWP).May be Intrathoracic Blood Volume(ITBV)/Global End Diastolic Volume(GEDV)was a better indicater of circulation blood volume in critical ill patient.
Pulse indicator cardiac output (PICCO) would provide two important haemodynamics information-EVLW and cardic preload(ITBV/GEDV).In this study,PICCO was used to guide ARDS capacity management in order to ensure adequate capacity on the basis of minimizing extravasclar lung water and achieve an early negative fluid balance for improvement of patients’prognosis.
Methods:Twenty-four patients with ARDS after esophagectomy were randomly divided into 2 groups(n=12each):①C VP monitoring-treated group,in which the traditional liberty fliud management strategy was given according to the CVP,urine output,heart rate and mean arterial pressure;②PICCO monitoring-treated group,in which a restrictive fliud management was given according to the PICCO monitoring of hemodynamic data in conbination with urine output,heart rate,mean arterial pressure.Then the amount of liqud into and out volume,fliud balance,extravascular lung water index(EVLWI)changes and oxygenation index(PaO2/FiO2)were record during study days 1 to 7,ventilator days,length of stay and the 28-days mortality were record too.
Statistical analysis was performed using SPSS 13.0 software package. Data were expressed as mean±SD;Compared two-sample using Student’s t-tests.The means of each group were analysed with ANOVA;Compared two-sample rate use chi-square test;The relationship bettween EVLWI with GEDVI,ITBVI,PVPI,LIS,PaO2/FiO2 ratio,CI,SVRI and CVP were analyzed by linea correlation analysis.A statistical significant was P-value<0.05.
Results:
1 No statistical difference developed to the overall 28-day mortality beteen the two groups(18.0%VS18.0%,P>0.05).The mean cumulative fluid input during 1 to 7 day was 27851.8±4578.6ml in PICCO group and 33247±4524.2 ml in cvp group,respectively(P<0.05).The net balance of the two groups of liquid was 4584.0±3615.0ml in the PICCO group,and 8402.0±4248.0ml in the cvp group(P<0.05)during the first seven days;The time by which a nagative fliuld balance(>500mL)was achieved was earlier in the PICCO group than in the cvp group(4.17±1.64d VS 6.75±2.63d,P=0.009);The oxygenation index of Day 5 was better in the PICCO group than in cvp group(248±21 VS 200±22, P<0.05).The PICCO group reduce the number of ventilator days (6.1±1.6d VS 8.0±2.4d,P<0.05) and ICU length of stay(8.4±2.5d VS 10.5±2.2d,P<0.05). The shock and acute kidney falure incidenc was not increased in the PICCO group than in the cvp group.There was a positive correlation between ventilator days and the achievement of negative fluid balance of the time(r=0.61,P<0.01);The mean CVP was high in CVP group compared with PICCO group(13±0.7mmHg VS 9±0.5mmHg,P<0.05).
2 Correlation with extravascular lung water index(EVLWI)
There was a positive correlation between EVLWI and ITBVI(r=0.512, P<0.01);EVLWI was well correlated with the GEDVI(r=0.573,P<0.05);The change in EVLWI has positive correlation with the change in fliud balance (r=0.439,P<0.05);EVLWI was also well correlated with the pumonary vascular endothelial permeability index(PVPI)(r=0.767,P<0.01)and lung injury score(LIS)(r=0.613,P<0.01);EVLWI was negative correlation with oxygenation index(r=0.48,P<0.01).There was a signifacant correlation between the highest EVLWI and the lowest PaO2/FiO2 ratio(r=0.65,P<0.01);There was no correlation between EVLWI with CI, SVRI,and CVP(P>0.05); There was also no correlation between CVP and GEDVI or ITBVI,either.
3 Lab Index
There was no statistical difference in pH value,acid-base status,serum urea nitrogen levels and serum creatinine levels between the PICCO group and the CVP group at each time point.But the ALB level was improved significantly in PICCO group compared with CVP group.The ALB level was 24.74±2.51g/l in PICCO group and 21.68±3.06g/l in CVP group at day 5,P<0.05.
Conclusions:Conservative-strategy with PICCO seystem moniter hemodynamic of patients with ARDS after esophagectomy has better outcome compared to liberal-strategy with CVP.Though there was no reduction in overall mortality, PICCO group can reduce the volume overload, reduce the incidence of acute pulmonary edema, improved the oxygenation index and decreased the number of ventilator days and ICU length of stay,without increse the extrapulmonary organ damage.
引文
1 Kathleen D. Liu and Michael A. Matthay Advances in Critical Care for the Nephrologist: Acute Lung Injury/ARDS Clin J Am Soc Nephrol,2008,3:578-586
2 Stapleton RD, Wang BM, Hudson LD, et al. Causes and timing of death in patients with ARDS. Chest,2005,128: 525-532
3 Doyle RL, Szaflarski N, Modin GW, et al. Identification of patients with acute lung injury: predictors of mortality. Am J Respir Crit Care Med, 1995,152:1818-1824
4 Matthay MA, Zimmerman GA, et al.Acute lung injury and the acute respiratory distress syndrome: four decades of inquiry into pathogenesis and rational management. Am J Respir Cell Mol Biol,2005,33: 319-327
5急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)中国实用外科杂志,2007(1),27:1
6 Alsous F, Khamiees M, DeGirolamo A, et al. Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study. Chest, 2000,117:1749-1754
7 Humphrey H, Hall J, Sznajder I, et al. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest, 1990,97:1176-1180
8 Simmons RS, Berdine GG, Seidenfeld JJ, et al. Fluid balance and the adult respiratory distress syndrome. Am Rev Respir Dis 1987,135:924 -929
9 Sakr Y, Vincent JL, Reinhart K, et al. High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest,2005,128:3098–3108
10 Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid management strategies in acute lung injury. N Engl J Med ,2006, 354: 2564-2575
11 Thomas Pohl ,Jan Kozieras, Samir G. Sakka, et al. Influence of extravascular lung water on transpulmonary thermodilution-derived cardiac output measurement . Intensive Care Med, 2008,34:533–537
12 Ferna’ndez-Monde’jar E,Rivera-Ferna’ndez R,Garci’a-Delgado M,et al. Small increases in extravascular lung water are accurately detected by transpulmonary thermodilution. J Trauma,2005,59:1420-1424
13 Bernard GR, Artigas A, Brigham KL The American-European Consensus Conference on ARDS: definitions,mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med,1994,149: 818-824
14 Rubenfeld GD, Caldwell E, Peabody E, et al.Incidence and outcomes of acute lung injury.N Engl J Med,2005, 353:1685–1693
15 Massimo Zambon and Jean-Louis Vincent.Mortality Rates for Patients With Acute Lung Injury/ARDS Have Decreased Over Time. Chest, 2008, 133:1120-1127
16 Mitchell J,Schuller D,Calandrino F,et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization.Am Rev Respir Dis,1992,145:990-998
17 SAKKA S G,KLEIN M,EEINHART K,et a1.Prognostic value of extravascular lung water in critically ill patients. Chest, 2002, 122: 2080-2086
18 Boussat S, Jacques T, LevyB, et al. Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema.Intensive Care Med, 2002,28:712-718
19 Ros Cottis, Neil Magee and David J. Higgins. Haemodynamic monitoring with pulse-induced contour cardiac output (PiCCO) in critical care .Intensive and Critical Care Nursing ,2003,19, 301-307
20 Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effectsof intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens; a randomized assessor-blinded multicenter trial. Ann Surg,2003,238:641-648
21 HUDSON E,BEALE R.Lung water and blood volume measurements in critically ill[J].Curt Opin Crit Care,2000,6:222-226
22 T.SZAKMANY, P.HEIGI, Z.MOLNAR Correlation Between Extravascular Lung Water and Oxygenation in ALI/ARDS Patients in Septic Shock:Possible Role in the Development of Atelectasis?Anaesth Intensive Care, 2004,32:196-201
23 Ferna’ndez-Monde’jar E,Rivera-Ferna’ndez R,Garcl’-Delgado M,et al. Small increases in extravaseular lung water are accurately detected by trans Pulmonary thermodilution. Jtrauma,2005,59:1420-1424
24 Charmaine A. Lewis and Greg S. Martin Understanding and Managing fluid balance in patients with acute lung injury. Curr Opin Crit Care 2004, 10:13-17
25 Andew L,Rosenberg,MD.Fluid management in distress syndrome.Respir Care Clin,2003,9:481-493
26 Guyton AC, Lindsey AW. Effect of elevated left atrial pressure and decreasedplasma protein concentration on the development of pulmonary edema. Circ Res,1959;7:649-657
27 Humphrey H, Hall J, Sznajder I, et al. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest,1990,97:1176-1180
28 Rackow EC, Fein IA, Siegel J. The relationship of colloid oncotic pressure-pulmonary artery wedge pressure gradient to pulmonary edema and mortalityin critically ill patients. Chest, 1982,82:433-437
29 Mangliardi RJ, Martin GS, Bernard GR, et al. Hypoproteinemia predicts acuterespiratory distress syndrome development, weight gain, and death in patientswith sepsis. Crit Care Med, 2000,28:3137-3145
30 Quinlan GJ ,Mumby S ,Martin GS , et al1 .Albumin influences plasma and tioxidants favorably in ALI[J]. Crit.Care Med, 2004,32(3):755-759
31 Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med,2002,30:2175-2182
32 Mohsenifar Z,Goldbach P,Tashkin DP,et al.Relationship betwween O2 delivery and O2 consumption in the adult respiratory distress syndrome. Chest ,1983,84:1176
33 Shoemaker WC,Appel PL,Kram HB,et al.Prospective trail of supranormal values of survivors as therapeutic goals in high-risk surgical patients.Chest, 1988,94:1176
34 Yu M,Levy MM,Smith P,et al.Effect of maximizing oxyen delivery on morbility and mortality rates in criticlly ill patients:a prospective randomized controlled study.Crit Care Med, 1993,21:830-837
35 Hayes MA,Timmins AC,Yau EH,et al.Elevation of systemic oxygen delivery in the treatment of critically ill patients.N Engl JMED , 1994,330:1717
36 Sivak ED,Tita J,Meden G,et al.Effects of furosemide versus isolated ultrafiltration on extravascular lung water in oleic acid-induced pulmonary edama. Crit Care Med ,1986,14:48-51
37 Schuster DP,Haller J.A quantitative correlation of extravascular lung water accumulation with vascular permeability and hydrostatic pressure measurements:a positron emission tomography study. J Crit Care,1990, 5:161-168
38 Simmons RS,Berdine GG,Seidenfeld JJ,et al. Fluid balance and adult respiratory distress syndronme.Am Rev Respir Dis,1987,135:924-929
39 Luce JM.Acute lung injury and the acute respiratory distress syndrome. Crit Care Med, 1998,26(2):369-376
40 Mitchell JP,Schuller D,Calandrino FS, et al.Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization.Am Rev Respir Dis,1992,145(5):990-998
41 .Schuster DP.Fluid management in ARDS:"keep them dry"or does it matter?Intensive CareMed,1995,21:101-103
42 Alsous F, Khamiees M, DeGirolamo A, et al. Negative fluid Balance predicts survival in patients with septic shock: a retrospective pilot study. Chest,2000,117:1749-1754
43 Lakshmi Durairaj,Gregory A Schmidt. Fluid Therapy in Resuscitated Sepsis-Less Is More. CHEST,2008,133:252-263
44 Epstein CD, Peerless JR. Weaning readiness and fluid balance in older critically ill surgical patients. Am J Crit Care,2006,15:54-64
45 Upadya A, Tilluckdharry L, Muralidharan V, et al. Fluid balance and weaning outcomes. Intensive Care Med,2005,31: 1643–1647
1 Heather R,Elizabeth A Beltz,Mary B.Ross,et al. Recent R,developmentsin the management of acute respiratory distress syndrome in adults.Am J Health-Syst Pharm, 2008,65:29-36
2 Krishnan Raghavendran,Gloria S. Pryhuber, Patricia R. Chess, et al. Pharmacotherapy of Acute Lung Injury and Acute Respiratory Distress Syndrome. Current Medicinal Chemistry, 2008,15,1911-1924
3 Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet,1967,2: 319-323
4 Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl Jmed,2005,353:1685-1693
5 Bernard GR ,Artigas A ,Brigham KL ,et al. The American-European consensus conference on ARDS:definitions,mechanism,relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med , 1994,149: 818–824
6 K Atabai, M A Matthay: Acute lung injury and the acute respiratory distress syndrome:definitions and epidemiology.Thorax, 2002, 57: 452 -458
7 Kenji Tsushima1, Landon S King, Neil R Aggarwal, et al.Acute Lung Injury Review.Inter Med, 2009,48: 621-630
8急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)中国实用外科杂志,2007(1),27:1
9 Ware LB, Matthay MA. The acute respiratory distress syndrome.N Engl J Med,2000,342: 1334-1349
10 Ciesla DJ, Moore EE, Johnson JL, et al. Decreased progression of postinjury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery,2006,140:640-647
11 Suchyta MR, Orme JF Jr, Morris AH. The changing face of organ failure in ARDS. Chest, 2003,124:1871-1879
12 Calfee CS, Matthay MA. Nonventilatory treatments for acute lung injury and ARDS. Chest, 2007,131:913-920
13 Tousignat CP,Walsh F, Mazer CD. The use of transoesopha geal echocardiography for preload assessment in critically ill patients . AnesthAnalg , 2000,90:351-355
14 Diebel L, Wilson RF, Heins J, et al.End-diastolic volume versus pulmonary artery wedge pressure in evaluating cardiac preload in trauma patients.J Trauma Inj Infect Crit Care,1994,37:950-955
15 Wiesenack C,Prasser C,Keyl C,et al.Assessment of Intrathoracic Blood Volume as an Indicator of Cardiac Preload:Single Transpulmonary Thermodilution Technique Versus Assessment of Pressure Preload Parameters Derived From a Pulmonary Artery Catheter.Cardiothoracic and Vascular Anesthesia, 2001,15(5):584-588
16 Sakka SG,Klein M,Reinhart K.Assessment of intrathoracic blood volume and extravascular lung water by singal transpulmonary thermodilution. Crit Care Med,1999,27(1):110
17 Sandrine Boussat,Thierry Jacques, Bruno Levy ,et al.Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema.Intensive Care Med,2002, 28:712-718
18 Mitchell J P , Schuller D , Calandrino FS , et al.Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization . Am Rev Respir Dis,1992,145:990-998
19 Takayama Y, Iwasaka T, Sugiura T, etal. Increased extravascular lung water in patients with low pulmonary artery occlusion pressure after acute myocardial infarction. Crit Care Med,1991, 19:21-25
20 Neff MJ. Time for a new definition of acute lung injury [abstract]. Am JRespir Crit Care Med, 2007,175:948
21 Sakka SG, Klein M, Reinhart K,et al: Prognostic value of extravascular lung water in critically ill patients. Chest 2002, 122:2080–2086
22 Phillips, Charles R. MD; Chesnutt, Mark S. MD; Smith, Stephen M. PhD, Extravascular lung water in sepsis-associated acute respiratory distress syndrome: Indexing with predicted body weight improves correlation with severity of illness and survival. Critical Care Medicine,2008, 36:69-73
23 Martin GS, Mangialardi RJ, Wheeler AP,et al.Albumin and furosemidetherapy in hypoproteinemic patients with acute lung injury. Crit Care Med,2002,30:2175-82
24 Thomas Pohl, Jan Kozieras, SamirG. Sakka:Influence of extravascular lung water on transpulmonary thermodilution-derived cardiac output measurement. Intensive Care Med,.2008, 34:533-537
25 Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid management strategies in acute lung injury. N Engl J Med, 2006, 354:2564-2575
26 Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units:results of the SOAP study. Crit Care Med, 2006, 34:344-353
27 Schuller D, Mitchell JP, Calandrino FS, et al. Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome? Chest,1991,100:1068-1075
28 Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens–a randomized assessor-blinded multicenter trial. Ann Surg, 2003,238:641-648
29 Jose′e Boucharda and Ravindra L. Mehtab. Fluid accumulation and acute kidney injury: consequence or cause .Curr Opin Crit Care, 2009, 15: 509 -513
30 Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury.Kidney Int ,2009,76:422-427
31 Didier Payen1, Anne Cornélie de Pont2, Yasser Sakr3.A positive fluid balance is associated with a worse outcome in patients with acute renal failure . Investigators Critical Care, 2008, 12:R74
32 Jean-Louis Vincent, Yasser Sakr, Charles L. Sprung,et al.Sepsis in European intensive care units: Results of the SOAP study.Crit Care Med ,2006,34:344–353
33 Fadi Alsous, Mohammad Khamiees, Angela DeGirolamo.Negative Fluid Balance Predicts Survivalin Patients With Septic Shock. CHEST,2000,117;1749-1754
34 Wise RA. Effect of circulatory mechanics on hydrostatic forces producing pulmonary edema. J Crit Care ,1986, 1:247-256
35 ShoemakerWC,Appel P,Bland R.Use of physiolgic monitoring to predict outcome and to assist in clinical decision in critically ill postoperative patients.Am J Surg,1983,146:43-50
36 Simmons RS,Berdine GG,Seidenfeld JJ,et al. Fluid balance and adult respiratory distress syndronme.Am Rev Respir Dis ,1987,135:924-929
37 HumphreyH, Hall J, Sznajder I, et al.Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest, 1990,97:1176-80
38 Schuster DP.Fluid management in ARDS:"keep them dry"or does it matter[J]?Intensive CareMed ,1995,21:101-103
39 Charmaine A. Lewis and Greg S. MartinC. Understanding and managing fluid balance in patients with acute lung injury. curr Opin Crit Care, 2004,10:13-17
40 Rackow EC, Fein IA, Siegel J.The relationship of colloid oncotic pressure-pulmonary artery wedge pressure gradient to pulmonary edema and mortalityin critically ill patients. Chest ,1982,82:433-437
2 Stapleton RD, Wang BM, Hudson LD, et al. Causes and timing of death in patients with ARDS. Chest,2005,128: 525-532
3 Doyle RL, Szaflarski N, Modin GW, et al. Identification of patients with acute lung injury: predictors of mortality. Am J Respir Crit Care Med, 1995,152:1818-1824
4 Matthay MA, Zimmerman GA, et al.Acute lung injury and the acute respiratory distress syndrome: four decades of inquiry into pathogenesis and rational management. Am J Respir Cell Mol Biol,2005,33: 319-327
5急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)中国实用外科杂志,2007(1),27:1
6 Alsous F, Khamiees M, DeGirolamo A, et al. Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study. Chest, 2000,117:1749-1754
7 Humphrey H, Hall J, Sznajder I, et al. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest, 1990,97:1176-1180
8 Simmons RS, Berdine GG, Seidenfeld JJ, et al. Fluid balance and the adult respiratory distress syndrome. Am Rev Respir Dis 1987,135:924 -929
9 Sakr Y, Vincent JL, Reinhart K, et al. High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest,2005,128:3098–3108
10 Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid management strategies in acute lung injury. N Engl J Med ,2006, 354: 2564-2575
11 Thomas Pohl ,Jan Kozieras, Samir G. Sakka, et al. Influence of extravascular lung water on transpulmonary thermodilution-derived cardiac output measurement . Intensive Care Med, 2008,34:533–537
12 Ferna’ndez-Monde’jar E,Rivera-Ferna’ndez R,Garci’a-Delgado M,et al. Small increases in extravascular lung water are accurately detected by transpulmonary thermodilution. J Trauma,2005,59:1420-1424
13 Bernard GR, Artigas A, Brigham KL The American-European Consensus Conference on ARDS: definitions,mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med,1994,149: 818-824
14 Rubenfeld GD, Caldwell E, Peabody E, et al.Incidence and outcomes of acute lung injury.N Engl J Med,2005, 353:1685–1693
15 Massimo Zambon and Jean-Louis Vincent.Mortality Rates for Patients With Acute Lung Injury/ARDS Have Decreased Over Time. Chest, 2008, 133:1120-1127
16 Mitchell J,Schuller D,Calandrino F,et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization.Am Rev Respir Dis,1992,145:990-998
17 SAKKA S G,KLEIN M,EEINHART K,et a1.Prognostic value of extravascular lung water in critically ill patients. Chest, 2002, 122: 2080-2086
18 Boussat S, Jacques T, LevyB, et al. Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema.Intensive Care Med, 2002,28:712-718
19 Ros Cottis, Neil Magee and David J. Higgins. Haemodynamic monitoring with pulse-induced contour cardiac output (PiCCO) in critical care .Intensive and Critical Care Nursing ,2003,19, 301-307
20 Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effectsof intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens; a randomized assessor-blinded multicenter trial. Ann Surg,2003,238:641-648
21 HUDSON E,BEALE R.Lung water and blood volume measurements in critically ill[J].Curt Opin Crit Care,2000,6:222-226
22 T.SZAKMANY, P.HEIGI, Z.MOLNAR Correlation Between Extravascular Lung Water and Oxygenation in ALI/ARDS Patients in Septic Shock:Possible Role in the Development of Atelectasis?Anaesth Intensive Care, 2004,32:196-201
23 Ferna’ndez-Monde’jar E,Rivera-Ferna’ndez R,Garcl’-Delgado M,et al. Small increases in extravaseular lung water are accurately detected by trans Pulmonary thermodilution. Jtrauma,2005,59:1420-1424
24 Charmaine A. Lewis and Greg S. Martin Understanding and Managing fluid balance in patients with acute lung injury. Curr Opin Crit Care 2004, 10:13-17
25 Andew L,Rosenberg,MD.Fluid management in distress syndrome.Respir Care Clin,2003,9:481-493
26 Guyton AC, Lindsey AW. Effect of elevated left atrial pressure and decreasedplasma protein concentration on the development of pulmonary edema. Circ Res,1959;7:649-657
27 Humphrey H, Hall J, Sznajder I, et al. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest,1990,97:1176-1180
28 Rackow EC, Fein IA, Siegel J. The relationship of colloid oncotic pressure-pulmonary artery wedge pressure gradient to pulmonary edema and mortalityin critically ill patients. Chest, 1982,82:433-437
29 Mangliardi RJ, Martin GS, Bernard GR, et al. Hypoproteinemia predicts acuterespiratory distress syndrome development, weight gain, and death in patientswith sepsis. Crit Care Med, 2000,28:3137-3145
30 Quinlan GJ ,Mumby S ,Martin GS , et al1 .Albumin influences plasma and tioxidants favorably in ALI[J]. Crit.Care Med, 2004,32(3):755-759
31 Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med,2002,30:2175-2182
32 Mohsenifar Z,Goldbach P,Tashkin DP,et al.Relationship betwween O2 delivery and O2 consumption in the adult respiratory distress syndrome. Chest ,1983,84:1176
33 Shoemaker WC,Appel PL,Kram HB,et al.Prospective trail of supranormal values of survivors as therapeutic goals in high-risk surgical patients.Chest, 1988,94:1176
34 Yu M,Levy MM,Smith P,et al.Effect of maximizing oxyen delivery on morbility and mortality rates in criticlly ill patients:a prospective randomized controlled study.Crit Care Med, 1993,21:830-837
35 Hayes MA,Timmins AC,Yau EH,et al.Elevation of systemic oxygen delivery in the treatment of critically ill patients.N Engl JMED , 1994,330:1717
36 Sivak ED,Tita J,Meden G,et al.Effects of furosemide versus isolated ultrafiltration on extravascular lung water in oleic acid-induced pulmonary edama. Crit Care Med ,1986,14:48-51
37 Schuster DP,Haller J.A quantitative correlation of extravascular lung water accumulation with vascular permeability and hydrostatic pressure measurements:a positron emission tomography study. J Crit Care,1990, 5:161-168
38 Simmons RS,Berdine GG,Seidenfeld JJ,et al. Fluid balance and adult respiratory distress syndronme.Am Rev Respir Dis,1987,135:924-929
39 Luce JM.Acute lung injury and the acute respiratory distress syndrome. Crit Care Med, 1998,26(2):369-376
40 Mitchell JP,Schuller D,Calandrino FS, et al.Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization.Am Rev Respir Dis,1992,145(5):990-998
41 .Schuster DP.Fluid management in ARDS:"keep them dry"or does it matter?Intensive CareMed,1995,21:101-103
42 Alsous F, Khamiees M, DeGirolamo A, et al. Negative fluid Balance predicts survival in patients with septic shock: a retrospective pilot study. Chest,2000,117:1749-1754
43 Lakshmi Durairaj,Gregory A Schmidt. Fluid Therapy in Resuscitated Sepsis-Less Is More. CHEST,2008,133:252-263
44 Epstein CD, Peerless JR. Weaning readiness and fluid balance in older critically ill surgical patients. Am J Crit Care,2006,15:54-64
45 Upadya A, Tilluckdharry L, Muralidharan V, et al. Fluid balance and weaning outcomes. Intensive Care Med,2005,31: 1643–1647
1 Heather R,Elizabeth A Beltz,Mary B.Ross,et al. Recent R,developmentsin the management of acute respiratory distress syndrome in adults.Am J Health-Syst Pharm, 2008,65:29-36
2 Krishnan Raghavendran,Gloria S. Pryhuber, Patricia R. Chess, et al. Pharmacotherapy of Acute Lung Injury and Acute Respiratory Distress Syndrome. Current Medicinal Chemistry, 2008,15,1911-1924
3 Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet,1967,2: 319-323
4 Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl Jmed,2005,353:1685-1693
5 Bernard GR ,Artigas A ,Brigham KL ,et al. The American-European consensus conference on ARDS:definitions,mechanism,relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med , 1994,149: 818–824
6 K Atabai, M A Matthay: Acute lung injury and the acute respiratory distress syndrome:definitions and epidemiology.Thorax, 2002, 57: 452 -458
7 Kenji Tsushima1, Landon S King, Neil R Aggarwal, et al.Acute Lung Injury Review.Inter Med, 2009,48: 621-630
8急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)中国实用外科杂志,2007(1),27:1
9 Ware LB, Matthay MA. The acute respiratory distress syndrome.N Engl J Med,2000,342: 1334-1349
10 Ciesla DJ, Moore EE, Johnson JL, et al. Decreased progression of postinjury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery,2006,140:640-647
11 Suchyta MR, Orme JF Jr, Morris AH. The changing face of organ failure in ARDS. Chest, 2003,124:1871-1879
12 Calfee CS, Matthay MA. Nonventilatory treatments for acute lung injury and ARDS. Chest, 2007,131:913-920
13 Tousignat CP,Walsh F, Mazer CD. The use of transoesopha geal echocardiography for preload assessment in critically ill patients . AnesthAnalg , 2000,90:351-355
14 Diebel L, Wilson RF, Heins J, et al.End-diastolic volume versus pulmonary artery wedge pressure in evaluating cardiac preload in trauma patients.J Trauma Inj Infect Crit Care,1994,37:950-955
15 Wiesenack C,Prasser C,Keyl C,et al.Assessment of Intrathoracic Blood Volume as an Indicator of Cardiac Preload:Single Transpulmonary Thermodilution Technique Versus Assessment of Pressure Preload Parameters Derived From a Pulmonary Artery Catheter.Cardiothoracic and Vascular Anesthesia, 2001,15(5):584-588
16 Sakka SG,Klein M,Reinhart K.Assessment of intrathoracic blood volume and extravascular lung water by singal transpulmonary thermodilution. Crit Care Med,1999,27(1):110
17 Sandrine Boussat,Thierry Jacques, Bruno Levy ,et al.Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema.Intensive Care Med,2002, 28:712-718
18 Mitchell J P , Schuller D , Calandrino FS , et al.Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization . Am Rev Respir Dis,1992,145:990-998
19 Takayama Y, Iwasaka T, Sugiura T, etal. Increased extravascular lung water in patients with low pulmonary artery occlusion pressure after acute myocardial infarction. Crit Care Med,1991, 19:21-25
20 Neff MJ. Time for a new definition of acute lung injury [abstract]. Am JRespir Crit Care Med, 2007,175:948
21 Sakka SG, Klein M, Reinhart K,et al: Prognostic value of extravascular lung water in critically ill patients. Chest 2002, 122:2080–2086
22 Phillips, Charles R. MD; Chesnutt, Mark S. MD; Smith, Stephen M. PhD, Extravascular lung water in sepsis-associated acute respiratory distress syndrome: Indexing with predicted body weight improves correlation with severity of illness and survival. Critical Care Medicine,2008, 36:69-73
23 Martin GS, Mangialardi RJ, Wheeler AP,et al.Albumin and furosemidetherapy in hypoproteinemic patients with acute lung injury. Crit Care Med,2002,30:2175-82
24 Thomas Pohl, Jan Kozieras, SamirG. Sakka:Influence of extravascular lung water on transpulmonary thermodilution-derived cardiac output measurement. Intensive Care Med,.2008, 34:533-537
25 Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid management strategies in acute lung injury. N Engl J Med, 2006, 354:2564-2575
26 Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units:results of the SOAP study. Crit Care Med, 2006, 34:344-353
27 Schuller D, Mitchell JP, Calandrino FS, et al. Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome? Chest,1991,100:1068-1075
28 Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens–a randomized assessor-blinded multicenter trial. Ann Surg, 2003,238:641-648
29 Jose′e Boucharda and Ravindra L. Mehtab. Fluid accumulation and acute kidney injury: consequence or cause .Curr Opin Crit Care, 2009, 15: 509 -513
30 Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury.Kidney Int ,2009,76:422-427
31 Didier Payen1, Anne Cornélie de Pont2, Yasser Sakr3.A positive fluid balance is associated with a worse outcome in patients with acute renal failure . Investigators Critical Care, 2008, 12:R74
32 Jean-Louis Vincent, Yasser Sakr, Charles L. Sprung,et al.Sepsis in European intensive care units: Results of the SOAP study.Crit Care Med ,2006,34:344–353
33 Fadi Alsous, Mohammad Khamiees, Angela DeGirolamo.Negative Fluid Balance Predicts Survivalin Patients With Septic Shock. CHEST,2000,117;1749-1754
34 Wise RA. Effect of circulatory mechanics on hydrostatic forces producing pulmonary edema. J Crit Care ,1986, 1:247-256
35 ShoemakerWC,Appel P,Bland R.Use of physiolgic monitoring to predict outcome and to assist in clinical decision in critically ill postoperative patients.Am J Surg,1983,146:43-50
36 Simmons RS,Berdine GG,Seidenfeld JJ,et al. Fluid balance and adult respiratory distress syndronme.Am Rev Respir Dis ,1987,135:924-929
37 HumphreyH, Hall J, Sznajder I, et al.Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest, 1990,97:1176-80
38 Schuster DP.Fluid management in ARDS:"keep them dry"or does it matter[J]?Intensive CareMed ,1995,21:101-103
39 Charmaine A. Lewis and Greg S. MartinC. Understanding and managing fluid balance in patients with acute lung injury. curr Opin Crit Care, 2004,10:13-17
40 Rackow EC, Fein IA, Siegel J.The relationship of colloid oncotic pressure-pulmonary artery wedge pressure gradient to pulmonary edema and mortalityin critically ill patients. Chest ,1982,82:433-437