Critical hemodynamic therapy oriented resuscitation helping reduce lung water production and improve survival
Background: Increased extravascular lung water (EVLW) in shock is common in the critically ill patients.This study aimed to explore the effect of cardiac output (CO) on EVLW and its relevant influence on prognosis.Methods: The hemodynamic data of 428 patients with pulse-indicated continuous CO catheterization from Department of Critical Care Medicine, Peking Union Medical College Hospital were retrospectively collected and analyzed.The patients were assigned to acute respiratory distress syndrome group, cardiogenic shock group, septic shock group, and combined shock (cardiogenic and septic) group according to their symptoms.Information on 28-day mortality and renal function was also collected.Results: The CO and EVLW index (EVLWI) in the cardiogenic and combined shock groups were lower than those in the other groups (acute respiratory distress syndrome group vs.cardiogenic shock group vs.septic shock group vs.combined shock group:CO, 5.1 4.0, 6.2 vs.4.7 4.0, 5.7 vs.5.5 4.3, 6.7 vs.4.6 3.5, 5.7 at 0 to 24 h, P=0.009;4.6 3.8, 5.6 vs.4.8 4.1, 5.7 vs.5.3 4.4, 6.5 vs.4.5 3.8, 5.3 at 24 to 48 h, P=0.048;4.5 4.1, 5.4 vs.4.8 3.8, 5.5 vs.5.3 4.0, 6.4 vs.4.0 3.2, 5.4 at 48 to 72 h,P=0.006;EVLWI, 11.4 8.7, 19.1 vs.7.9 6.6, 10.0 vs.8.8 7.4, 11.0 vs.8.2 6.7, 11.3 at 0 to 24 h, P < 0.001;11.8 7.7, 17.2 vs.7.8 6.3, 10.2 vs.8.7 6.6, 12.2 vs.8.0 6.6, 11.1 at24 to 48 h, P< 0.001;and 11.3 7.7, 18.7 vs.7.5 6.3, 10.0 vs.8.8 6.3, 12.2 vs.8.4 6.4, 11.2 at 48 to 72 h, P < 0.001.The trend of the EVLWI in the septic shock group was higher than that in the cardiogenic shock group (P<0.05).Moreover, there existed some difference in the pulmonary vascular permeability index among the cardiogenic shock group, the septic shock group, and the combined shock group, without statistical significance (P > 0.05).In addition, there was no significant difference in tissue perfusion or renal function among the four groups during the observation period (P > 0.05).However, the cardiogenic shock group had a higher 28-day survival rate than the other three groups log rank (Mantel-Cox) =31.169, P < 0.001.Conclusion: Tissue-aimed lower CO could reduce the EVLWI and achieve a better prognosis.
Extravascular lung water Cardiac output Tissue perfusion Organ function Prognosis
Pan Pan Long-Xiang Su Xiang Zhou Yun Long Da-Wei Liu Xiao-Ting Wang
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
国际会议
珠海
英文
1139-1146
2019-05-23（万方平台首次上网日期，不代表论文的发表时间）