Objective To analyze different characteristics of extra-vascular lung water ( EVLW) in the patients with acute respiratory distress syndrome( ARDS) , and examine its prognostic value. Methods 23 patients with ARDS admitted between November 2010 and December 2011 were divided into a survival group( n=13) and a dead group( n =10) according to the outcome. The hemodynamic status including extravascular lung water index( EVLWI) was measured in 3 consecutive days, and the relationship between EVLWI and the prognosis of patients was analyzed. Results On the first day of diagnosis, the EVLWI was higher in both groups in comparison with normal value. It was ( 13. 9 ±3. 45) mL/kg in the survival group and ( 14. 87 ±5. 75) mL/kg in the dead group( P gt;0. 05) . However, on the second day, the EVLWI in the survival group dropped significantly after intensive intervention, but the patients in the dead group did not respond well to the treatment and the EVLWI declined slightly. The EVLWI of both groups began to diverge significantly fromeach other, showing average value of ( 11. 07 ±2. 51) mL/kg and ( 15.63 ±5. 05) mL/kg, respectively( P lt; 0. 05) . On the third day, this difference between two groups was still more remarkable, resulting in ( 10.32 ±1.57) mL/kg vs. ( 16. 6 ±4. 33) mL/kg( P lt; 0. 01) . Conclusions The changes of EVLWI can be used to evaluate the effectiveness of treatment and predict the prognosis of patients with ARDS. EVLWI would likely be an indicator to evaluate the pulmonary capillary leakage.
ObjectiveTo observe the level of extravascular lung water index (ELWI) in serious septic patients with ARDS,and the effects of ulinastatin (UTI) on ELWI. MethodsA perspective control study was performed on 48 severe septic patients with ARDS from the emergency department and ICU in Shanghai Changzhen Hospital from January 2010 to December 2012. Pulse indicator continuous cardiac output (PICCO) technique was utilized for measuring ELWI. Meanwhile the oxygenation index (PaO2/FiO2) was detected. The patients were randomized as an UTI group (n=30) and a control group (n=18). Both groups received routine comprehensive treatments,and the UTI group additionally received 30 000 units/kg UTI intravenous drip 4 times a day for continuous 3 days. The PaO2/FiO2,ELWI,Murray lung injury score,APACHEⅡ score,SOFA score and 28-day mortality were determined. ResultsThe APACHE Ⅱ score,Murray and SOFA score had no statistical difference between the UTI group and the control group before treatment (P>0.05),and decreased significantly after 4 and 7 days of treatment in both groups compared with those before treatment (P<0.05). There were varying degrees of PaO2/FiO2 decrease and ELWI increase before treatment in both groups with no significant difference between two groups (P>0.05). After treatment,the PaO2/FiO2 increased and ELWI decreased in both groups,and the UTI group had better PaO2/FiO2 and ELWI than the control group (P<0.05). The difference in 28-day mortality between the UTI group and the control group was statistically significant (10.0% vs. 33.3%,P<0.05). ConclusionsSevere septic patients with ARDS are all complicated with ELWI increase. Routine therapy combined with UTI can decrease ELWI,improve clinical symptoms,and decrease 28-day mortality.
ObjectiveTo evaluate the application value and significance of pulse indicator continuous cardiac output (PiCCO) in perioperative treatment of adult congenital heart disease (ACHD). MethodsBetween June 2014 and June 2015, 100 adult patients (44 females and 56 males) underwent congenital heart disease operation. Patients were randomly divided into a PiCCO group and an experience treatment (control) group. According to the data of PiCCO detection, the PiCCO group was treated with vasoactive drugs and liquid balance management, the control group was treated by routine monitoring data. The clinical effectiveness of the two groups was compared. ResultsThe ventilator time, ICU time and length of stay in the PiCCO group were significantly shorter than those in the control group with statistical differences (P=0.02, 0.03, 0.04). The drug dosage (dopamine, milrinone) during ICU were higher in the PiCCO group than those in the control group (P<0.01, P=0.04). There was no mortality in both groups. No significant difference was found in the incidence of postoperative complications between the two groups (P>0.05). ConclusionThe application of PiCCO in the perioperative treatment of adult congenital heart disease can promote the early recovery of ACHD patients, and has a certain safety and effectiveness. Actively vasoactive drugs application to maintain circulation early in ICU has positive effect on the patient's recovery.
ObjectiveTo evaluate the predictive value of mini-fluid challenge for volume responsiveness in patients under shock.MethodsSixty patients diagnosed as shock were included in the study. A 50 mL infusion of physiological saline over 10 seconds and a further 450 mL over 15 minutes were conducted through the central venous catheter. Cardiac output (CO), global end-diastolic volume index (GEDVI), central venous pressure (CVP) and extravascular pulmonary water index (EVLWI) were monitored by the pulse indicator continuous cardiac output monitoring. If the increase of CO after 500 mL volume expansion (ΔCO500) ≥10%, the patient was considered to be with volume responsiveness. The relevance between ΔCO50 and ΔCO500 was analyzed, and the sensitivity and specificity of the ΔCO50 were analyzed by receiver operating characteristic (ROC) curve.ResultsAfter 50 mL volume injection, the heart rate and systolic blood pressure of the two groups did not change obviously. The CVP of non-responders changed slightly higher than that of responders, but neither of them had obviously difference (P>0.05). The CO of responders had increased significantly (P<0.05) which was in accord with that after a further 450 mL volume injection. GEDVI and EVLWI did not change significantly (P>0.05). ΔCO50 and ΔCO500 were strongly correlated (r=0.706, 95%CI 0.677 - 0.891, P>0.05). The area under ROC curve for ΔCO50 was 0.814 (95%CI 0.707 - 0.922).ConclusionThe volume responsiveness of patients under shock can be predicted by mini-fluid challenge study which is related to normal volume expansion and it does not increase the risk of pulmonary edema.