Vascular pedicle width in acute lung injury correlation with intravascular pressures and ability to discriminate fluid status 英文参考文献.docVIP

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Vascular pedicle width in acute lung injury correlation with intravascular pressures and ability to discriminate fluid status 英文参考文献.doc

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Vascular pedicle width in acute lung injury correlation with intravascular pressures and ability to discriminate fluid status 英文参考文献

Riceetal.CriticalCare2011,15:R86 /content/15/2/R86 RESEARCH OpenAccess Vascularpediclewidthinacutelunginjury: correlationwithintravascularpressuresand abilitytodiscriminatefluidstatus ToddWRice1*,LorraineBWare1,EdwardFHaponik2,CarolineChiles3,ArthurPWheeler1,GordonRBernard1, JaySSteingrub4,RDuncanHite2,MichaelAMatthay5,PatrickWright6,EWesleyEly1, theNIHNHLBIARDSNetwork Abstract Introduction:Conservativefluidmanagementinpatientswithacutelunginjury(ALI)increasestimealiveandfree frommechanicalventilation.Vascularpediclewidth(VPW)isanon-invasivemeasurementofintravascularvolume status.TheVPWwasstudiedinALIpatientstodeterminethecorrelationbetweenVPWandintravascularpressure measurementsandwhetherVPWcouldpredictfluidstatus. Methods:Thisretrospectivecohortstudyinvolved152patientswithALIenrolledintheFluidandCatheter TreatmentTrial(FACTT)fromfiveNHLBIARDS(AcuteRespiratoryDistressSyndrome)Networksites.VPWand centralvenouspressure(CVP)orpulmonaryarteryocclusionpressure(PAOP)fromthefirstfourstudydayswere correlated.TherelationshipsbetweenVPW,positiveend-expiratorypressure(PEEP),cumulativefluidbalance,and PAOPwerealsoevaluated.Receiveroperatorcharacteristic(ROC)curveswereusedtodeterminetheabilityofVPW todetectPAOP8mmHgandPAOP≥18mmHg. Results:Atotalof71and152patientsprovided118and276pairedVPW/PAOPandVPW/CVPmeasurements, respectively.VPWcorrelatedwithPAOP(r=0.41;P0.001)andlesswellwithCVP(r=0.21;P=0.001).Inlinear regression,VPWcorrelatedwithPAOP1.5-foldbetterthancumulativefluidbalanceand2.5-foldbetterthanPEEP. VPWdiscriminatedachievementofPAOP8mmHg(AUC=0.73;P=0.04)withVPW≤67mmdemonstrating 71%sensitivity(95%CI30to95%)and68%specificity(95%CI59to75%).Fordiscriminatingahydrostatic componentoftheedema(thatis,PAOP≥18mmHg),VPW≥72mmdemonstrated61.4%sensitivity(95%CI47to 74%)and61%specificity(49to71%)(areaunderthecurve(AUC)0.69;P=0.001). Conclusions:VPWcorrelateswithPAOPbetterthanCVPinpatientswithALI.Duetoitsonlymoderatesensitivity andspecificity,theabilityofVPWtodiscriminatefluidstatusinp