The Study Of Extravascular Lung Water Index And Pulmonary Vascular Permeability Index Value In Patients With Acute Respiratory Distress Syndrome

Background:Acute respiratory distress syndrome(ARDS) is a common clinical acute respiratory failure. Hypoxemia and respiratory distress are characteristic of ARDS clinical manifestations. In recent years, with the deepening of the basic and clinical study of ARDS, the diagnosis and treatment studies of ARDS have made considerable progress, but the mortality rate of ARDS is still as high as 30%~40%[1-2].Sepsis 、multiple trauma 、acute severe pancreatitis and other remains are common risk factors of ARDS, multiple organ failure is the main death reason.In 1994,European Consensus Conference(AECC) regulated and revised the definition of ARDS, put forward the corresponding diagnosis criteria, The criteria had been widely used in the past 10 years, but at the same time, the criteria of AECC was questioned for the terms of accuracy.In 2011,The European critical medical association initiatived, the expert group of the American Thoracic association and the critical care medicine association participated in the study of the database of 4188 cases of ARDS patients from the clinical research database of 4 multi center and 3 single center physiological database on 269 patients with ARDS: a meta-analysis, which lasted for 4 months through discussion to reach a consensus on the formation of the Berlin ARDS diagnostic criteria, the criteria was published in the Journal JAMA in June 2012[3]. Compared to the AECC standard, the Berlin standard has been improved greatly, but it has also been found that the Berlin standard did not increase significantly the sensitivity and specificity for ARDS diagnosis. How to find the characteristic indexe that can reflect the characteristic high permeability pulmonary edema of ARDS, so as to improve the reliability of ARDS diagnosis, It has become an important problem to be solved in clinical.The clinical research of ARDS was mostly based on the 1994 diagnostic criteria, At the present stage, the research is not much based on the Berlin standard in 2012,Pulse indicator continuous cardiac output monitoring(PiCC0) technology is an emerging invasive monitoring technology,but is becoming more and more mature in clinical application of recent years. The accuracy and validity on the monitoring lung water are reported in the literature, The reports and studies on the extravascular lung water index(EVLWI) are relatively more, but the study of pulmonary vascular permeability(PVPI) is not much,Therefore, to investigate the clinical value of EVLWI and PVPI in patients with ARDS, we apply PiCC0 monitoring technology to carry out the study. Methods:The ARDS patients who accept mechanical ventilation in EICU of the second affiliated hospital of Wenzhou medical university from January 2014 to March 2015. Patients were divided into 3 groups by oxygenation index(PaO2/FiO2) of Berlin definition: severe group: PaO2/FiO2 ≤100 mm Hg(1 mmHg=0.133 kPa); moderate group: 100 mmHg < PaO2/FiO2≤200 mmHg;mild group: 200 mmHg < PaO2/FiO2≤300 mmHg. We recorded general conditions of the patients, such as height, weight, age, gender, blood pressure, blood lipids, blood glucose, uric acid, creatinine and other indicators of primary disease and vital signs, APACHE II score, PEEP level, etc.The PVPI 、EVLWI、ITBVI、oxygenation index were recorded at admission、24h and 72 h, The mortality of 28 d patients admitted to hospital and the ICU mortality rate and ICU days of hospitalization were recorded tooThe datas were analyzed by SPSS16.0 statistics software.Results :Statistical analysis showed,In 3 groups, compared to the mild group, the PVPI and EVLWI of moderate and severe groups increased( all P<0.05). compared to the moderate group, the PVPI and EVLWI of severe groups increased(P<0.05).28 days mortality increased(12.5% VS 28.5%,50%, P<0.05). compared to the mild group, 28 days mortality of moderate and severe groups increased( all P<0.05). compared to the moderate group, the 28 days mortality of severe groups increased(P<0.05). PVPI was correlated with EVLWI and oxygenation index(r=0.778,r=-0.437;P<0.05), There was no correlation between CI and ITBVI(P>0.05);EVLWI was correlated with oxygenation index and ITBVI(r=-0.448,r=0.347;P<0.05). the correlation coefficient between PaO2/FiO2 and PVPI was not statistically significant compared with the correlation coefficient of EVLWI and PaO2/FiO2.With the mean EVLWI value(13ml/kg) as the boundary point, the ARDS patients were divided into high EVLWI group and low EVLWI group, In high EVLWI group, the ICU of patients with the hospitalization time, the mortality rate of ICU, and 28 d mortality rate were all significantly higher than that of the low EVLWI group(P<0.05); With the PVPI value 3 as the boundary point, the ARDS patients were divided into high PVPI group and low PVPI group, the ICU of patients with the hospitalization time, the mortality rate of ICU, 28 d mortality rate of the high PVPI group were all significantly higher than that of the low PVPI group(P<0.05).. Due to lung in ARDS group and extra pulmonary causes of ARDS group were compared and found extrapulmonary causes ARDS group of oxygenation index was lower than that in group extrapulmonary causes, and lung water index were higher than extrapulmonary causes group, and the difference is statistically significant. We analyzed the PVPI further by the receiver operating characteristic curve(ROC curve) analysis, PVPI prediction of ARDS mild and moderate to severe ROC ARDS curve,AUC=0.673±0.0826,95%CI(0.519,0.804),Taking PVPI=3 as the cut-off value, PVPI prediction ARDS distinguish between mild and moderate to severe sensitivity was 60%, specificity was 100%. ARDS prediction of ROC curve of mild to moderate and severe ARDS based on PVPI prediction,AUC=0.747±0.0792,95%CI(0.597,0.863),Taking PVPI=4.4 as the cut-off value, PVPI prediction ARDS distinguish between mild to moderate and severe sensitivity was 37.75%, the specificity was 93.33%. Conclusion:Our study suggests PVPI and EVLWI are both correlated with oxygenation index. they maybe correlated with the severity categories of ARDS. EVLWI and PVPI are in good correlation, PVPI and EVLWI,especially PVPI,may help to improve clinical acute respiratory disreess syndrome diagnostic specificity and maybe valuable to assess the severity and the prognosis of the disease.