Clinical Value Of Impedance Method For Monitoringthoracic Fluid Contentwith Severe Multiple Trauma Complicated With ARDS

Rationale: With the rapid development of society and frequent traffic industry,construction industry and public disaster events,more severe trauma cases,and the occurrence of severe trauma complicated with acute respiratory distress syndrome(ARDS)is one of the major causes that can lead to multiple organ dysfunction or failure.In the Intensive Care Unit(ICU),it is the main reason for high mortality in trauma patients.Early fluid resuscitation of trauma and disease often associates with the increase ofthoracic fluid content(TFC)so as to further aggravate lung injury.Although the lung water has been carried out in a lot of researches,but the impedance monitoring pleural fluid level of lung injury caused by trauma and its clinical value is not reported at home and abroad Avenue.Background:ARDS is an acute diffuse lung injury induced by various pathogenic factors including pulmonary and extrapulmonary.It could develop acute respiratory failure,characterized by increasing inflammation of the pulmonary microvascular permeability,alveolar exudate protein-rich liquid,and then induced pulmonary edema and hyaline membrane formation,the main pathophysiological changes were about lung volume reduction,decreased lung compliance and ventilation / perfusion imbalance.Lung imaging showed bilateral pulmonary exudative lesions.While,ICU is the main reason for the mortality and complication of severe trauma patients with ARDS,it is also an important cause of mortality in trauma patients.Although the pharmacological research has made some progress,but its clinical effect is very small,there is still a lot of unknown questiongs need to be deeply discussed.ARDS with Increased pleural fluidanddecreased lung compliance,has certain significance of monitoring and quantitatively evaluating thepleural fluid level in estimating the severity of ARDS disease and therapeutic efficacy.Recent reports have pointed out that the connetion between pleural fluid level and ARDS mortality,especially time of mechanical ventilation and air cleanliness in ICU.Anyway that can reduce the pleural fluid could reduce the incidence,ventilator time,ICU stay time and possible complications.However,the higher pleural fluid level,themore increased occurrence and development of ARDS.Moreover,it is also the basic pathophysiologica-l features of ARDS.Mornitoring pleural fluid levels is valuable to understand the circulatory system,especially pulmonary circulation.Furthermore,the pathological changes of lung and the gas diffusion is very important.The liquid treatment in clinic by monitoring pleural fluid level can guide for the recovery,which can be used for evaluation of pulmonary function,capillary permeability,and as well as the anti-inflammatory effects of mechanical ventilation on thoracic fluid level.So,monitoring pleural fluid level is key to reduce the occurrence and development of ARDS.There are many methods for mornitoring EVLW at present,especially in recent years,the pulse indicator continuous cardiac output(Pi CCO)can be used as real-time monitoring the hemodynamic parameters,and it has being widely used in clinic.But there are some disadvantages of Pi CCO monitoring technology,such as its expensive cost,certain risk factors in operation,relatively short monitoring time,it’s generally not more than 7 days.Besides,there are possible somecomplications induced by catheter-related infection.Up to now,this method is always the pursuit of clinicians.Impedance method only needs simple operation,or indirectly acquires variety of hemodynamics and thoracic fluid level parameters through the skin mucosa.It can be used for early detection of inadequate circulating blood flow and tissue perfusion,and as soon as possible to guide recovery.At the same time,recovery after treatment with liquid limit provides an ideal method,in view of severe multiple trauma complicated with ARDS caused by pleural liquid level detection method has not been reported yet.It is urgent to carry in-depth studies for clinical treatment,and provide guidance for effective fluid balance.trauma with ARDS Part one:Clinical values of impedance method for monitoring lung water ofObjectives: This study was aimed to the feasibility of impedance method for monitoring the thoracic fluid content of patients sufferring traumatic injuries with ARDS.At the same time,to know the variatic rules of thoracic fluid content in severe traumatic patients,which can be used as better dynamic guidance for the liquid treatmentand reduction of the riskin utilizing other invasive methods or carrying the patients.Methods: The project intends to observe impedance method used to monitor the content of thoracic fluid and the change rule in traumatic patients complicated with ARDS.Non invasive method is used for dynamic guiding fluid resuscitation treatment,at the same time,imaging examination is also used.It canprovide new clues for traumaic patients complicated with ARDS by mornitoring pleural liquid level.Results: 1.The severe multiple trauma patients in medicine caused by traffic accidents,accounting for 68%,the age distribution is between 20 and 60 years old.2.With the progression of the disease,chest X-ray examination showed exudative lesions,chest CT displayed that there were different degrees of lung consolidation and atelectasis with effusion in 40 patients.3.ICG group and CVP group on the first day and third days changes of oxygenation index,SOFA,lactic acid,data measured by t-test,ICG group improved significantly(P < 0.05)after treatment in TFC(t=5.033 p=0.007),oxygenation index(t=2.36 p=0.029),SOFA score(t=-4.397 p=0.001)and lactic acid(t=-3.899 p=0.001).Conclusion: ICG can be applied for dynamic monitoring TFCof severe multiple trauma complicated with ARDS and in the-evaluation of disease progression,treatment options.patients with severe multiple trauma complicated by ARDS Part two:Correlation of ICG and lung ultrasound for monitoring TFC inObjective:Thoracic fluid content in multiple trauma with ARDS patients was determined both by thoracic impedance method and lung ultrasound hemodynamic monitoring method.It is intended to study the correlation of the two monitoring technologies and its clinical value.Methods: 50 cases of severe trauma with acute respiratory distress syndrome patients came from the ICU of Tongling People’s Hospital from April 2014 to October 2016.Each patient was used both impedance method and lung ultrasound monitoring method to acquire hemodynamic parameters,then compared the changes of B line score andthoracic cavity liquid content.Data was presented as the mean ±SD.Pearson correlation analysis was used to calculate the relations betweenthe two methods for the detection of B line score and thoracic fluid content.Statistically,P<0.05 was displayed as significant difference..Results: 1.After treatment,TFC(t=-5.254 p=0.001)and B score(t=-9.441 p=0.001)were significantly improved(P<0.05).2.Correlation of thoracic fluid content and ultrasonic B line: thoracic fluid content and B score were analysed by the bivariate Pearson line correlation analysis.Results showed that the thoracic fluid content and B score line was positively correlated(r=0.896)at the level of p=0.01,which indicated that the lung ultrasound impedance method measured B line score had a good correlation with impedance method measured thoracic cavity liquid content.Conclusion:1.The volume index of noninvasive hemodynamic monitoring system TFC can be used to guide the management of liquid as well as the B line score of pulmonary ultrasound.2.Thoracic fluid content of ICG and B line score of lung ultrasound has great correlation.hemodynamics--A Systematic Review and Meta-Analysis Part three:Significance of Impedance Cardiography in monitoringObjective:To evaluate the effect of impedance cardiography on hemodynamics and provide evidence for clinic individualized medication.Methods: All of the clinical randomized controlled studies about Impedance Cardiography in the detection of hemodynamics were collected by electronic retrieval from the home and abroad database,such as Cochrane Library,Pub Med,Springer,Science Direct,Wiley-Blackwell,CNKI,Wanfang Data Resource,VIP,and other Chinese database,ranging from 1990 to 2016.Then,we used the Cochrane system evaluation method to assess the qualities of the researches,used Revman5.1 software to conduct Meta-analysis.Results: We retrived 14 English and 34 Chinese literature,after Screening and removing duplicate documents,finally,there were 5 clinical controlled trials,including 570 cases.In view of heterogeneity(I2>50%,P <0.05),the random effect model was used to analyze.Meta analysis showed that:Monitoring hemodynamic parameters using impedance cardiography can be a good clinical evaluation and monitoring efficacy.(SMD=6.18,95% CI 1.05-11.32,P <0.05).Conclusion:Impedance cardiography can be used to monitor hemodynamics and to evaluate of disease progression.What This Study Adds to the Field We validated the validity of impedance method for monitoring severe multiple trauma complicated with ARDS.It is convenient for monitoring the thoracic fluid content,characterized by dynamic mornitoring hemodynamicsand operating in a noninvasive way.It has a very important application value,can be utilized for ofguiding clinical treatment,improving the prognosis reducing mortality for critically ill patients.