The Clinical Study Of Extravascular Lung Water And Pulmonary Vascular Permeability Index In Acute Lung Edema

1 Comparison of PiCCO monitoring technique versus gravimetric measurement in determination of extravascular lung water index in sheep with acute respiratory distress syndrome@@@@Objective: To compare the measurement of extravascular lung water index(EVLWI) by PiCCO monitoring technique and gravimetric measurement in sheep with acute respiratory distress syndrome (ARDS).@@@@Methods: 4 anaesthetized sheep were performed tracheotomy, and then ventilated, monitored hemodynamics, and received PiCCO monitoring. Then saline was performed through branchifibroscope and ARDS was produced. 24 hours after ARDS, sheep were sacrificed and then EVLWI was quantitated by gravimetric measurement.@@@@Results: EVLWI measured by PiCCO monitoring technique and gravimetric measurement was 16.68±2.03ml/kg,13.87±1.91ml/kg respectively, and there was statistical difference between the two methods (P=0.001). The correlation between the two methods was0.979(P<0.05).@@@@Conclusion: There was a close positive correlation between PiCCO monitoring technique and gravimetric measurements. 2 The prognostic value of EVLWI and PVPI in acute respiratory distress syndrome@@@@Objective:To study the the diagnostic value and prognostic judgement of Extravascular lung water index (EVLWI) and pulmonary vascular permeability index(PVPI) in acute respiratory distress syndrome (ARDS) patients.@@@@Methods:To analyze 34 ARDS patients who received Pulse index continuous cardiac output (PiCCO) monitoring retrospectively, and divide them into survivor group and nonsurvivor group according to their prognosis. The hemodynamic and lung volume parameters of O hour, 24hour, and 72hour were recorded respectively. And the changing tendency of every parameter, difference between groups and the correlation of parameters were analyzed.@@@@ResuLts:①With time going on, EVLWI and PVPI in survivor group decreased significantly, while increased in nonsurvivor group.②PVPI correlated with EVLWI markedly(r=0.846 P<0.01), correlated with lung injury score(LIS) well (r=0.796 P<0.05), and with APACHEⅡscore poorly (r=0.264 P>0.05).③No correlation was found between intrathoracic blood volume index (ITBVI) and central venous pressure(CVP) (r＝0.338 P>0.05).④Portracted receiver operating characteristic curve(ROC), and area under the curve (AUC) of EVLWI and PVPI at 72 hour was 0.902±0.06 (p<0.01), 0.920±0.077 (p<0.01) respectively.@@@@Conclusion: combining EVLWI and PVPI monitoring is of important clinical value in diagnosis and prognostic judgement of acute respiratory distress syndrome patients. The Clinical study of EVLWI and PVPI in diagnosis of lung edema.@@@@Objective: To study the clinical value of Extravascular lung water index (EVLWI) and pulmonary vascular permeability index(PVPI) in diagnosis and continuous monitoring of lung edema.@@@@Methods:To analyze 40 patients with lung edema who received Pulse index continuous cardiac output(PiCCO) monitoring retrospectively, and divide them into two groups: acute cardiac pulmonary edema group (ACPE group) and acute respiratory distress syndrome group(ARDS group), according to their ease history, symptom, physical sign, auxiliary examination and cardiac index (CI). Parameters such as EVLWI and Intrathoracic blood volume index (ITBVI) were recorded, and PVPI were calculated.@@@@Results:①PVPI in ARDS group was significantly higher than groupⅠ(P<0.01).②PVPI had no correlation with ITBVI, EVLWI, OI and APACHEⅡscore in ACPE group (P>0.05), while had significant correlation with EVLWI (r=0.904 p<0.01), and some correlation with oxygen index(OI) and APACHEⅡ(r=0.-554 P<0.01; r=0.390P <0.05) in ARDS group.③There were some correlation between EVLWI and OI, APACHEⅡin the two groups (groupⅠ: r=-0.672 p <0.01, r=0.412 P<0.05; groupⅡ: r=-0.602 P<0.01, r=0.457P <0.05).④Portracted receiver operating characteristic curve(ROC) of PVPI and Area under the curve (AUC) was 0.9764±0.019 (P< 0.01). When2.23, one of the cut-off points of PVPI, was selected, the sensitivity was 92.0%, and the specificity was 93.3 %.⑤According to their prognosisdivided them into survivor group and nonsurvivor group, EVLWI decreased gradually in the survivor group (groupⅠ: P<0.05, groupⅡ:P<0.01), and PVPI of ACPE patients increased in nonsurvivor group (P<0.01) Conclusion: EVLWI and PVPI monitoring is of clinical value in some degree in early diagnosis of hydrostatic pulmonary edema and permeability pulmonary edema.