The Relationship Between The Extravascular Lung Water And The Prognosis Of Patients With Acute Respiratory Distress Syndrome

ObjectiveTo analyze the variable characteristics of the extravascular lung water index (EVLWI) in the patients with acute respiratory distress syndrome (ARDS), to clarify its value in the prognosis of these patients, and to find out the clinical values in fluid management.MethodsThe investigation was carried out with cohort study.24 patients with acute respiratory distress syndrome (ARDS) in ICU in the first affiliated hospital of Zhejiang University, which admitted from January to December,2013, were administrated by the monitor of the pulse indicated continuous cardiac output (PiCCO). They were divided into survival group (16 cases) and fatal group (8 cases) according to the prognosis. The differences of the APACHE II scores, MAP, CVP, PaO2/FiO2, EVLWI, CI and LAC between these two groups were researched, the relevance of EVLWI and FiO2, CVP, prognosis were analyzed. And the clinical values of EVLWI in evaluating the prognosis of patients with ARDS were also assessed.ResultsDuring the initial time after the patients were admitted into intensive care unit, there were no statistical differences among the general situation, APACHE Ⅱ Score, CVP, MAP, PaO2/FiO2, lactic acid levels, EVLWI. However, from the second day, compare to the fatal group, the PaO2/FiO2 obviously increased, lactic acid levels and EVLWI decreased in the survival group, but the opposite results came out in the fatal group. And there were significant differences among these three indexes above in the two groups. Otherwise, EVLWI and PaO2/FiO2 were significantly negative correlated (r= 0.46, P< 0.01); but there were no obvious correlations between EVLWI and CVP (r=-0.11, P=0.146). By the method of receiver operating characteristic (ROC) analysis, mean value of the area under curve (AUC) for EVLWI was 0.738 at the third day after cathetered. As EVLWI>13ml/kg at the 3rd day, the sensitivity and the specificity of accurate judgment were 85.3% and 56.8%.ConclusionThe dynamic changes of EVLWI could be used to evaluate the effectiveness of treatment and to predict the prognosis of the patients with acute respiratory distress syndrome (ARDS). EVLWI might be one of the indicators to evaluate the pulmonary capillary leakage.