Critical hemodynamic therapy oriented resuscitation helping reduce lung water production and improve survival

作     者：Pan Pan Long-Xiang Su Xiang Zhou Yun Long Da-Wei Liu Xiao-Ting Wang Pan Pan;Su Long-Xiang;Zhou Xiang;Long Yun;Liu Da-Wei;Wang Xiao-Ting

作者机构：Department of Critical Care Medicine Peking Union Medical College Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing 100730 China. 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2019年第132卷第10期

页      面：1139-1146页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：supported by a grant from Capital Characteristic Clinic Project of Beijing 

主　　题：Extravascular lung water Cardiac output Tissue perfusion Organ function Prognosis 

摘      要：Background: Increased extravascular lung water (EVLW) in shock is common in the critically ill patients. This study ai explore the effect of cardiac output (CO) on EVLW and its relevant influence on prognosis. Methods: The hemodynamic data of 428 patients with pulse-indicated continuous CO catheterization from Department of Critical Care Medicine, Peking Union Medical College Hospital were retrospectively collected and analyzed. The patients were assigned to acute respiratory distress syndrome group, cardiogenic shock group, septic shock group, and combined shock (cardiogenic and septic) group according to their symptoms. Information on 28-day mortality and renal function was also collected. Results: The CO and EVLW index (EVLWI) in the cardiogenic and combined shock groups were lower than those in the other groups (acute respiratory distress syndrome group vs. cardiogenic shock group vs. septic shock group vs. combined shock group: CO, 5.1 [4.0, 6.2] vs. 4.7 [4.0, 5.7] vs. 5.5 [4.3, 6.7] vs. 4.6 [3.5, 5.7] at 0 to 24 h, P=0.009;4.6 [3.8, 5.6] vs. 4.8 [4.1, 5.7] vs. 5.3 [4.4, 6.5] vs. 4.5 [3.8, 5.3] at 24 to 48 h, P=0.048;4.5 [4.1, 5.4] vs. 4.8 [3.8, 5.5] vs. 5.3 [4.0, 6.4] vs. 4.0 [3.2, 5.4] at 48 to 72 h, P=0.006;EVLWI, 11.4 [8.7,19.1] vs. 7.9 [6.6,10.0] vs. 8.8 [7.4,11.0] vs. 8.2 [6.7,11.3] at 0 to 24 h, P 0.05). In addition, there was no significant difference in tissue perfusion or renal function among the four groups during the observation period (P0.05). However, the cardiogenic shock group had a higher 28-day survival rate than the other three groups [log rank (Mantel-Cox)= 31.169, P 0.001]. Conclusion: Tissue-aimed lower CO could reduce the EVLWI and achieve a better prognosis.