부산대학교 도서관

Byline: Sandrine Boussat (1), Thierry Jacques (2), Bruno Levy (2), Evelyne Laurent (2), Antoine Gache (2), Gilles Capellier (2), Alain Neidhardt (2) Keywords: Sepsis Extravascular lung water Total end-diastolic volume Intrathoracic blood volume Central venous pressure Pulmonary artery occlusion pressure Abstract: Objective. To evaluate whether different indicators using for guiding volume expansion are valuable tools to assess edematous lung injury in patients with septic shock. Design and setting. Prospective observational clinical study in a university intensive care unit. Patients. Sixteen consecutive mechanically ventilated patients developing septic shock with evidence of pulmonary edema on chest radiograph and severe hypoxemia (PaO.sub.2/FIO.sub.2 Measurements and results. A pulmonary artery catheter was used for the measurement of cardiac index (CI), central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP). A fiberoptic catheter was placed in the descending aorta. Measurements of extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI), and total end-diastolic volume index (TEDVI) were obtained using the thermal dye dilution technique. Measurements were taken just after placement of catheters and 24 h later. Fluid balance was also estimated within the first 24 h. TEDVI and ITBVI were significantly correlated with EVLWI, but not CVP and PAOP. Analysis of 24-h changes showed that the changes in TEDVI and in ITBVI reflected the change in EVLWI, whereas PAOP, CVP, and fluid balance did not. Conclusions. Volume variables (TEDVI, ITBVI) are more useful indicators than pressure variables (CVP, PAOP) for assessment of EVLWI in septic patients with pulmonary edema. Author Affiliation: (1) Service de Reanimation Respiratoire et Maladies Respiratories, Hopital de Brabois, Allee du Morvan, 54511 Vandoeuvre-les-Nancy Cedex, France (2) Polyvalent Intensive Care Unit, University Hospital of Besancon, Boulevard Fleming, 25030 Besancon Cedex, France Article History: Received Date: 09/02/2001 Accepted Date: 04/03/2002 Article note: Electronic Publication