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The relationship between these categories and pulmonary microvascular permeability as well as extravascular lung water content, which is the hallmark of lung pathophysiology, remains to be elucidated. The aim of this study was to evaluate the relationship between extravascular lung water, pulmonary vascular permeability, and the severity categories as defined by the Berlin definition, and to confirm the associated predictive validity for severity.Methods: The extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) were measured using a transpulmonary thermodilution method for three consecutive days in 195 patients with an EVLWi of ≥10 mL/kg and who fulfilled the Berlin definition of ARDS. Collectively, these patients were seen at 23 ICUs. Using the Berlin definition, patients were classified into three categories: mild, moderate, and severe.Results: Compared to patients with mild ARDS, patients with moderate and severe ARDS had higher acute physiology and chronic health evaluation II and sequential organ failure assessment scores on the day of enrollment. Patients with severe ARDS had higher EVLWi (mild, 16.1; moderate, 17.2; severe, 19.1; P \u003c0.05) and PVPI (2.7; 3.0; 3.2; P \u003c0.05). When categories were defined by the minimum PaO2/FIO2ratio observed during the study period, the 28-day mortality rate increased with severity categories: moderate, odds ratio: 3.125 relative to mild; and severe, odds ratio: 4.167 relative to mild. On independent evaluation of 495 measurements from 195 patients over three days, negative and moderate correlations were observed between EVLWi and the PaO2/FIO2ratio (r = -0.355, P\u003c0.001) as well as between PVPI and the PaO2/FIO2ratio (r = -0.345, P \u003c0.001). ARDS severity was associated with an increase in EVLWi with the categories (mild, 14.7; moderate, 16.2; severe, 20.0; P \u003c0.001) in all data sets. The value of PVPI followed the same pattern (2.6; 2.7; 3.5; P \u003c0.001).Conclusions: Severity categories of ARDS described by the Berlin definition have good predictive validity and may be associated with increased extravascular lung water and pulmonary vascular permeability. 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Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition
http://hdl.handle.net/10069/33912
http://hdl.handle.net/10069/33912b99c84ad-9c01-4ab0-9c11-35f57d84dcde
名前 / ファイル | ライセンス | アクション |
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CriCar17_R132.pdf (613.8 kB)
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Item type | 学術雑誌論文 / Journal Article(1) | |||||
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公開日 | 2013-10-24 | |||||
タイトル | ||||||
タイトル | Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition | |||||
言語 | ||||||
言語 | eng | |||||
資源タイプ | ||||||
資源タイプ識別子 | http://purl.org/coar/resource_type/c_6501 | |||||
資源タイプ | journal article | |||||
著者 |
Kushimoto, Shigeki
× Kushimoto, Shigeki× Endo, Tomoyuki× Yamanouchi, Satoshi× Sakamoto, Teruo× Ishikura, Hiroyasu× Kitazawa, Yasuhide× Taira, Yasuhiko× Okuchi, Kazuo× Tagami, Takashi× Watanabe, Akihiro× Yamaguchi, Junko× Yoshikawa, Kazuhide× Sugita, Manabu× Kase, Yoichi× Kanemura, Takashi× Takahashi, Hiroyuki× Kuroki, Yuuichi× Izumino, Hiroo× Rinka, Hiroshi× Seo, Ryutarou× Takatori, Makoto× Kaneko, Tadashi× Nakamura, Toshiaki× Irahara, Takayuki× Saito, Nobuyuki |
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抄録 | ||||||
内容記述タイプ | Abstract | |||||
内容記述 | Introduction: The Berlin definition divides acute respiratory distress syndrome (ARDS) into three severity categories. The relationship between these categories and pulmonary microvascular permeability as well as extravascular lung water content, which is the hallmark of lung pathophysiology, remains to be elucidated. The aim of this study was to evaluate the relationship between extravascular lung water, pulmonary vascular permeability, and the severity categories as defined by the Berlin definition, and to confirm the associated predictive validity for severity.Methods: The extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) were measured using a transpulmonary thermodilution method for three consecutive days in 195 patients with an EVLWi of ≥10 mL/kg and who fulfilled the Berlin definition of ARDS. Collectively, these patients were seen at 23 ICUs. Using the Berlin definition, patients were classified into three categories: mild, moderate, and severe.Results: Compared to patients with mild ARDS, patients with moderate and severe ARDS had higher acute physiology and chronic health evaluation II and sequential organ failure assessment scores on the day of enrollment. Patients with severe ARDS had higher EVLWi (mild, 16.1; moderate, 17.2; severe, 19.1; P <0.05) and PVPI (2.7; 3.0; 3.2; P <0.05). When categories were defined by the minimum PaO2/FIO2ratio observed during the study period, the 28-day mortality rate increased with severity categories: moderate, odds ratio: 3.125 relative to mild; and severe, odds ratio: 4.167 relative to mild. On independent evaluation of 495 measurements from 195 patients over three days, negative and moderate correlations were observed between EVLWi and the PaO2/FIO2ratio (r = -0.355, P<0.001) as well as between PVPI and the PaO2/FIO2ratio (r = -0.345, P <0.001). ARDS severity was associated with an increase in EVLWi with the categories (mild, 14.7; moderate, 16.2; severe, 20.0; P <0.001) in all data sets. The value of PVPI followed the same pattern (2.6; 2.7; 3.5; P <0.001).Conclusions: Severity categories of ARDS described by the Berlin definition have good predictive validity and may be associated with increased extravascular lung water and pulmonary vascular permeability. Trial registration: UMIN-CTR ID UMIN000003627. | |||||
書誌情報 |
Critical Care 巻 17, 号 4, p. R132, 発行日 2013-06-20 |
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出版者 | ||||||
出版者 | BioMed Central | |||||
ISSN | ||||||
収録物識別子タイプ | ISSN | |||||
収録物識別子 | 13648535 | |||||
DOI | ||||||
関連タイプ | isIdenticalTo | |||||
識別子タイプ | DOI | |||||
関連識別子 | 10.1186/cc12811 | |||||
権利 | ||||||
権利情報 | © 2013 Kushimoto et al.; licensee BioMed Central Ltd. | |||||
権利 | ||||||
権利情報 | This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. | |||||
著者版フラグ | ||||||
出版タイプ | VoR | |||||
出版タイプResource | http://purl.org/coar/version/c_970fb48d4fbd8a85 | |||||
引用 | ||||||
内容記述タイプ | Other | |||||
内容記述 | Critical Care, 17(4), R132; 2013 |