Fluid management of extravascular lung water in elderly patients with severe pneumonia and spetic shock

doi:10.3877/cma.j.issn.2095-8757.2014.01.009

Abstract

Abstract:

Objective

To evaluate the clinical value of pulse-indicated continuous cardiac output (PiCCO) in elderly patients with severe pneumonia and spetic shock.

Methods

Treat 46 elderly patients with severe pneumonia and respiratory failure with Extravascular Lung Water Index (ELWI) or conventional central venous pressure (CVP) and radiographic exam to monitor fluid management. Comparison between two groups include 24 h, 48 h and 72-h Acute Physiology and Chronic Health Evaluation(APACHE) Ⅱ score, oxygenation index, blood lactate and mixed venous oxygen saturation (ScVO₂). Fluid intake and output, duration of mechanical ventilation, ICU stay and 28-day mortality were also observed.

Results

Seventy-two h-APACHE Ⅱ score was significantly lower in PiCCO group than CVP group (t=26.45, P<0.05). 48 h, 72 h-oxygenation index and ScVO₂ in ELWI group were significantly higher than those in CVP group (t=4.16、15.43, P<0.05), while the 72 h-blood lactate was significantly lower in ELWI group than that in CVP group (t=16.22, P<0.05). The net liquid income were significantly reduced in ELWI group than that in CVP group (t=18.42、25.64、3.32、11.82, P<0.05). Compared with CVP group, duration of mechanical ventilation and ICU stay were significantly reduced in ELWI group (t=18.55、22.12, P<0.05). Compared with CVP group, 28-day mortality in PiCCO-monitoring patients decreased, but no significant difference was found (χ²=0.55, P>0.05).

Conclusion

Extravascular lung water for fluid management in elderly patients with severe pneumonia and respiratory failure can significantly reduce the total fluid intake, improve patient oxygenation index, reduce ventilating time, shorten ICU length of stay and reduce mortality.

Key words: Extravascular lung water, Aged, Pneumonia, Central vellous pressure

Jun Wu, Wei Lu, Xiang Zheng, Linjun Wu, Dongying Wang. Fluid management of extravascular lung water in elderly patients with severe pneumonia and spetic shock[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2014, 01(01): 30-33.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlnbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8757.2014.01.009

https://zhlnbyjdzzz.cma-cmc.com.cn/EN/Y2014/V01/I01/30

Figures/Tables 4

References 11

[1]	Lange M, Hamahata A, Traber DL, et al.Pulmonary microvascular hyperpermeability and expression of vascular endothelial growth factor in smoke inhalation and pneumonia-induced acute lung injury [J]. Burns，2012，38(7)：1072-1078.
[2]	Corradi F, Ball L, Brusasco C, et al. Assessment of extravascular lung water by quantitative ultrasound and CT in isolated bovine lung[J]. Respir Physiol Neurobiol，2013，187(3)：244-249.
[3]	Mandell LA, Wunderink RG, Anzueto A，et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J]．Clin Infect Dis，2007，44(Suppl 2)：S27-S72.
[4]	Mitchell JP, Schuller D, Calandrino FS，et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization[J]．Am Rev Respir Dis，1992，145(5)：990-998.
[5]	Delinger RP, Levy MM, Rhodes A, et al.Surviving sepsis campaign：international guidelines for management of severe sepsis and septic shock：2012[J]．Crit Care Med，2013，41(2)：580-637.
[6]	Cordemans C, De Lael I, Van Regenmortel N, et al.Fluid management in critically ill patients：the role of extravascular lung water，abdominal hypertension，capillary leak，and fluid balance[J]．Ann intensive care, 2012，5(2)：1186-1192.
[7]	Bovd JH, Forbes J, Nakada TA，et al.Fluid resuscitation in septic shock：a positive fluid balance and elevated central venous pressure are associated with increased mortality[J]. Crit Care Med，2011，39(2)：259-265.
[8]	Takeda A, Okumura S, Miyamoto T, et al. Comparison of extravascular lung water volume with radiographic findings in dogs with experimentally increased permeability pulmonary edema[J]. J Vet Med Sci，1995，57(3)：481-485.
[9]	Brown LM, Calfee CS, Howard JP, et al. Comparison of thermodilution measured extravascular lung water with chest radiographic assessment of pulmonary oedema in patients with acute lung injury [J]. Ann Intensive Care，2013，3(1)：25.
[10]	方志成，郑翔，陈黎．强化液体管理对重症肺炎机械通气的影响[J]．临床肺科杂志，2012，17(9)：1580-1582.
[11]	陈齐红，郑瑞强，林华，等．不同液体管理策略对感染性休克患者死亡率的影响[J]．中国危重病急救医学，2011，23(3)：142-144.

组别	例数	年龄	性别(男/女，例)	体重(kg)	APACHEⅡ评分	氧合指数	血乳酸(mmol/L)	ScVO₂(%)
ELWI组	22	71.54±10.43	12/10	64.32±13.54	21.54±7.31	186.65±58.21	3.54±2.54	62.15±12.43
CVP组	24	69.54±13.52	14/10	60.24±15.43	19.12±8.63	169.76±69.61	3.13±2.12	64.54±16.12

组别	例数	年龄	性别(男/女，例)	体重(kg)	APACHEⅡ评分	氧合指数	血乳酸(mmol/L)	ScVO₂(%)
ELWI组	22	71.54±10.43	12/10	64.32±13.54	21.54±7.31	186.65±58.21	3.54±2.54	62.15±12.43
CVP组	24	69.54±13.52	14/10	60.24±15.43	19.12±8.63	169.76±69.61	3.13±2.12	64.54±16.12

组别	n	APACHEⅡ评分			氧合指数
组别	n	第24h	第48h	第72h	第24h	第48h	第72h
ELWI组	22	21.65±6.13	20.42±5.15	17.45±2.51	201.56±56.45	263.03±64.55	277.53±47.45
CVP组	24	20.11±5.43	22.43±3.76	20.21±4.33	212.53±45.54	192.74±53.12	200.11±61.64
t值	?	12.43	5.63	26.45	11.32	5.12	45.23
P值	?	>0.05	>0.05	<0.05	>0.05	<0.05	<0.05
血乳酸(mmol/L)			ScVO2(%)
第24h	第48h	第72h	第24h	第48h	第72h
2.34±0.63	2.10±1.81	1.23±1.79	64.72±8.22	72.25±6.23	75.15±7.43
2.65±0.65	2.48±1.60	2.46±1.25	65.46±7.54	66.52±6.32	63.07±8.18
13.65	10.64	4.16	8.63	15.43	16.22
>0.05	>0.05	<0.05	>0.05	<0.05	<0.05

组别	n	APACHEⅡ评分			氧合指数
组别	n	第24h	第48h	第72h	第24h	第48h	第72h
ELWI组	22	21.65±6.13	20.42±5.15	17.45±2.51	201.56±56.45	263.03±64.55	277.53±47.45
CVP组	24	20.11±5.43	22.43±3.76	20.21±4.33	212.53±45.54	192.74±53.12	200.11±61.64
t值	?	12.43	5.63	26.45	11.32	5.12	45.23
P值	?	>0.05	>0.05	<0.05	>0.05	<0.05	<0.05
血乳酸(mmol/L)			ScVO2(%)
第24h	第48h	第72h	第24h	第48h	第72h
2.34±0.63	2.10±1.81	1.23±1.79	64.72±8.22	72.25±6.23	75.15±7.43
2.65±0.65	2.48±1.60	2.46±1.25	65.46±7.54	66.52±6.32	63.07±8.18
13.65	10.64	4.16	8.63	15.43	16.22
>0.05	>0.05	<0.05	>0.05	<0.05	<0.05

组别	例数	液体总入量			液体净入量
组别	例数	第24 h	第48 h	第72 h	第24 h	第48 h	第72 h
ELWI组	22	2564.12±1023.55	2973.00±652.54	2541.15±535.63	805.55±455.23	492.22±442.54	－158.17±563.20
CVP组	24	3231.53±653.53	3644.13±452.64	2582.44±1061.54	1231.65±573.34	1052.64±554.22	104.56±652.23
t值	?	18.42	25.64	6.13	3.32	11.82	26.52
P值	?	<0.05	<0.05	>0.05	<0.05	<0.05	>0.05

Please choose a citation manager

Content to export