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Objective:To evaluate the prognostic value of extravascular lung water index (EVLWI) , soluble intercellular adhesion molecule-1(sICAM-1) and Krebs yon den lungen-6 (KL-6) in severe pneumonia patients with Severe Acute Respiratory Syndrome (ARDS).Methods:A prospective study was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from October 2017 to February 2020. The study included 65 severe pneumonia patients with ARDS, who was performed by measurement of pulse index continuous cardiac output and survived more than 3days after admission. The Extravascular Lung Water Index (EVLWI) , sICAM-1, KL-6 and Oxygenation Index(OI) on 1st, 3rd and 5th day were detected. APACHEⅡ score, patient survival events (days) and survival outcome were recorded. Correlation analysis between EVLWI, sICAM-1, KL-6 and OI was performed on the 1st, 3rd and 5th day after admission. Independent risk factors of mortality in severe pneumonia patients with ARDS were analyzed by multiple logistic regression. Receiver operating characteristic curve was drawn, and the prognostic value of each parameter was assessed finally.Results:The PCT, EVLWI, sICAM-1, KL-6 and APACHEⅡ score in the death group were significantly higher than those in the survival group ( P<0.05) at RICU admission, and the length of RICU stay was significantly shorter than that in the survival group ( P<0.05), while differences in other clinical characteristics between two groups were not statistically significant ( P>0.05) . These parameters including levels of EVLWI, sICAM-1, KL-6, Procalcitonin and APACHE Ⅱscore in the death group were significantly higher than those in the survival group on the 1st, 3rd and 5th day ( P<0.05), whereas the OI was significantly lower than that of the survival group on the 3rd and 5th day ( P<0.05). Logistic regression analysis showed that EVLWI, sICAM-1, KL-6 level were significantly related with the mortality of these patients. The levels of sICAM-1, kl-6 and EVLWI on 1st, 3rd and 5th day after RICU admission showed a significant negative correlation with OI ( P<0.001). Whereas, The levels of sICAM-1, kL-6 on 1st, 3rd and 5th day showed a significant positive correlation with EVLWI ( P<0.001). The sensitivity and specificity of sICAM-1, KL-6 combined with EVLWI in prognosis evaluation on 1st, 3rd and 5th day were 75.0%, 84.4%, 85.0%, 66.7%, 80.0%, 86.7%, respectively. The AUC was 0.864, 0.881, 0.892 on 1st, 3rd and 5th day, respectively ( P<0.001), which had a better prognostic value than each of them. Conclusions:EVLWI, sICAM-1 and KL-6 were independent risk factors for the prognosis of severe pneumonia patients with ARDS. The combination of EVLWI, sICAM-1 and KL-6 might be important in early predicting the prognosis of the 28d mortality.
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The aim of this study was to investigate the influence of enhanced external counterpulsation (EECP) on the cardiac function of beagle dogs after prolonged ventricular fibrillation. Twenty-four adult male beagles were randomly divided into control and EECP groups. Ventricular fibrillation was induced in the animals for 12 min, followed by 2 min of cardiopulmonary resuscitation. They then received EECP therapy for 4 h (EECP group) or not (control group). The hemodynamics was monitored using the PiCCO2 system. Blood gas and hemorheology were assessed at baseline and at 1, 2, and 4 h after return of spontaneous circulation (ROSC). The myocardial blood flow (MBF) was quantified by 18F-flurpiridaz PET myocardial perfusion imaging at baseline and 4 h after ROSC. Survival time of the animals was recorded within 24 h. Ventricular fibrillation was successfully induced in all animals, and they achieved ROSC after cardiopulmonary resuscitation. Survival time of the control group was shorter than that of the EECP group [median of 8 h (min 8 h, max 21 h) vs median of 24 h (min 16 h, max 24 h) (Kaplan Meyer plot analysis, P=0.0152). EECP improved blood gas analysis findings and increased the coronary perfusion pressure and MBF value. EECP also improved the cardiac function of Beagles after ROSC in multiple aspects, significantly increased blood flow velocity, and decreased plasma viscosity, erythrocyte aggregation index, and hematocrit levels. EECP improved the hemodynamics of beagle dogs and increased MBF, subsequently improving cardiac function and ultimately improving the survival time of animals after ROSC.
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Animals , Male , Dogs , Counterpulsation/methods , Cardiopulmonary Resuscitation/methods , Hemodynamics/physiology , Case-Control Studies , Disease Models, Animal , Kaplan-Meier EstimateABSTRACT
Objective To compare the accuracy of inferior vena cava (IVC) ultrasound,central venous pressure (CVP) and pulse indicator continuous cardiac output (PiCCO) in predicting fluid responsiveness in septic shock patients with myocardial depression.Methods Fifty patients with septic shock complicated with myocardial depression,aged ＞ 18 yr,were enrolled in the study.The method for fluid replacement test was as follows:0.9％ sodium chloride injectionor lactated Ringer's solution 500 ml was intravenously infused over 20 min,and positive fluid responsiveness was defined as an increase in PiCCO-monitored CO＞ 10％ after fluid replacement.Patients were divided into positive fluid responsiveness group and negative fluid responsiveness group according to the fluid replacement test.PiCCO was used to monitor stroke volume (SV),stroke volume variation (SVV) and pulse pressure variability (PPV) before fluid replacement,CVP was measured,and the diameter of IVC (d-IVC) and variability of IVC (v-IVC) were measured by bedside ultrasound.The receiver operating characteristic curve was drawn to evaluate the accuracy of each index in predicting fluid responsiveness.Results Compared with negative fluid responsiveness group,d-IVC was significantly decreased and v-IVC,SVV and PPV were increased before fluid replacement in positive fluid responsiveness group (P＜0.01).Three point five mmHg,14.5 mm,16.5％,17.0％ and 11.5％ were selected as the cutoff value for CVP,d-IVC,v-IVC,SVV and PPV,respectively.The sensitivity of CVP,d-IVC,v-IVC,SVV and PPV in predicting fluid responsiveness was 100％,92％,80％,44％ and 68％,respectively,and the specificity was 28％,80％,72％,100％ and 72％,respectively,and the area under the receiver operating characteristic curve (95％ confidence interval) was 0.609 (0.450-0.768),0.862 (0.750-0.974),0.777 (0.642-0.911),0.734 (0.596-0.873) and 0.733 (0.594-0.872),respectively.Conclusion PiCCO and IVC ultrasound provide higher accuracy in predicting fluid responsiveness in septic shock patients with myocardial depression,and IVC ultrasound is more superior because of non-invasive examination.
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Objective To compare the accuracy of the lung ultrasound and pulse indicator continuous cardiac output (PiCCO) in predicting volume responsiveness in septic shock patients with myocardial suppression.Methods Fifty patients of both sexes with septic shock complicated with myocardial depression,aged ≥ 18 yr,were enrolled in the study.The method for fluid replacement test was as follows:0.9％ sodium chloride injection or lactated Ringer's solution 500 ml was rapidly infused intravenously.PiCCO was used to monitor cardiac output,stroke volume,extravascular lung water index (EVLWI),pulmonary vascular penetration index (PVPI),intra-thoracic blood volume index and global end-diastolic volume index.The chest wall was scanned by ultrasound and the lung ultrasound score (LUS) was assessed.Positive fluid responsiveness was defined as an increase in PiCCO-monitored cardiac output＞ 10％ after fluid replacement.Patients were divided into positive fluid responsiveness group and negative fluid responsiveness group according to the results of fluid resuscitation test.The receiver operating characteristic (ROC) curve was drawn to evaluate the accuracy of each index in predicting fluid responsiveness.Results Compared with negative fluid responsiveness group,EVLWI,PVPI and LUS were significantly decreased,the number of patients in whom the bilateral anterior chest wall presented as B-line was increased in positive fluid responsiveness group (P＜0.01).The area under the ROC curve and 95％ confidence interval of LUS in predicting volume responsiveness was 0.836 (0.720-0.952),the cutoff value was 14.5 points,sensitivity 88％,and specificity 72％.The area under the ROC curve and 95％ confidence interval of EVLWI in predicting volume responsiveness was 0.818 (0.701-0.936),the cutoff value was 9.6 ml/kg,sensitivity 84％,and specificity 72％.The area under the ROC curve and 95％ confidence interval of PVPI in predicting volume responsiveness was 0.720 (0.575-0.865),the cutoff value was 1.55,sensitivity 92％,and specificity 52％.Conclusion The lung ultrasound and PiCCO produce higher accuracy in predicting volume responsiveness in septic shock patients with myocardial suppression;LUS has more advantages due to non-invasive examination.
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Objective To evaluate the prognosis value of plasma soluble vascular endothelial growth factor receptor (sFlt-1) combined with extravascular lung water index (EVLWI) in acute respiratory distress syndrome (ARDS) complicated with septic shock caused by severe pneumonia. Methods A retrospective analysis was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from January 2015 to July 2017. The study included 52 severe pneumonia patients with ARDS complicated with septic shock, who was performed by measurement of pulse index continuous cardiac output (PICCO) and survived more than 3 days after admission. According to the 28-day mortality, these patients were divided into the survival group (31 cases) and the death group (21 cases). PICCO was used to record the EVLWI level. The plasma level of sFlt-1 was measured by enzyme-linked immunosorbent assay (ELISA). Acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score were calculated. Independent risk factors were analyzed by multiple logistic regression. Correlation analysis between plasma sFlt-1 and EVLWI and APACHE II values was performed on the 1st, 2nd and 3rd day after admission. Receiver operating characteristic curve (ROC) was calculated, and the prognostic value of each parameter was assessed. Results The blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group at RICU admission (P<0.05), and the length of RICU stay was significantly shorter than that in the survival group (P<0.05), while differences in other clinical characteristics between the two groups were not statistically significant. The levels of EVLWI, sFlt-1 and blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group on the 1st, 2nd and 3rd day (all P<0.05), whereas the PaO2/FiO2 was significantly lower than that of the survival group on the 2nd and 3rd day (all P<0.05). Logistic regression analysis showed that sflt-1 level and EVLWI were significantly related with the patient mortality. The levels of sFlt-1 on day 1, 2 and 3 after RICU admission were positively related to EVLWI and APACHE II score (all P<0.01). The sensitivity and specificity of sFlt-1 combined with EVLWI in prognosis evaluation were 89.7％, 78.2％ and 86.3％, 75.7％, respectively. The AUC of sFlt-1 combined with EVLWI was 0.875 and 0.856 on the 1st and 3rd day, respectively (all P<0.01), which had a better prognostic value than each of them. Conclusions SFlt-1 could be used as a biomarker of mortality for severe pneumonia patients with ARDS complicated with septic shock. The combination of sFlt-1 and EVLWI might be important in early prediction of the prognosis of the 28-day mortality in patients with ARDS complicated with septic shock caused by severe pneumonia.
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Objective To explore the correlation of heart rate variability(HRV)and cardiac output by PICCO with anesthetic depth by Narcotrend monitoring. Methods 60 patients with radical resection of esophageal cancer were enrolled in the study. PICCO was used to monitor ECG and Narcotrend was use to monitor anesthetic depth.The NT value,NT grade,Cardiac index(CI),heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),Poincare scattergram Scatter plot minor axis(SD1)and scatter plot major axis(SD2)were recorded and measured at the time points of pre-anesthesia induction(T1),post-successful intubation(T2),tracheal intu-bation moment(T3),lung collapse for 30 min(T4),post-lung ventilation(T5)and 10min after operation(T6). Results Person's correlation analysis showed that during the monitoring period(T1-T6),CI,CO,SD1 and NT showed a low linear correlation(P < 0.001);SD2 was significantly correlated with NT(P <0.001). There was a low linear correlation between CI,CO,SD1,SD2 and NT at the operation time(T2-T5). Conclusion During general anesthesia,heart rate variability(SD1,SD2)and cardiac output(CO)are correlated with the NT value of anesthesia depth.Collaborative monitoring could help to enhance the safety of anesthesia.
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Objective To explore the clinical value of pulse indicates continuous cardiac output (PICCO) in fluid resuscitation of patients with ARDS complicated with septic shock caused by severe pneumonia. Methods Thirty-nine ARDS patients complicated with septic shock caused by severe pneumonia were divided into two groups, namely PICCO group and control group. The data of demographics and clinical findings of both groups were collected. At the same time, the data of serum lactic acid, Pa02/Fi02, MAP, the volume of fluid input, the amount of vasoactive agent, APACHE Ⅱ Scores of both groups at 6 hours and 24 hours after admission were collected, and the data of EVLWI, PVPI, CI, SVRI, GEDVI in PICCO group were documented at admission and 24 hours later, as well as the duration of mechanical ventilation, length of stay in the respiratory ICU and 30-day mortality were recorded. SPSS software of version 21.0 was used to statistically analyze the data. Results ① There were no statistically significant differences in in age, gender, APACHEII score and other relevant physiological parameters between two groups.② Compared with control group at 6 h and 24 h, the PICCO-guided treatment significantly reduced the level of Lac, elevated the MAP value and decreased the volume of fluid input (all P＜0.05) At the same time, this approach improved 24 h-Pa02/ Fi02(P=0.001).More importantly, the PICCO-guided treatment significantly reduced the duration of mechanical ventilation[(8.83 ± 3.57) vs (13.54 ± 4.06)d, P=0.000],shortened the stay in the respiratory ICU[(10.12 ± 4.46) vs (14.10 ± 5.65)d,P=0.020]and decreased the 30d mortality 15.79％ vs 50％,p=0.041. ③ In PICCO group, EVLWI and PVPI were significantly decreased[(12.27 ± 4.42) vs (16.11 ± 5.99) mL/ kg,P=0.028; (3.66 ± 1.71) vs (6.88 ± 2.93) mL/m2, P=0.000]; respectively and SVRI and GEDVI were significantly increased[(1212.70 ± 304.10) vs (958.50 ± 192.40)kPa·s/(min·m2),P=0.004; (676.57 ± 77.86) vs (616.33 ± 57.49)mL/(min · M2),P=0.010]; respectively at 24h compared those at admission. Conclusions Compared with conventional fluid resuscitation, PICCO-oriented treatment can quickly improve the relevant physiological parameters, direct the fluid resuscitation more accurately, shorten the duration of mechanical ventilation as well as the stay in ICU, and decrease the 30d mortality in patients with ARDS complicated with septic shock caused by severe pneumonia. Therefore, PICCO-oriented fluid resuscitation has noticeable clinical value, and be worthy of further clinical application especially in this kind of patients.
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Objective:To observe the application of pulse indicator continuous cardiac output (PICCO) system monitoring in the treatment of patients with severe thoracic trauma with the complication of acute respiratory distress syndrome (ARDS).Methods: 60 patients with severe thoracic trauma with complication of ARDS were randomly divided into the PICCO group (30cases) and the PAC group (30cases). The differences of PaO2/FiO2 score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, mortality, mechanical ventilation time, ICU stay time and total treatment cost between the two groups were observed.Results: The PaO2/FiO2 of PICCO group in 1d, 3d and 7d were significantly higher than that of PAC group, respectively (t=4.46,t=3.87, t=5.15,P0.05). Conclusion: In the treatment for patients with severe thoracic trauma with ARDS, PICCO system monitoring could reduce the mechanical ventilation time, ICU stay time and total treatment costs of patients, and enhance the treatment effect of patients.
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Objective To study whether there is a correlation between the content of neutrophil gelatinase-asociated lipocalin (NGAL) and extravascular lung water index (EVLWI) in patients with acute lung injury (ALI) induced by septic shock.Methods We prospectively collected 110 patients with septic shock from December 2013 to June 2015,who had already completed the initial fluid resuscitation within 6 hours according to the guide.In accordance with whether combined with ALI,patients were divided into two groups:non ALI group was A group (n =61),and ALI group was B group (n =49).Baseline information,EVLWI and other indexes of hemodynamic monitored by PICCO of each group was collected prior to admission in intensive care unit.EVWI and the content of NGAL in alveolar lavage fluid,which detected by ELISA,were gathered after the initial fluid resuscitation.Results There were no significant differences at the baseline level between the two groups (P ＞ 0.05).The risk factors of EVLWI in patients with septic shock were analyzed by multivariate linear regression analysis.The risk factors contained fluid balance,NGAL,cardiac index (CI),Global end diastolic volume index (GEDI),human albumin (ALB),globulin (GLO).The results showed that EVLWI had linear regression with NGAL and GEDI.The equation of linear regression were Y(NGAL) =2.017 + 0.035X,and Y(GEDt) =-0.671 + 0.004X,respectively.Correlation analysis indicated that there was significantly positive correlation between EVLWI and GEDI (r=0.835,P=0.000)and between NGAL and GEDI (r=0.489,P=0.000).In contrast,after immobilization of GEDI,we did not find any significant correlation between EVLWI and NGAL (r =0.381,P =0.060).Conclusions In case of fluid infusion volume is relatively too much,there is a strong correlation between NGAL in alveolar lavage fluid and EVLWI levels for early fluid resuscitation in patients with sepetic shock.
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A reliable estimation of cardiac preload is helpful in the management of severe circulatory dysfunction. The estimation of cardiac preload has evolved from nuclear angiography, pulmonary artery catheterization to echocardiography, and transpulmonary thermodilution (TPTD). Global end‑diastolic volume (GEDV) is the combined end‑diastolic volumes of all the four cardiac chambers. GEDV has been demonstrated to be a reliable preload marker in comparison with traditionally used pulmonary artery catheter‑derived pressure preload parameters. Recently, a new TPTD system called EV1000™ has been developed and introduced into the expanding field of advanced hemodynamic monitoring. GEDV has emerged as a better preload marker than its previous conventional counterparts. The advantage of it being measured by minimum invasive methods such as PiCCO™ and newly developed EV1000™ system makes it a promising bedside advanced hemodynamic parameter.
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Background: Perioperative fluid management is essential to the practice of anaesthesia. Outcomes may be improved if fluid therapy is individualized according to the patient's fluid responsiveness. Pulse-induced continuous cardiac output (PiCCO) monitor is an invasive device that quantifies several parameters, including cardiac output (CO), stroke volume variation (SVV) and extravascular lung water (EVLW). Trans-oesophageal Doppler monitoring (TED) is another minimally invasive form and has the benefit of providing beat to beat analysis. Aim of Work: We designed this prospective, randomized comparative study to evaluate the use of PiCCO monitor from the fluid and haemodynamic point of view in comparison to TED monitor in order to maintain an adequate circulatory volume ensuring end-organ perfusion and oxygen delivery. Patients and Methods: This study was performed on 72 patients of either sex (ASA I-II), undergoing major abdominal surgery. Patients were randomly allocated into two groups; PiCCO group (n=36); where fluid management was guided by SVV & colloid boluses were given to maintain SVV below 10% and TED group (n=36); where fluid management was guided by (systolic flow time corrected for heart rate) (FTc) & colloid was infused when the (FTc) ˂ 0.35 second, the fluid challenge would be repeated until FTc raised ˃ 0.40 second with no change in SV. Laboratory parameters of organ hypoperfusion in perioperative period were recorded as well as the number of postoperative complications, mortality and length of ICU stay. Results: PiCCO group received more intraoperative colloids (P=0.001) and had lower incidence of hypotensive events (P=0.001). Postoperative lactate levels were lower in PiCCO group (P=0.04). PiCCO group showed fewer numbers of patients developed complications & overall number of postoperative complications (P=0.01). It also showed shorter duration of ICU length of stay (P=0.01). No mortality was recorded in both groups. Conclusions: During major abdominal surgery; intraoperative fluid optimization using PiCCO monitor showed more haemodynamic stability and was associated with a lower incidence of postoperative complications, organ dysfunction and infectious complications with a tendency to decrease the ICU length of stay in comparison to TED monitor.
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Objective:To investigate the curative effect and safety of slow continuous ultrafiltration(SCUF) treatment on congestive refractory heart failure with renal failure, and to investigate the correlation between fluid balance and the postoperative complications.Methods:Thirty patients with congestive refractory heart failure with renal failure were chosen to receive slow continuous ultrafiltration treatment after deep vein catheterization, blood flow volume being 100-150 ml/min and therapy time being 24h. PiCCO was used to monitor the hemodynamic parameters, along with the change of blood pressure, blood oxygen saturation, heart beat and electrolyte.Results: After the slow continuous ultrafiltration treatment, the hemodynamic parameters of all patients showed obvious improvements, with better results on cardiac function and electrolyte balance. All the patients patients developed cardiopulmonary complications postoperatively have a larger total fluid balance of the first two days postoperatively than those without complications.Conclusion:SCUF have therapeutic effect and safety for treating congestive refractory heart failure with renal failure, and the status of the fluid balance can be a predictor of the postoperative morbidity and mortality.
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Objective To guide fluid management for sever heart failure patients by using PICCO indicators, in order to direct clinical fluid management and nursing care. Methods Sixty-four heart failure patients with level IV cardiac function were randomly divided into the control group and the experimental group according to random number table, and each one had 32 patients. Fluid management for patients in the control group was implemented with CVP monitoring technology, while the patients in the experimental group accepted PICCO monitoring technology as fluid management. Then compare these indicators between the two groups--length of stay in ICU, mortality rate of 28 days, daily fluid intake, output and time of achieving negative fluid balance, and observe the change of cardiac function index (CFI) and capacity indicators (ITBVI, GEDVI, EVLWI) in the experiment group before and after treatment. Results Indicators of ITBVI、GEDVI、EVLWI in the experiment group recovered to normal state and CFI improved. The indicators which had mentioned above was (1 203.41±111.08) ml/m2, (1 087.78±66.91) ml/m2, (12.91±3.54) ml/kg, (2.91±0.29) L·min-1·m-2 respectively when before the treatment, while the values after the treatment was (895.50 ± 50.27) ml/m2, (728.19 ± 73.33) ml/m2, (6.51 ± 0.75) ml/kg, (4.61 ± 0.69) L · min-1 · m-2, the difference was significant (t=-18.52-54.42, P<0.05). The length of stay in ICU, mortality rate of 28 days, daily fluid intake, output and time of achieving negative fluid balance of the experimental group were significantly lower than those in the control group(t=-17.19,-76.80,-12.38, χ2=3.26, P<0.05). Conclusions PICCO monitoring indicators are better than CVP method in the aspect of fluid management for patients with sever heart failure, which can increase the rescue success rate, promote the treatment effect, improve prognosis, and promote the rehabilitation of patients.
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PURPOSE: It has been reported that the Pulse Contour Cardiac Output (PiCCO) is very useful mainly in the field of intensive care and treatment to grasp the pathophysiological conditions of pulmonary edema because of its capability of obtaining data such as Pulmonary Vascular Permeability Index (PVPI) and Extra Vascular Lung Water (EVLW). Furthermore, a high degree of usability of various markers has been reported for better understanding of the pathological conditions in cases with septicemia. MATERIALS AND METHODS: The correlation between the cardiorespiratory status based upon the PiCCO monitor (EVLW and PVPI) and inflammatory markers including C reactive protein, procalcitonin (PC), and Endotoxin Activity Assay (EAA) were evaluated in 11 severe cases that required treatment with a respirator in an intensive care unit. RESULTS: The EAA values were significantly higher in patients with abnormal EVLW at 0.46+/-0.20 compared to the normal EVLW group at 0.21+/-0.19 (p=0.0064). In a similar fashion, patients with abnormal PVPI values tended to have higher PC levels at 18.9+/-21.8 compared to normal PVPI cases at 2.4+/-2.2 (p=0.0676). On the other hand, PVPI was significantly higher in the abnormal EAA group at 3.55+/-0.48 in comparison with the normal EAA group at 1.99+/-0.68 (p=0.0029). The abnormal EAA group tended to have higher PVPI values than the normal EAA group. CONCLUSION: The EAA is a measurement method designed to estimate the activity of endotoxins in the whole blood. Our results suggest that the EAA value, which had the greatest correlation with lung disorders diagnosed by the PiCCO monitoring, reflects inflammatory reactions predominantly in the lungs.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cardiac Output/physiology , Endotoxins/blood , Lung Injury/blood , Pulmonary Edema/bloodABSTRACT
Objective In order to extrapolate the respiratory dysfunction of patients in early stage of acute organophosphorus pesticide poisoning (AOPP),transpulmonary thermodilution technique was used in swine models of severe acute dichlorvos poisoning (SADP) to evaluate respiratory function.Methods Twenty healthy female swine were randomly divided into dichlorvos ( n =7 ),atropine ( n =7 ) and control (n =6) groups.In the dichlorvos group,the swine were administered with 80％ emulsified dichlorvos (100mg/kg) via the gastric tube toinduce SADP.In the atropine group,swinewere administered with dichlorvos,and 0.5h later,atropine was injected to obtain and maintain atropinization.The swine of control group were administered with saline solution instead.Arterial and venous blood samples were collected 0,0.5,1,2,4 and 6 hours after modeling for blood gas analysis and detecting acetylcholinesterase levels.Both extravascular lung water index (EVLWI) and pulmonary vascular permeability index ( PVPI ) were measured by using PiCCO (pulse indicator continuous cardiac output ). At the termination of the experiment,the animals were sacrificed and the lung wet/dry weight ratio was determined and histopathological changes of lung tissue were also observed under microscope.Results In the dichlorvos group,EVLWI and PVPI were substantially increased from 0.5 h to 6 h after modeling but PaO2/FiO2 decreased from 0-6 h after modeling.In the atropine group,EVLWI and PVPI increased initially,but then they decreased 1 h afterwards and PaO2/FiO2 was also gradually decreased from 0-1 h.In both dichlorvos group and atropine group,the EVLWI was negatively correlated with PO2/FiO2 and positively correlated with PVPI.Compared with the control group,the lung wet/dry weight ratio increased markedly in the dichlorvos group and mildly increased in the atropine group.Meanwhile,the histopathological changes of lung tissue were obvious in the dichlorvos group and mild in the atropine group.Conclusions SADP swine experienced substantial changes in respiratory function. EVLWI was a reliable and valuable indicator for evaluating respiratory function in the early stage of AOPP.
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PURPOSE: Atrial natriuretic peptide (ANP) has a variety of pharmacologic effects, including natriuresis, diuresis, vasodilatation, and suppression of the renin-angiotensin system. A recent study showed that ANP infusion improved hypoxemia and pulmonary hypertension in a lung injury model. On the other hand, the pulse contour cardiac output (PiCCO(TM)) system (Pulsion Medical Systems, Munich, Germany) allows monitoring of the intravascular volume status and may be used to guide volume therapy in severe sepsis and critically ill patients. MATERIALS AND METHODS: We treated 10 pulmonary edema patients without heart disease with human ANP (HANP). The patients were divided into two groups: a group with normal Intrathoracic Blood Volume (ITBV) (900-1100 mL/m2) (n = 6), and a group with abnormal ITBV (n = 4), as measured by the PiCCOtrade mark device; the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) in the two groups were compared. RESULTS: The average patient age was 63.9 +/- 14.4 years. The normal ITBV group showed significant improvement of the EVLW (before, 16.7 +/- 2.7 mL/kg; after, 10.5 +/- 3.6 mL/kg; p = 0.0020) and PVPI (before, 3.2 +/- 0.3; after, 2.1 +/- 0.7; p = 0.0214) after the treatment. The abnormal ITBV group showed no significant improvement of either the EVLW (before, 16.3 +/- 8.9 mL/kg; after, 18.8 +/- 9.6 mL/kg; p = 0.8387) or PVPI (before, 2.3 +/- 0.8; after, 2.7 +/- 1.3; p = 0.2782) after the treatment. In both groups, the EVLW and PVPI were strongly correlated with the chest X-ray findings. CONCLUSION: We conclude that HANP supplementation may improve the EVLW and PVPI in pulmonary edema patients without heart disease with a normal ITBV. The PiCCO(TM) system seems to be a useful device for the management of pulmonary edema.