抄録
Objective: Pulmonary edema is divided into cardiogenic and permeability types. There are no quantitative diagnostic criteria for differentiating between the pathologic mechanisms. The purpose of this study is to establish quantitative differential criteria for cardiogenic pulmonary edema and acute lung injury/acute respiratory distress syndrome (ALI/ARDS) (permeability edema). Methods: In this multicenter study, 91 patients ventilated for acute respiratory failure with a P/F ratio < 300 and bilateral infiltration on chest radiographs, necessitating transpulmonary thermodilution technique monitoring, were enrolled. We assessed the pulmonary vascular permeability index (PVPI) as the extravascular lung water index (ELWI)/pulmonary blood volume index. Pulmonary edema was defined as ELWI > 10 ml/kg. The cause of pulmonary edema was determined by three or more experts, taking into account medical history, clinical features, respiratory and hemodynamic variables, and clinical course with therapy. The experts were blinded to the PVPI data. Results: ALI/ARDS was diagnosed in 58 cases, pleural effusion/atelectasis in 11, and cardiogenic pulmonary edema in 6 (16 suspected cases). The ELWI of pleural effusion/atelectasis was below that of pulmonary edema (7.7±1.2 ml/kg). The PVPI in ALI/ARDS was significantly higher than that of non-ALI/ARDS (ALI/ARDS, 2.91±0.92; pleural effusion/atelectasis, 1.51±0.55; cardiogenic pulmonary edema, 1.53±0.31). The area under the curve (AUC) of receiver operating characteristic (ROC) curve using the PVPI to distinguish ALI/ARDS from non-ALI/ARDS was 0.926. A PVPI of 2.0–2.2 was thus proposed as the differential value. There was a positive correlation between PVPI and ELWI in ALI/ARDS (Sr = 0.652, P < 0.001), but not in non-ALI/ARDS. Conclusions: PVPI combined with ELWI may be useful for determining the pathologic mechanisms of pulmonary edema and respiratory failure in the critical care setting. (UMIN-CTR number, UMIN 000003627)
