Increased morbidity with increased pulmonary albumin flux in sepsis-related adult respiratory distress syndrome.
OBJECTIVE
To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate and morbidity in adult respiratory distress syndrome (ARDS) patients.


METHODS
Prospective study.


METHODS
University hospital ICUs.


METHODS
Thirty-five control volunteers, 19 patients with congestive heart failure, 30 patients with a diagnosis of sepsis.


RESULTS
All patients were infused iv with technetium 99m-labeled albumin and underwent computerized gamma-scintigraphic analysis with a portable gamma camera. Lung-to-heart ratio of tracer was calculated and expressed as the slope index. Increase in slope index indicated increased pulmonary albumin flux. Slope index was no different in controls compared with congestive heart failure patients, unless the pulmonary artery occlusion pressure (PAOP) was greater than 30 mm Hg. Patients with a diagnosis of sepsis had an overall increased slope index compared with the other groups. A subgroup of patients in the septic group had a normal slope index. Septic patients with an increased slope index had a significantly (p less than .01) longer duration of mechanical ventilation (36 +/- 5 vs. 7 +/- 1 days), spent longer in the ICU (67 +/- 9 vs. 11 +/- 1 days), and had a longer hospital stay (113 +/- 20 vs. 35 +/- 5 days) than septic patients with a normal slope index.


CONCLUSIONS
Gamma scintigraphy successfully differentiated between control volunteers and patients with congestive heart failure with PAOP less than 30 mm Hg from patients with sepsis-induced ARDS. Although all of the patients with a clinical diagnosis of septic ARDS had similar impairments in oxygenation and chest roentgenograms, those patients with a significantly increased pulmonary albumin flux (greater than 2 SD above control mean) had a markedly increased morbidity.
Byrne
K
K
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0519.
Tatum
J L
JL
Henry
D A
DA
Hirsch
J I
JI
Crossland
M
M
Barnes
T
T
Thompson
J A
JA
Young
J
J
Sugerman
H J
HJ
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D003936:Diagnosis, Computer-Assisted / Q000592:standards*; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006785:Hospitals, University; D006801:Humans; D007239:Infections / Q000150:complications*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity; D011859:Radiography / Q000592:standards; D011877:Radionuclide Imaging / Q000592:standards*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012720:Severity of Illness Index; D015996:Survival Rate; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics
D013668:Technetium Tc 99m Aggregated Albumin