The relationship between ARDS, pulmonary infiltration, fluid balance, and hemodynamics in critically ill surgical patients.
Hypervolemia from fluid overload with resultant pulmonary edema is thought to be a frequent cause of Adult Respiratory Distress Syndrome (ARDS). However, ARDS may also occur as a result of the hypovolemic shock of surgery or trauma. To develop an appropriate rationale for fluid therapy in high-risk surgical patients, the relationship between fluid balance, hemodynamics, the onset of ARDS by physiologic criteria (shunt greater than or equal to 20%, and/or PaO2/FiO2 ratio less than 250) and the onset of pulmonary infiltration (PI) associated with ARDS were examined. Fifty patients were prospectively followed from admission throughout their hospitalizations; 38 (76%) had trauma and 12 (24%) were postoperative. Cardiac index, central venous pressure (CVP), wedge pressure (WP), and shunt (Qsp) were measured. All chest x rays were read by one staff radiologist who was blinded to the patients' identities. PI was graded from "0" to "4" (0 = no PI, 4 = maximum PI). The first x ray reading of "2" or greater was used as the time of onset of PI. ARDS by physiologic criteria occurred in 29 of 50 (58%) patients; 27 of these 29 (94%) also developed +2 or greater PI. The mean onset times of ARDS and of +2 PI were 40 +/- 41 hours and 40 +/- 38 hours, respectively. The ARDS patients had a significantly smaller net positive fluid balance than the non-ARDS patients over the first 40 hours after admission (+6,831 ml +/- 4,909 ml vs 12,440 ml +/- 7,817 ml, (P less than 0.01)).(ABSTRACT TRUNCATED AT 250 WORDS)
Bishop
M H
MH
Department of Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, California.
Jorgens
J
J
Shoemaker
W C
WC
Appel
P L
PL
Fleming
A
A
Williams
D
D
Jackson
G
G
Wo
C J
CJ
Babb
L
L
Manning
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002496:Central Venous Pressure / Q000502:physiology; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011659:Pulmonary Gas Exchange / Q000502:physiology; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D013514:Surgical Procedures, Operative; D015996:Survival Rate; D014882:Water-Electrolyte Balance / Q000502:physiology*
D010100:Oxygen