title: [Clinical study on pulmonary circulation changes in patients with acute respiratory distress syndrome induced by lung contusion].
abstract: OBJECTIVE
  To analyze the variation and significance of pulmonary circulation in patients with acute respiratory distress syndrome (ARDS) induced by lung contusion by means of Swan-Ganz catheter and the pulse index continuous cardiac output (PiCCO) monitoring.
  
  
  METHODS
  A prospective, randomized, non-blinded clinical trial was conducted. All patients admitted hospital from August 2009 to August 2011 met the inclusion criteria, were divided into the group with ARDS induced by lung contusion (contusion group, n = 18) and the group without lung contusion and ARDS (control group, n = 22). The measured parameters included pulmonary artery systolic pressure (PAS), pulmonary artery diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), pulmonary artery diastolic-pulmonary wedge pressure gradient (PAD-PAWP), and extravascular lung water index (ELWI) of each group at 0 hour after placing the catheter and at 12, 24, 36, 48, 60, 72 hours after contusion. The differences of all the parameters were compared within a group and among the different groups.
  
  
  RESULTS
  In the survivors with ARDS induced by lung contusion, PAS, PAD and PAD-PAWP were significantly higher than those in the control group and then gradually declined. PAS and PAD returned to the level of control group at 60 hours after contusion, and the PAD-PAWP restored to the level of control group at 48 hours after contusion. For the patients in the control group, there were no significant differences in PAS and PAD from the 0 hour after placing catheter to 72 hours after contusion, but PAD-PAWP increased at 72 hours after contusion compared with at 48 hours. Compared with the control group, the ELWI in contusion group increased significantly, and peaked at 12 hours after contusion and then gradually declined, and restored to the level of control group at 60 hours after contusion. For the patients in the control group, ELWI were lower at 60 hours and 72 hours after contusion than at 48 hours. Compared with control group, PAWP in contusion group decreased at 0 hour, and returned to the level of control group at 48 hours after contusion. For the patients in the control group, there were no significant differences in PAWP from the 0 hour after placing the catheter to 72 hours after contusion. The positive correlation were found between ELWI and  PAS, PAD, PAD-PAWP from 0 hour after placing the catheter to 48 hours after contusion in contusion group (r value, 0.554, 0.498, 0.629, respectively, all P < 0.01).
  
  
  CONCLUSIONS
  Among  the  patients  with  ARDS  induced  by  lung  contusion, it appears that changes in PAS, PAD and  PAD-PAWP,  as  well  as  ELWI  play  important roles in assessing fluid status, guiding mechanical ventilation and severity.
authors: Department of Critical Care Medicine, the Fifth Center Hospital in Tianjin, Tianjin, China. yang_wanjie@163.com
authors: Wan-jie
authors: WJ
authors: Yang
authors: Xue-feng
authors: XF
authors: Zhao
authors: Kai
authors: K
authors: Wei
authors: Qing-guo
authors: QG
authors: Feng
authors: Wei
authors: W
authors: Wang
authors: Xiao-zhi
authors: XZ
authors: Liu
mesh_terms: D000328:Adult; D003288:Contusions / Q000503:physiopathology*; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply; D055370:Lung Injury / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011652:Pulmonary Circulation; D011669:Pulmonary Wedge Pressure; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult