血流動力學(xué)監(jiān)測PICCO杜斌PPT學(xué)習(xí)教案

1、會計學(xué)1Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrel FE Jr, Wagner D, Desbjens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ Jr, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus WA. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigat

2、ors. JAMA 1996; 276(11): 889-897 第1頁/共110頁第2頁/共110頁2000年年2001年年降低降低%出院患者數(shù)1,636,0461,684,089PAC使用數(shù)5,9695,02215.8PAC使用率(/1000)3.652.98年齡0 17歲2195765 74歲1,7391,37521 75歲1,9171,62015.5性別男性3,4922,97015女性2,4732,05217Appavu S, Cowen J, Bunyer M. The use of pulmonary artery catheterization has declined. Cri

3、tical Care 2005; 9(Suppl 1): P69 (DOI 10.1186/cc3132)第3頁/共110頁2000年年2001年年降低降低%醫(yī)院大醫(yī)院87369620其他醫(yī)院5,0924,32615地區(qū)Chicago39.4Rockford40St. Louis33.6中部15Appavu S, Cowen J, Bunyer M. The use of pulmonary artery catheterization has declined. Critical Care 2005; 9(Suppl 1): P69 (DOI 10.1186/cc3132)第4頁/共110頁

4、Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553第5頁/共110頁0%20%40%60%PAWPCOSVRRAP預(yù)測準確性預(yù)測準確性Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compare

5、d to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553第6頁/共110頁Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. C

6、rit Care Med 1984; 12(7): 549-553第7頁/共110頁Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553第8頁/共110頁Squara P, Fourquet E, Jacquet L, Broccard A, Uhlig T, R

7、hodes A, Bakker J, Perret C. A computer program for interpreting pulmonary artery catheterization data: results of the European HEMODYN resident study. Intensive Care Med 2003; 29: 735-741第9頁/共110頁不同意見數(shù)目不同意見數(shù)目Kappa計算機輔助診治前住院醫(yī)生與計算機5.7 2.20.64 0.14*計算機輔助診治后住院醫(yī)生與計算機1.9 2.00.88 0.12住院醫(yī)生與主治醫(yī)生1.2 1.70.92

8、0.10主治醫(yī)生與計算機0.9 1.20.95 0.07*p 0.05Squara P, Fourquet E, Jacquet L, Broccard A, Uhlig T, Rhodes A, Bakker J, Perret C. A computer program for interpreting pulmonary artery catheterization data: results of the European HEMODYN resident study. Intensive Care Med 2003; 29: 735-741第10頁/共110頁計算機輔助前計算機輔助前

9、計算機輔助后計算機輔助后RCRCRSSC酸堿失衡0.830.930.950.98機械通氣0.780.950.960.98代謝0.520.860.900.96充盈狀態(tài)0.560.840.910.93泵功能0.530.840.900.90循環(huán)0.720.910.940.96RC: 住院醫(yī)生與計算機; RS: 住院醫(yī)生與主治醫(yī)生; SC: 主治醫(yī)生與計算機Squara P, Fourquet E, Jacquet L, Broccard A, Uhlig T, Rhodes A, Bakker J, Perret C. A computer program for interpreting pulm

10、onary artery catheterization data: results of the European HEMODYN resident study. Intensive Care Med 2003; 29: 735-741第11頁/共110頁Squara P, Bennett D, Perret C. Chest 2002; 121: 2009-2015第12頁/共110頁Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies on intensive care units: results fro

11、m a postal survey. Intensive Care Med 1998; 24: 147-151第13頁/共110頁01015191915100預(yù)計預(yù)計PAWP (mmHg)測定測定PAWP (mmHg)Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-

12、553No change in planned therapy after catheterizationChange in planned therapy after catheterization第14頁/共110頁004.57.0預(yù)計預(yù)計CO (L/min)測定測定CO (L/min)Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill pati

13、ents. Crit Care Med 1984; 12(7): 549-5534.57.0第15頁/共110頁Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553參數(shù)參數(shù)判斷正確數(shù)目判斷正確數(shù)目/測定數(shù)目測定數(shù)目正確率正確率(%)PAWP31/10230CO49

14、/9751SVR39/8844RAP54/9855第16頁/共110頁Cardiac outputWedge pressureConnors(NEJM 83)ICU pts44% 42%Eisenberg(CCM 84)ICU pts50% 33%Bayliss(BMJ 83)CCU pts71% 62%第17頁/共110頁第18頁/共110頁Dawson NV et al. Hemodynamic assessment in managing the critically ill: is physician confidence warranted? Med Decis Making 199

15、3; 13: 258-266第19頁/共110頁Clinical SettingAccurate Assessment, %Unanticipated Changes in Therapy Based on PAC, %Connors, et al62 noncardiac medical intensive care patients4848Eisenberg, et al103 critically ill patients5030Tuchschmidt and Sharma35 noncardiac medical intensive care patients 4265Steingru

16、b, et al154 combined medical/surgical intensive care patients 5147Connors, et alCardiac and noncardiac medical intensive care 6647第20頁/共110頁所有醫(yī)生所有醫(yī)生(n = 417)心內(nèi)科醫(yī)生心內(nèi)科醫(yī)生(n = 27)CO330 (79%)21 (75%)PAWP285 (68%)27 (100%)SvO2220 (53%)10 (38%)MPAP120 (37%)10 (38%)SV100 (24%)3 (13%)RAP20 (5%)RVEF20 (5%)RVE

17、DV18 (4%)Squara P, Bennett D, Perret C. Chest 2002; 121: 2009-2015第21頁/共110頁Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Groe J, Schirmer U. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a posta

18、l survey. Acta Anaesthesiologica Scandinavica 2007; 51(3): 347-358.第22頁/共110頁血流動力學(xué)監(jiān)測血流動力學(xué)監(jiān)測比例比例(%)基本監(jiān)測100肺動脈導(dǎo)管(PAC)58.2經(jīng)食道超聲(TEE)38.1PICCO13.0Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Groe J, Schirmer U. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-o

19、perative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiologica Scandinavica 2007; 51(3): 347-358.第23頁/共110頁Esdaile B, Raobaikady R. Survey of cardiac output monitoring in intensive care units in England and Wales. Critical Care 2005; 9(Suppl 1): P68 (DOI 10.1186/c

20、c3131)第24頁/共110頁Esdaile B, Raobaikady R. Survey of cardiac output monitoring in intensive care units in England and Wales. Critical Care 2005; 9(Suppl 1): P68 (DOI 10.1186/cc3131)第25頁/共110頁第26頁/共110頁Morris AH, Chapman RH, Gardner RM. Frequency of technical problems encountered in the measurement of

21、pulmonary artery wedge pressure. Crit Care Med 1984; 12(3): 164-170N (%) measurements% of technical problemsNo problem1868 (69)Technical problems843 (31)Criterion 1 (total)(12)(38)Unable to obtain an “atrial waveform”1238Criterion 2 (total)156 (6)19WP waveform intermediate between the phasic PA and

22、atrial waveforms100 (4)12Spontaneous variation of WP56 (2)7Criterion 3 (total)381 (14)45Poor dynamic response184 (7)22Damped tracing65 (2)8Overinflation42 (2)5Cannot aspirate blood with the catheter in the PA36 (1)4Cannot aspirate blood with the catheter in the wedge position54 (2)6第27頁/共110頁Morris

23、AH, Chapman RH, Gardner RM. Frequency of technical problems encountered in the measurement of pulmonary artery wedge pressure. Crit Care Med 1984; 12(3): 164-170WPTechnical ProblemCorrected byInitialConfirmed228OverinflationDeflated balloon812Venous bloodAdvance 2 cm308Venous bloodWithdrawn156Venous

24、 bloodNothing812Poor dynamic responseWithdrawn 4 cm248Poor dynamic responseDeflated and inflated balloon2313Poor dynamic responseWithdrawn128Poor dynamic responseFlushed3618Partial WPPatient coughed214Partial WPRepositioned720Partial WPNothing1420?RepositionedWP initial WP confirmed = 11 6 mmHgRange

25、 (-13, +22)第28頁/共110頁Morris AH, Chapman RH, Gardner RM. Frequency of wedge pressure errors in the ICU. Crit Care Med 1985; 13(9): 705-708ProblemDescriptionsNumber (%)Damped tracingReduced high-frequency content40 (43%)Poor dynamic responseAbsent oscillation, low frequency, or inadequate duration of

26、oscillations after a sudden pressure decrease from approximately 300 mmHg to vascular levels58 (62%)Over inflationSlow, frequently linear increase in pressure after balloon inflation10 (9%)Partial WPWaveform intermediate between phasic PA and atrial waveforms22 (25%)第29頁/共110頁Distribution of WP meas

27、urements and frequency of a WP error 4 mmHgTrauma ICURespiratory ICUN% (95%CI)N% (95%CI)Total WP attempts10917% (11 26%)17710% (6 15%)WP ultimately confirmed80158Initial WP without technical problems468% (3 16%)1334% (1 8%)Initial WP with technical problems5326% (18 44%)4031% (17 47%)No WP obtained1

28、04Morris AH, Chapman RH, Gardner RM. Frequency of wedge pressure errors in the ICU. Crit Care Med 1985; 13(9): 705-708第30頁/共110頁Gnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第31

29、頁/共110頁Gnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220PAC相關(guān)知識調(diào)查問卷的內(nèi)容分類1壓力或心輸出量測定的技術(shù)問題2相關(guān)指標的計算3血流動力學(xué)指標的解讀4留置導(dǎo)管5導(dǎo)管相關(guān)并發(fā)癥的識別, 預(yù)防及治療6應(yīng)用PAC指導(dǎo)治療7其他第32頁/共110頁In-TrainingPostgraduate Trai

30、ning CompletedPrimary Medical SpecialtyAnesthesiology69.9 13.777.0 12.6Internal Medicine67.9 14.378.3 11.5Others62.4 16.369.8 15.2Opinion of Respondents on Their Knowledge of PACsInadequate57.6 15.355.0 17.3Minimal65.7 14.371.9 14.1Adequate73.2 13.179.2 10.7Superfluous-83.3 0Gnaegi A, Feihl F, Perre

31、t C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第33頁/共110頁60.665.46977.380.874.373.878.283.378.95060708090Never 10/mthInserting PACs: Frequency in the Last 6 MthsMean ScoresIn-TrainingPostgraduate Traini

32、ng CompletedGnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第34頁/共110頁55.862.667.971.173.663.970.275.279.581.95060708090Never 10/mthUsing PAC Data for Guiding Therapy: Frequency i

33、n the Last 6 MthsMean ScoresIn-TrainingPostgraduate Training CompletedGnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第35頁/共110頁63.470.975.977.473.367.67379.979.678.85060708090Nev

34、er 10/mthSupervising PAC Insertion: Frequency in the Last 6 MthsMean ScoresIn-TrainingPostgraduate Training CompletedGnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第36頁/共110頁第37頁

35、/共110頁Central venous catheterInjectate temperature sensor housing PV4046 Arterial thermodilution catheter Injectate temperature sensor cablePC80109 PULSION disposable pressure transducer PV8115PCCIAP13.03 16.28 TB37.0AP 140117 92(CVP) 5SVRI 2762PCCI 3.24HR 78SVI 42SVV 5%dPmx 1140(GEDI) 625 DPT Monit

36、or cablePMK-206Interface cablePC80150 Connection cableto bedside monitorPMK - XXX AUX adaptercable PC81200 第38頁/共110頁a. 經(jīng)肺熱稀釋技術(shù)經(jīng)肺熱稀釋技術(shù)b. 動脈脈搏輪廓分析技術(shù)動脈脈搏輪廓分析技術(shù)第39頁/共110頁Tb注射注射t第40頁/共110頁中心靜中心靜脈注射脈注射右心右心左心左心肺肺PiCCO導(dǎo)導(dǎo)管如插管如插在股動在股動脈內(nèi)脈內(nèi)第41頁/共110頁PCCO動脈熱稀釋動脈熱稀釋測量位置測量位置靜脈注射靜脈注射RAEDVPBVEVLWLAEDVLVEDVEVLWRVEDV

37、常規(guī)熱稀釋常規(guī)熱稀釋測量位置測量位置s010203040500,00,20,40,6 C- -D DT注射注射熱熱稀稀釋釋測測量量曲曲線線D-dtTKV)T(TCObiibTDa Tb = 血流溫度血流溫度Ti = 注射指示劑溫度注射指示劑溫度Vi = 注射指示劑容積注射指示劑容積 Tb . dt = 熱稀釋曲線下面積熱稀釋曲線下面積K = 校正系數(shù)校正系數(shù)第42頁/共110頁t sP mm HgSV第43頁/共110頁壓力曲線壓力曲線下面積下面積壓力曲線型壓力曲線型狀狀PCCO = cal HR SystoleP(t)SVR+ C(p) dPdt() dt動脈順應(yīng)動脈順應(yīng)性參數(shù)性參數(shù)心心率率

38、與病人有關(guān)的校與病人有關(guān)的校正因子正因子 t sP mm HgPCCO is displayed as last 12s mean第44頁/共110頁AuthorPt/ObsCOTDa COTDpaBias SDrVon Spiegel, et al. Anaesthesist 1996; 45(11)21/48-4.7 1.5%.97McLuckie, et al. Acta Paediatr 1996; 859/?0.19 0.21 L/min/m2Goedje, et al. Chest 1998; 113(4)30/1500.16 0.31 L/min/m2.96Goedje, et

39、al. Thorac Cardiovasc Surg 1998; 4630/8100.26 0.71 L/min.96Zoolner, et al. Anaesthesist 1998; 47(11)18/1600.03 1.04 L/min.91Goedje, et al. Crit Care Med 1999; 27(11)24/216-0.29 0.66 L/min.93Sakka, et al. Intensive Care Med 1999; 2537/4490.68 0.62 L/min.97Sakka, et al. J Cardiothorac Vasc Anesth 2000

40、; 14(2)12/510.73 0.38 L/min.96Zoolner, et al. J Cardiothorac Vasc Anesth 2000; 14(2)19/760.21 0.73 L/min.96Bindels, et al. Crit Care 2000; 445/2830.49 0.45 L/min/m2.95第45頁/共110頁a. 經(jīng)肺熱稀釋技術(shù)經(jīng)肺熱稀釋技術(shù)b. 動脈脈搏輪廓分析技術(shù)動脈脈搏輪廓分析技術(shù)第46頁/共110頁ln c (I)注射注射At再循環(huán)再循環(huán)MTtte-1DStc (I)第47頁/共110頁第48頁/共110頁第49頁/共110頁第50頁/共11

41、0頁ln c (I)注射注射At再循環(huán)的影響再循環(huán)的影響MTtte-1DStc (I)MTt: Mean transit time平均傳輸時平均傳輸時間間 half of the indicator passed the point of detection DSt: Downslope time下降時間下降時間 exponential downslope time of TD curve第51頁/共110頁Vall = V1 + V2 + V3 + V4 = MTt x FlowMeier et al. J Appl Physiol. 1954V3 = 最大腔的容積最大腔的容積 = DSt

42、x FlowNewman et al. Circulation. 1951指示劑由注射點到檢測點的平均傳輸指示劑由注射點到檢測點的平均傳輸時間時間MTt由兩點間的總?cè)莘e決定由兩點間的總?cè)莘e決定下降時間下降時間DSt由其中最大的腔室決由其中最大的腔室決定定 (比其它腔至少大比其它腔至少大 20% 成立成立!)flowV3V4V2V1注射注射檢測檢測第52頁/共110頁GEDVPTVRAEDVPBVLAEDVLVEDVRVEDVEVLWEVLWITTVPTV = 肺內(nèi)熱容積肺內(nèi)熱容積, 在一系列混合腔室中具有最大的熱容積在一系列混合腔室中具有最大的熱容積 (DSt 容積容積)ITTV = 胸腔內(nèi)總

43、熱容積胸腔內(nèi)總熱容積, 從注射點到測量的熱容積之和從注射點到測量的熱容積之和 (MTt 容積容積)GEDV= 全心舒張末期容積全心舒張末期容積 = ITTV PTV第53頁/共110頁RAEDVPTVLAEDVLVEDVRVEDV胸腔總熱容積胸腔總熱容積(ITTV)ITTV = CO x MTtTDa肺內(nèi)總熱容積肺內(nèi)總熱容積(PTV)PTV = CO x DStTDa全心舒張末期容積全心舒張末期容積GEDV = ITTV PTVRAEDVRVEDVLAEDVLVEDVRAEDVRVEDVLAEDVLVEDVPTVPTV第54頁/共110頁Sakka et al, Intensive Care

44、Med 2000; 26: 180-187ITBV = 1.25 * GEDV 28.4 mlr = 0.96ITBVTD (ml)GEDVST (ml)GEDV vs. ITBV in 57 intensive care patients第55頁/共110頁Sakka et al, Intensive Care Med 26: 180-187, 2000n = 209r = 0.97Bias = -7.6 ml/m2SD = 57.4 ml/m2ITBVIST vs. ITBVITD in 209 intensive care patients第56頁/共110頁ITTV = CO x MT

45、tTDaPTV = CO x DStTDaITBV = 1.25 x GEDVGEDV = ITTV PTVRAEDVRVEDVLAEDVLVEDVRAEDVRVEDVLAEDVLVEDVPBVRAEDVRVEDVLAEDVLVEDVPTVPTV第57頁/共110頁第58頁/共110頁第59頁/共110頁PAOP (mmHg)有反應(yīng)者有反應(yīng)者無反應(yīng)者無反應(yīng)者Calvin et al8 17 2Schneider et al10 110 1Reuse et al10 410 3Diebel et al14 77 2 Diebel et al16 615 5Wagner and Leatherma

46、n10 314 4 Tavernier et al10 412 3Tousignant et al12 316 3 Michard et al10 311 2 p 0.05第60頁/共110頁第61頁/共110頁LVEDA (cm2/m2)有反應(yīng)者有反應(yīng)者無反應(yīng)者無反應(yīng)者Tavernier et al9 312 4 Tousignant et al15 520 5 Feissel et al10 410 2 p 0.05第62頁/共110頁 Lichtwarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147第63頁/共110頁 Lich

47、twarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147第64頁/共110頁1. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL. Relation between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients with Acute Circulato

48、ry Failure. Am J Respir Crit Care Med 2000; 162: 134-138. 2. Rex S, Brose S, Metzelder S, Huneke R, Schalte G, Autschbach R, Rossaint R, Buhre W. Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth 2004; 93: 782-788第65頁/共110頁所有患者所有患者單一患者單一患者相關(guān)系數(shù)相關(guān)系數(shù), rD DSVIartD DCIar

49、tD DCIart (最低值最低值 最高值最高值)DCVP-0.090.00-0.01 0.33DPAWP-0.02-0.01-0.36 0.03DRAEDVI0.28-0.11-0.02 0.37DRVEDVI0.03-0.020.02 0.03DITBVI0.760.830.67 0.91DGEDVI0.820.870.70 0.93Goedje et al, Eur J Cardiothorac Surg 1998; 13 (5): 533-539;discussion 539-540第66頁/共110頁第67頁/共110頁第68頁/共110頁Sensitivity 1 Specific

50、ity Berkenstadt et al, Anesth Analg 2001; 92: 984-989- - - CVP_ SVV 第69頁/共110頁第70頁/共110頁Scillia P, Delcroix M, Lejeune P, Melot C, Struyven J, Naeije R, Gevenois PA. Hydrostatic pulmonary edema: evaluation with thin-section CT in dogs. Radiology 1999; 211: 161-168第71頁/共110頁Martin GS, Eaton S, Mealer

51、 M, Moss M. Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care 2005; 9: R74-R82 (DOI 10.1186/cc3025)第72頁/共110頁Sturm, In: Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelberg - NewYork 1990, pp 129-139第73頁/共

52、110頁第74頁/共110頁ITTV = CO x MTtTDaPTV = CO x DStTDaITBV = 1.25 x GEDVEVLW = ITTV ITBVGEDV = ITTV PTVRAEDVRVEDVLAEDVLVEDVRAEDVRVEDVLAEDVLVEDVPBVRAEDVRVEDVLAEDVLVEDVPTVPTVEVLWEVLW第75頁/共110頁Sturm, In: Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelberg -

53、 NewYork 1990, pp 129-139第76頁/共110頁Sakka et al, Intensive Care Med 26: 180-187, 2000Bias = -0.2 ml/kgSD = 1.4 ml/kgn = 209r = 0.96EVLWIST vs. EVLWITD in 209 intensive care patients第77頁/共110頁Mitchell et al, Am Rev Resp Dis 145: 990-998, 1992第78頁/共110頁第79頁/共110頁指標指標EVLW增加增加臨床癥狀100 200%胸片100 200%氧合(機械通

54、氣時)300%EVLW (PiCCO)10 15%第80頁/共110頁Morisawa K, Taira Y, Takahashi H, Matsui K, Ouchi M, Fujinawa N, Noda K. Do the data obtained by the PiCCO system enable one to differentiate between direct ALI/ARDS and indirect ALI/ARDS? Critical Care 2006, 10(Suppl 1):P326 (doi: 10.1186/cc4673)第81頁/共110頁Morisawa

55、 K, Taira Y, Takahashi H, Matsui K, Ouchi M, Fujinawa N, Noda K. Do the data obtained by the PiCCO system enable one to differentiate between direct ALI/ARDS and indirect ALI/ARDS? Critical Care 2006, 10(Suppl 1):P326 (doi: 10.1186/cc4673)直接直接ARDS/ALI間接間接ARDS/ALIP值值ITBVI984 331.71279 312.10.0001EVLW

56、I13.2 4.716.8 6.50.014PVPI0.59 0.270.44 0.220.006第82頁/共110頁PVPISIRS組(n = 31)2.37 1.0ARDS組(n = 13)3.2 1.10非ARDS組(n = 18)1.7 0.44非SIRS組(n = 10)1.2 0.21Tagami T, Kushimoto S, Atsumi T, Matsuda K, Miyazaki Y, Oyama R, Koido Y, Kawai M, Yokota H, Yamamoto Y. Investigation of the pulmonary vascular permea

57、bility index and extravascular lung water in patients with SIRS and ARDS under the PiCCO system. Critical Care 2006; 10(Suppl 1): P352 (doi: 10.1186/cc4699)第83頁/共110頁第84頁/共110頁第85頁/共110頁Wolf S, Plev D, Schrer L, Lumenta C. The repeatability of transpulmonary thermodilution measurements. Critical Car

58、e 2004; 8(Suppl 1): P57 (DOI 10.1186/cc2524)第86頁/共110頁差值中位數(shù)差值中位數(shù)兩次測定兩次測定95%可重復(fù)系數(shù)可重復(fù)系數(shù)相當(dāng)于正常相當(dāng)于正常值百分比值百分比CI (L/min)0.30.7248%ITBVI (ml/m2)80270180%EVLWI (ml/kg)13.587%Wolf S, Plev D, Schrer L, Lumenta C. The repeatability of transpulmonary thermodilution measurements. Critical Care 2004; 8(Suppl 1): P

59、57 (DOI 10.1186/cc2524)第87頁/共110頁Alaya S, Abdellatif S, Nasri R, Ksouri H, Ben Lakhal S. PiCCO monitoring are two injections enough? Critical Care 2007; 11(Suppl 2): P293第88頁/共110頁Alaya S, Abdellatif S, Nasri R, Ksouri H, Ben Lakhal S. PiCCO monitoring are two injections enough? Critical Care 2007;

60、11(Suppl 2): P293CI (L/min/m2)M13.28 1.07M25.74 1.0743%第89頁/共110頁Alaya S, Abdellatif S, Nasri R, Ksouri H, Ben Lakhal S. PiCCO monitoring are two injections enough? Critical Care 2007; 11(Suppl 2): P293第90頁/共110頁Schmidt S, Westhoff TH, Hofmann C, Schaefer J-H, Zidek W, Compton F, van der Giet M. Eff