The Significance Of Liquid Management Under The Guidance Of Bedside Sonography In The Treatment Of ARDS

BackgroundAcute Respiratory Distress Syndrome(ARDS)is an acute system of severe respiratory distress and refractory hypoxemia caused by pulmonary system failure.It is associated with a high mortality rate.The pathogenesis varies by different triggering mechanisms.The symptoms may include rapidly developing shortness of breath,fast breathing and severely low oxygen level in the blood that is refractory to oxygen therapy.The current international consensus criteria for ARDS were most recently updated in 2011 and are known as the "Berlin definition".It also requires differential diagnosis from other diseases.Imaging has become increasingly important for diagnostic,monitoring,and investigative purposes of ARDS in the past century,especially in past few decades.Besides traditional chest X-ray and chest CT,some other novel imaging technologies,such as lung sonography,position emission tomography(PET),electrical impedance tomography(CIT)and nuclear magnetic resonance(NMR),have been successfully applied in the diagnostic of respiratory system diseases.These technologies have significantly improved the diagnostic and treatment.ObjectiveThis thesis mainly focuses on applying bedside sonography to measure and monitor inferior vena cava filling index(collapsible index)to assess critical patent’s hemodynamic status and estimate atrium dextrum pressure,central venous pressure(CVP)and blood vessel capacity.The information can be used to guide the liquid management of ARDS patents,such as transfusion type(crystal,colloid etc.)and transfusion volume,to avoid exacerbation pulmonary edema by excessive transfusion or under-capacity by insufficient transfusion,and hence to increase the remedy rate of ADRS patents.MethodsIn this research,40 cases of ARDS patients,selected from The Forth Hospital of Jinan City in period of June 2013 to December 2016,were investigated by retrospective analysis and case-control study method.According to the difference of monitoring method,these cases were divided into two groups:Group Ⅰ in which liquid management was guided under bedside sonography,and Group Ⅱ in which liquid management was guided under CVP with non-invasive blood pressure measurement.The investigated parameters include comparison of heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR),Airway Plateau Pressure(Pplat),Positive end-expiratory pressure(PEEP),Acute Physiology and Chronic Health Evaluation II(APACHE Ⅱ),Murray lung injury score and calculated oxygenation index(PaO2/FiO2)and Static compliance of lung(Clst)in the first and fifth day of hospitalization;recording heart failure(HF)rate,acute renal failure(ARF)rate,mechanical ventilation time,ICU time and 28-day case-fatality rate.These differences,however,were not statistically significant.ResultsThe differences of 5-day oxygenation index,Clst,HR,RR,PEEP,Pplat,APACHEⅡ,Murray lung injury score,mechanical ventilation time and ICU time between GroupⅠ and Group Ⅱ are statistically significant(P<0.05).However,the difference of MAP,HF rate,ARF rate and 28-day case-fatality rate are not statistically significant(P>0.05).ConclusionsUsing bedside sonography to measure inferior vena cava filling index(collapsible index)is a non-invasive,fast,safe,timely and effective clinical test method,and is significant to liquid management of ARDS patients.