Effect Of The Open Lung Protective Ventilation Strategy And CRRT On Patients With ARDS Of Different EVLWI Levels

Objective:To observe the change of the concentration of the plasma cytokines and the extravasculur lung ware index,before and after the treatment with the Open Lung Protective Ventilation Strategy and continuous renal replacement therapy (CRRT),in patients with acute respiratory distress syndrome(ARDS) of different EVLWI levels,and record in-hospital mortality,to explore effect of the open lung protective ventilation strategy and CRRT on patients with ARDS of different EVLWI levels.Method:After entering ICU,156 ARDS patients received base mechanical ventilation.EVLWI was masured by PiCCO,and divided into 4 EVLWI levels: EVLWI≤10ml/kg,10ml/kg20ml/kg.Then,patients with same level of EVLWI were randomized into control group(group M) and CRRT group(group H).There were 8 groups all together:group M 1 and group H 1,group M 2 and group H 2,group M 3 and group H 3,group M 4 and group H 4.The patients in the control group received mechanical ventilation therapy and medication,while the CRRT group patients receieved continuous renal replacement therapy in addition to mechanical ventilation treatment and medication.In the CRRT groups,the patients underwent continuous veno-venous hemofiltration(CVVH) for 72 hours using PSHF hemofilter,the ultrafiltrate volume was set at 3L/h and the blood flow was 180～200ml/min,and the filter was replaced every 12 hours.At the time pretreatment(0h) and each 24h after treatmen (24h,48h,72h),the concentration of the plasma cytokines(TNF-α,IL-6,IL-8) was detected with Enzyme Linked Immunosorbent Assay(ELISA).At the same time, extravasculur lung water index(EVLWI) were detected.In addition,in-hospital mortality rate of each group was record.All the data of the above is expressed by the (?)±s,all the data is record and analyzed with SPSS11.0.Results:The in-hospital mortality in M1～M4 groups were respectively 6.7%, 23.3%,54.5%,77.8%;and the in-hospital mortality in H1～H4 groups were respectively 7.7%,16.7%,31.6%,53.3%.The total in-hospital mortality in H group were much lower than that in M group(24.7%vs 43.0%,p<0.01).There was no significant difference between the in-hospital mortality in H1～H2groups and M1～M2 groups(respectively 7.1%vs.6.7%,16.7%vs.23.3%,p>0.05).The in-hospital mortality in H3～H4 groups were much lower than that in M3～M4 groups (respectively31.6%vs.54.5%,53.3%vs.77.8%,p<0.01).TNF-α,IL-6,IL-8 in M1～M4groups changed little at 24h and 48h(p>0.05),but decreased significantly at 72h (p<0.05)when compared with what at Oh.TNF-α,IL-6,IL-8 in H1～H4 groups decreased significantly at 24h(p<0.05),and even more significantly at 48h and 72h (p<0.01) when compared with what at Oh.TNF-α,IL-6,IL-8 in H1～H2 groups were significantly lower than that in H1～H2groups at 24h,48h and 72h(p<0.01).TNF-α, IL-6,IL-8 in H3～H4groups were much lower than that in M3～M4groups at 24h(p <0.05),and the difference became even more significantly at 48h and 72h(p<0.01). When compared with what at Oh,EVLWI in M1～M2 groups decreased significantly at 24h and 48h(p<0.05),and even more significantly at 72h(p<0.01);EVLWI in M3～M4 groups changed little at 24h(p>0.05);EVLWI in M3 group decreased significantly at 48h and 72h(p<0.05),and EVLWI in M4 group still had no significant change at 48h and 72h(p>0.05);EVLWI in H1～H4 groups decreased significantly at 24h and 48h(p<0.05),and even more significantly at 72h(p<0.01). There was no significant difference between EVLWI in H1 group and in M1 group (p>0.05);EVLWI in H2～H4 groups were much lower than that in M2～M4 groups at 24h(p<0.05),and the difference between H3～H4 groups and M3～M4 groups became even more significantly at 48h and 72h(p<0.01).Conclusion:EVLWI has a good predictive value of in-hospital mortality in patients with ARDS,in-hospital mortality increased significantly when EVLWI> 15ml/kg;compared with the open lung protective ventilation strategy,the open lung protective ventilation strategy and CRRT can be more effectively to remove plasma cytokines and reduce extravascular lung water index,significantly decrease the in-hospital mortality in ARDS patients with EVLWI>15ml/kg,but does not reduce the in-hospital mortality in ARDS patients with EVLWI≤15ml/kg.