Comparison Of The Beside DR Quantitative Analysis Versus The Monitoring Of Extravascular Lung Water With The Pulse Indicator Continuous Cardiac Output In Measurement Of Pulmonary Edema Patients

Objective:In order to evaluate the patients with pulmonary edema,the Pulse indicator Continuous Cardiac Output(PiCCO)was used to quantitative monitor the extravascular lung water index(EVLWI)and global end-diastolic volume index(GEDI)in bedside.Based on the above,the check of bedside DR and quantitative analysis were carried out,to evaluate the correlation and consistency of pulmonary edema by EVLWL,monitored by the bedside DR quantitative analysis method and PiCCO.Simultaneously,weather the bedside DR quantitative analysis can also be used to evaluate the diagnosis of pulmonary edema and then the severity of pulmonary edema,and even the diagnosis of the cardiogenic and non-cardiogenic pulmonary edema.Method:During March 2015 to December 2016,twenty-three patients in the respiratory and general surgery critical care unit of Jinling hospital were chose to be monitored by the bedside PiCCO to determine the EVLWI and GEDI.Simultaneously,all patients underwent a thorax with the bedside DR to further evaluate the lesions scope and degree.Moreover,according to the above thorax,the vascular pedicle width(VPW)and cardiothoracic ratio(CTR)were measured.At the same time,the white blood cell count(WBC)and C-reactive protein(CRP),and the reaction of the colloid osmotic pressure indicators of total protein(TP),albumin(Alb),globulin(Glb)content in the blood of patients were collected.Based on the sperman rank correlation analysis,these indicators of the above mentioned were compared with EVLWI to determine the correlation between the two variables.Then,the unitary and multiple linear regression analysis were used to determine the risk factors of EVLWL.In order to diagnose pulmonary edema,the accuracy test analysis method(ROC curve)was used to access the bedside DR quantitative analysis indicators(the scope and degree score)and the diagnostic significance of PiCCO with the GEDI and the abnormal EVLWI were monitored.According to the EVLWI,all the patients were divided into two groups,including the mild pulmonary edema with the EVLWI in the range of 7 ml/kg to 10 ml/kg and the severe pulmonary edema(EVLWI>10 ml/kg).Based on the above,the ROC curve analysis was used to confirm the chest radiograph score cut-off value of mild and moderately severe pulmonary edema group.Then the statistically significant of above two groups were analyzed by chi-square analysis method.Similarly,according to the indicators of PiCCO(CI,GEDI,EVLWI),all the patients were divided into two groups of cardiogenic and non-cardiogenic pulmonary edema groups,and then access the diagnostic significance of the indicators(CTR,degree of VPW,chest radiograph lesion range score,score)for the cardiogenic pulmonary edema group.Results:(1)The indicators monitored by PiCCO were shown as follows:EVLWI 8.65±7.6ml/kg,CI4.37±1.28 1/min.m2,GEDI 879.96±175.06 ml/kg;The indicators of bedside DR quantitative analysis were shown as follows:Scope score 6.83±3.34 marks,severity score:5.78±2.63 marks,VPW 83.88±8.12 mm,CTR 0.56±0.07.Blood test:WBC 14.78±9.74×109/L,CRP 145.28±70.31 mg/L,TP 51.87±7.89 g/L,Alb 30.9±2.9 g/L,Glb 20.97±7.6 g/L.(2)The significant positive correlations were found respectively between the pulmonary edema related indicators of EVLWI and GEDI(R=0.611,P<0.05),the bedside DR lesions scope score(R=0.670,P<0.05),and the correlation were better than that of EVLWI with the bedside DR lesions severity score(R=0.500,P<0.05),the DR measurement of VPW(R=0.516,P<0.05),while there was no correlation between EVLWI and the DR measurement of CTR(R=0.355,P>0.05).There was no significant correlation between the pulmonary edema related indicators of EVLWI and the WBC,CRP,TP,Alb and Glb(P>0.05)in the blood.(3)According to the unitary linear regression analysis,the GEDI,scope score,degree score and VPW are the risk factors of EVLWI(P<0.05).Then,the multiple regression analysis revealed that the degree of GEDI,scope score and degree score were still not knocked out in the regression equation.Therefore,they are the relatively independent risk factors which led to the increase of EVLWI(P<0.05).(4)The ROC curve exhibited the highest diagnosis accuracy of GEDI for the EVLWI with the AUC of 0.902 and the sensitivity and specific degree are of 91.7%,and 81.8%,respectively.The bedside DR lesions scope score is lower than that of GEDI.The area under the ROC curve(AUC)is 0.792(P<0.05),which exhibited a higher sensitivity of 91.7%and a lower specificity of 54.5%.Conversely,the diagnostic accuracy of the bedside DR lesions severity score is the lowest of the above with the AUC of 0.701 and a lower sensitivity of the above.However,after the combination of the bedside DR lesions scope score and the severity score,the diagnostic accuracy was much higher than those of any single indicator with their AUC of 0.845,the sensitivity of 83.3%and the specificity of 90.9%.The Youden index of 0.742 was also increased than that of before.According to the diagnostic criteria of EVLWI>7 ml/kg,there are 5 cases of pulmonary edema in false positive,and 2 case in false negatives in all the patients,diagnosed by the scope and degree score of bedside DR.However,according to the imaging characteristics of chest radiographs score,the clinical features and their dynamic variation as the diagnostic criteria of pulmonary edema,1 case in false positive and 2 cases of false negative were observed in the diagnosis of pulmonary edema monitored by the PiCCO.(5)There is no statistical difference between two groups based on the chest radiograph scope score and the comprehensive score of scope and degree score,while the degree score exhibited the statistical difference between the above two groups.(6)When the ROC curve was used to analyze the cardiogenic and non-cardiogenic pulmonary edema,the AUC is the highest of 0.741,as the combination of bedside DR lesions scope score and the severity score in order to elevate both above pulmonary edema.However,the P value is higher than 0.05 which demonstrate the diagnosis of cardiogenic pulmonary edema need to be further validated.The others of VPW,CTR and VPW+CTR exhibited a low AUC of 0.704 and a higher P values(P>0.05).Conclusion:1.The degree and severity of pathological changes diagnosed by beside DR quantitative analysis method show good correlation and consistency with EVLWI monitored by PiCCO.2.The bedside DR quantitative analysis can be used to diagnose the pulmonary edema.3.The degree of pathological changes diagnosed by beside DR can be used to evaluate the severity of pulmonary edema.4.There is no differential diagnosis significance of beside DR for the cardiogenic and non-cardiogenic pulmonary edema,which need more samples to validate it.