Guiding Role Of Critical Ultrasonography In Fluid Management Of Patients With Acute Respiratory Distress Syndrome

Objective:Objective to study the effect of fluid management therapy on the prognosis of patients with acute respiratory distress syndrome（ARDS）by intensive care unit（ICU）physicians using critical ultrasonography technology under dynamic monitoring.Methods:In this paper,a retrospective analysis and comparison method was adopted to select 50 cases of acute respiratory distress syndrome（ARDS）admitted to the Department of critical care medicine of the Affiliated Hospital of Youjiang Medical University for Nationalities from October 2019 to December 2020.The patients diagnosed with ARDS were randomly divided into two groups.Two groups of patients in the treatment based on the primary disease,the control group using the traditional liquid management,namely the use of central venous pressure（CVP）,CVP guided fluid management,monitored the change of central venous pressure,and controlled CVP between 12-15cm H₂O（the lowest risk rate of cardiovascular adverse events in severe patients）;the observation group used critical ultrasonography for dynamic evaluation of patients for fluid management,combined with ultrasound for fluid management of systemic circulation capacity,cardiopulmonary function,and the main indicators of systemic circulation capacity evaluation were as follows The diameter of inferior vena cava and the rate of inferior vena cava respiratory variability（the rate of inferior vena cava respiratory variability=（maximum diameter-minimum diameter）/maximum diameter×100%）were included.The diameter of inferior vena cava>2cm and respiratory variation rate<20%indicated that the fluid was in high volume state or fluid supplement was limited,and dehydrated urine was given;on the contrary,the diameter of inferior vena cava<1cm or 1.5cm in controlled ventilation mode and the respiratory variation rate of inferior vena cava>50%in spontaneous breathing mode It is suggested that the fluid is in a low volume state or has good volume responsiveness,and the safety of rehydration is good.The rehydration can be terminated when the rate of inferior chamber breathing variation is less than 40%（the best oxygenation of lung guided by bedside ultrasound and the lowest impact on hemodynamics）.The study indexes included hemodynamic indexes,acute physiology and chronic health evaluation（APACHEⅡ）,positive end expiratory pressure（PEEP）,airway plateau pressure,lung compliance and blood lactic acid,And the changes of related indexes after 1 day,3 days and 5 days of treatment,At the same time,the oxygenation index（OI）was monitored by bedside blood gas analysis The length of stay in ICU,the duration of mechanical ventilation,the incidence of heart failure and acute renal insufficiency/renal failure and the 28 day mortality were observed.Results:After 5 days of treatment,the important hemodynamic indexes and important parameters of ventilator in the observation group were better than those in the control group,with statistical significance（P<0.05）;the blood lactic acid value and APACHEⅡin the observation group were better than those in the control group,with statistical significance（P<0.05）score was lower than that of the control group,with statistical significance（P<0.05）;the mechanical ventilation time and ICU hospitalization days of the observation group were lower than those of the control group（P<0.05）;the incidence of heart failure and acute kidney injury/failure in the observation group was lower than that of the control group（P<0.05）;there was no significant difference in 28 day mortality between the two groups,with no statistical significance（P>0.05）.Conclusion:Compared with conventional auxiliary examination and monitoring methods,critical ultrasonography has the characteristics of noninvasive,safe,fast,accurate and effective,good repeatability and so on.It plays an important role in guiding the fluid management of ARDS patients.