Plućni žilni permeabilni indeks i izvanžilna plućna tekućina u bolesnika sa sepsom [Pulmonary vascular permeability index and extravascular lung water in patients with sepsis]

Drvar, Željko (2016) Plućni žilni permeabilni indeks i izvanžilna plućna tekućina u bolesnika sa sepsom [Pulmonary vascular permeability index and extravascular lung water in patients with sepsis]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

It is possible to measure pulmonary vascular permeability index (PVPI) and extravascular lung water (EVLW) with PiCCO (Pulse-induced Contour Cardiac Output) monitoring. Hypothesis of the study was: due to the toxic impairment of alveolocapillary membrane, patients with sepsis syndrome suffer of reduced pulmonary complinace and have higher PVPI and EVLW values. Aim of our study was to investigate PVPI and EVLW values and dynamics in development of pulmonary oedema in sepsis syndrome, identify possible differences in measured values, as well as determine their correlation with other investigated parameters. Investigated group included 50 patients, after urgent abdominal surgery, with clinically and laboratoy confirmed sepsis, and mild ARDS (ARDS - acute respiratory distress syndrome) according to Berlin definition. Control group included 50 patients without mild ARDS. All patients were intubated and mechanically ventilated. PVPI and EVLW measurements were taken in both study groups three times a day. Values of P<0,05 were considered statistically significant. Study results showed statistically significant difference of PVPI and EVLW in investigated compared to control group. In conclusion, PVPI and EVLW can be used in the early diagnosis and dynamics of mild ARDS in surgical patients with sepsis.

Abstract in Croatian

Plućni žilni permeabilni indeks (PVPI - pulmonary vascular permeability index) i izvanžilnu plućnu vodu (EVLW - ekstravascular lung water) moguće je mjeriti PiCCO (PiCCO – pulse induced contour cardiac output) monitoringom. Hipoteza rada bila je: bolesnici u sepsi zbog toksičnog oštećenja alveolokapilarne membrane imaju smanjenu popustljivost pluća i veće izmjerene vrijednosti PVPI i EVLW. Cilj rada bio je istražiti pojavnost i dinamiku PVPI i EVLW u nastanku plućnog edema u sindromu sepse, utvrditi moguću razliku u izmjerenim vrijednostima kao i njihovu povezanost s ostalim istraživanim pokazateljima. Istraživanu skupinu činilo je 50 bolesnika nakon hitnog operativnog zahvata u abdominalnoj kirurgiji s klinički i laboratorijski dokazanom sepsom i blagim ARDS- om (ARDS – acute respiratory distress syndrome) prema Berlinskoj definiciji. Kontrolnu skupinu činilo je 50 bolesnika sa sepsom bez blagog ARDS. Svi bolesnici su bili intubirani, strojno ventilirani. Mjerenje PVPI i EVLW u obje skupine bolesnika vršeno je tri puta dnevno. Sve P vrijednosti manje od 0,05 smatrane su značajnima. Rezultati istraživanja pokazali su statistički značajnu razliku u vrijednosti PVPI i EVLW kod bolesnika istraživane skupine kao i pozitivne korelacije s ostalim isptivanim pokazateljima. Zaključno, PVPI i EVLW mogu se koristiti kao pokazatelji nastanka i dinamike blagog ARDS-a u kirurških bolesnika sa sepsom.

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