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Báo cáo y học: "Acute lung injury, overhydration or both"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Acute lung injury, overhydration or both? | Critical Care April 2005 Vol 9 No 2 Groeneveld and Polderman Commentary Acute lung injury overhydration or both AB Johan Groeneveld and Kees H Polderman Department of Intensive Care Vrije Universiteit Medical Centre Amsterdam The Netherlands Corresponding author ABJ Groeneveld johan.groeneveld@vumc.nl Published online 17 January 2005 This article is online at http ccforum.Com content 9 2 136 2005 BioMed Central Ltd Critical Care 2005 9 136-137 DOI 10.1186 cc3039 See related research by Martin et al. in this issue http ccforum.com content 9 2 R74 Abstract Acute lung injury or acute respiratory distress syndrome ALI ARDS in the course of sepsis is thought to result from increased pulmonary capillary permeability and resultant edema. However when the edema is assessed at the bedside by measuring the extravascular thermal volume by transpulmonary dilution some ALI ARDS patients with sepsis may have normal extravascular lung water EVLW . Conversely a raised EVLW may be present even when criteria for ALI ARDS are not met according to GS Martin and colleagues in this issue of Critical Care. This commentary puts the findings into a broader perspective and focuses on the difficulty at the bedside in recognizing and separating various types of pulmonary edema. Some of these forms of edema classically differentiated on the basis of increased permeability and cardiogenic hydrostatic factors may overlap whereas the criteria for ALI ARDS may be loose poorly reproducible relatively insensitive and nonspecific and highly therapy-dependent. Overhydration is particularly difficult to recognize. Additional diagnostics may be required to improve the delineation of pulmonary edema so as to redirect or redefine treatment and improve patient morbidity and perhaps mortality. Monitoring EVLW by single transpulmonary thermal dilution for instance might have a future role in this process. In this issue of Critical Care Martin and colleagues 1 describe that in 29 patients with sepsis .