TRIAL OF PULMONARY ARTERY CATHETER VS CENTRAL VENOUS CATHETER FOR ARDS

肺动脉导管与中心静脉导管治疗 ARDS 的试验

• 批准号: 7376263
• 负责人: BENNETT P DEBOISBLANC
• 金额: $ 2.12万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7376263
• 关键词: TRIAL; PULMONARY; ARTERY; CATHETER; VS

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The pulmonary arterial catheter (PAC) was introduced for clinincal use in 1970 to provide diagnostic and monitoring information not available from other clinical sources. The PAC provides a wealth of direct and indirect information about circulatory, and respiratory systems and intravascular fluid volume over time. The PAC allows measurement of central venous and pulmonary arterial pressure, pulmonary artery occlusion pressure (PAOP or "wedge pressure"), mixed venous blood gases, and indicator-dilution cardiac output. This data is quantitative and since it is, more information, such as systemic and pulmonary vascular resistance can be derived. The accuracy of these measurements is high in well-trained and qualified hands, but is subject to proper placement of the catheter, calibration of transducers and user interpretation of waveforms and data. PAC data properly interpreted help to assess the right and left ventricle function, intracardiac shunts, pulmonary ventilatory function and intra-vascular fluid status. A pulmonary arterial catheter that is properly maintained allows for ongoing monitoring, which may provide early information regarding trends towards improvement or deterioration in response to therapeutic intervention. The PAC catheter is used commonly in patients with acute lung injury (ALI) and its most severe subset, the acute respiratory distress syndrome (ARDS). ALI is a clinical problem of significant magnitude in terms of incidence (150,000 patients per year), mortality (30-60% in most series) and cost (in part due to long stays in intensive care). In patients with ALI, the PAC has been employed widely both to confirm the diagnosis as well as to optimize hemodynamic management. Theoretically, measurement of the PAOP and cardiac output may make it possible for physicians to maintain pulmonary vascular pressures at a lower level, thus reducing the quantity of pulmonary edema that may develop in the presence of increases in lung vascular permeability. Also, maintaining a lower pulmonary capillary pressure may prevent or minimize damage ("stress failure") to the capillary wall. The measurement of pulmonary arterial pressure and cardiac output may make it possible for physicians to administer vasoactive agents more skillfully in order to optimize cardiac output, maintain or improve renal function, and increase systemic blood pressure and blood flow to vital organs. On the other hand, it is possible that the measurement of central venous pressure along with a central venous catheter (CVC) is adequate to optimize hemodynamics in patients with ALI.

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子弹和调查员（PI）可能已经从其他NIH来源获得了主要资金，因此可以在其他清晰的条目中代表。列出的机构适用于该中心，这不一定是调查员的机构。肺动脉导管（PAC）于1970年引入临床使用，以提供其他临床来源可获得的诊断和监测信息。 PAC随着时间的流逝，PAC提供了有关循环系统，呼吸系统以及血管内流体体积的大量直接和间接信息。 PAC允许测量中央静脉和肺动脉压，肺动脉闭塞压力（PAOP或“楔形压力”），混合静脉血液气体和指示液心脏输出。这些数据是定量的，因为它可以得出更多信息，例如系统性和肺血管抗性。这些测量值的准确性在训练有素且合格的手中很高，但要适当地放置导管，换能器的校准以及对波形和数据的用户解释。 PAC数据正确解释了帮助，以评估右室和左心室功能，心内分流，肺部通气功能和血管内液体状态。适当维护的肺动脉导管可以进行持续的监测，这可能会提供有关响应治疗干预措施改善或恶化的趋势的早期信息。 PAC导管通常用于急性肺损伤（ALI）及其最严重的急性呼吸窘迫综合征（ARDS）的患者。 ALI是一个临床问题，就发病率（每年15万名患者），死亡率（大多数系列中30-60％）和成本（部分是由于长期停留在重症监护）方面的临床问题。在患有ALI的患者中，PAC已被广泛用于确认诊断以及优化血液动力学管理。 从理论上讲，对PAOP和心脏输出的测量可能使医生可以在较低水平的肺血管压力下保持肺血管压力，从而减少在肺血管渗透性增加的情况下可能发展的肺水肿量。同样，保持较低的肺毛细管压力可能会防止或最大程度地减少对毛细管壁的损伤（“应力故障”）。肺动脉压和心输出量的测量可能使医生更熟练地管理血管活性剂，以优化心脏输出，维持或改善肾功能，并增加全身性血压以及血液流动到重要器官的血液流动。另一方面，在中央静脉压力以及中央静脉导管（CVC）的测量可能足以优化ALI患者的血液动力学。