期刊
JOURNAL OF CRITICAL CARE
卷 56, 期 -, 页码 222-228出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jcrc.2020.01.012
关键词
Respiratory distress syndrome; Chest X-ray; Pulmonary Edema; Phenotype; Heterogeneity; Extubation
资金
- National Institutes of Health [K23 HL139987, U01 HL098962, P01 HL114453, R01 HL097376, K24 HL123342, U01 HL137159, R01 LM012087, R01 HL142084, R01 HL136143, F32 HL137258, F32 HL142172, K08 HS025455, K23 GM122069]
Purpose: To assess the longitudinal evolution of radiographic edema using chest X-rays (CXR) in patients with Acute Respiratory Distress Syndrome (ARDS) and to examine its association with prognostic biomarkers, ARDS subphenotypes and outcomes. Materials and methods: We quantified radiographic edema on CXRs from patients with ARDS or cardiogenic pulmonary edema (controls) using the Radiographic Assessment of Lung Edema (RALE) score on day of intubation and up to 10 days after. We measured baseline plasma biomarkers and recorded clinical variables. Results: The RALE score had good inter-rater agreement (r = 0.83, p < 0.0001) applied on 488 CXRs from 129 patients, with higher RALE scores in patients with ARDS (n = 108) compared to controls (n = 21, p = 0.01). Baseline RALE scores were positively correlated with levels of the receptor for end-glycation end products (RAGE) in ARDS patients (p < 0.05). Baseline RALE scores were not predictive of 30- or 90-day survival. Persistently elevated RALE scores were associated with prolonged need for mechanical ventilation (p = 0.002). Conclusions: The RALE score is easily implementable with high inter-rater reliability. Longitudinal RALE scoring appears to be a reproducible approach to track the evolution of radiographic edema in patients with ARDS and can potentially predict prolonged need for mechanical ventilation. (C) 2020 Elsevier Inc. All rights reserved.
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