A prospective, randomized, non-blinded clinical trial was conducted. All patients admitted hospital from August 2009 to August 2011 met the inclusion criteria, were divided into the group with ARDS induced by lung
contusion (
contusion group, n = 18) and the group without lung
contusion and ARDS (control group, n = 22). The measured parameters included pulmonary artery systolic pressure (PAS), pulmonary artery diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), pulmonary artery diastolic-pulmonary wedge pressure gradient (PAD-PAWP), and extravascular lung water index (ELWI) of each group at 0 hour after placing the
catheter and at 12, 24, 36, 48, 60, 72 hours after
contusion. The differences of all the parameters were compared within a group and among the different groups.
RESULTS: In the survivors with ARDS induced by lung
contusion, PAS, PAD and PAD-PAWP were significantly higher than those in the control group and then gradually declined. PAS and PAD returned to the level of control group at 60 hours after
contusion, and the PAD-PAWP restored to the level of control group at 48 hours after
contusion. For the patients in the control group, there were no significant differences in PAS and PAD from the 0 hour after placing
catheter to 72 hours after
contusion, but PAD-PAWP increased at 72 hours after
contusion compared with at 48 hours. Compared with the control group, the ELWI in
contusion group increased significantly, and peaked at 12 hours after
contusion and then gradually declined, and restored to the level of control group at 60 hours after
contusion. For the patients in the control group, ELWI were lower at 60 hours and 72 hours after
contusion than at 48 hours. Compared with control group, PAWP in
contusion group decreased at 0 hour, and returned to the level of control group at 48 hours after
contusion. For the patients in the control group, there were no significant differences in PAWP from the 0 hour after placing the
catheter to 72 hours after
contusion. The positive correlation were found between ELWI and PAS, PAD, PAD-PAWP from 0 hour after placing the
catheter to 48 hours after
contusion in
contusion group (r value, 0.554, 0.498, 0.629, respectively, all P < 0.01).
CONCLUSION: Among the patients with ARDS induced by lung
contusion, it appears that changes in PAS, PAD and PAD-PAWP, as well as ELWI play important roles in assessing fluid status, guiding
mechanical ventilation and severity.