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Spectroscopic approach to capillary-alveolar membrane damage: RESULTS AND DISCUSSION (5)

Classification of pulmonary HES leakage in a patient population: The clinical data and HES leakage determined for the IR-bronchial washing assay are given in Table 1. Using the criteria of the consensus committee from the report of the American-European Consensus Conference on ARDS , a comparison can now be made between the clinical PaO2/FiO2 values and the HES leakage as determined from the IR spectra. Patients (n=55) with PaO2/FiO2 less than 300 mmHg (which included both ARDS and ALI patients), were placed in the injury group, while patients (n=12) with PaO2/FiO2 greater than 300 mmHg were placed in the risk group. A 2×2 contingency table was set up (Table 2), which compares the clinical PaO2/FiO2 values with the IR spectroscopic classification: 40 of 55 (sensitivity of 72.7%) injured patients showed IR positive for HES leakage. This indicates a strong relationship between the PaO2/FiO2 ratio and the IR results for ALI/ARDS patients, and implies that, in most of the injured patients, IR did detect the HES leakage. To evaluate the leakage associated with the degree of injury, an additional comparison was made using all 55 patients in the injury group. For this comparison, patients were subdivided into three subgroups: a group of patients with severe ARDS who had PaO2/FiO2 ratios of less than 100 mmHg (n=10); a group of ARDS patients with PaO2/FiO2 ratios of 100 to 200 mmHg (n=23); and a group of patients with ALI who had PaO2/FiO2 ratios of 200 to 300 mmHg (n=22) (Table 3). All 10 patients with severe cases of ARDS (PaO2/FiO2 less than 100 mmHg) were found IR-positive for HES leakage by using the IR-bronchial washing method. For the other two subgroups (PaO2/FiO2 between 100 and 200 mmHg and PaO2/FiO2 between 200 and 300 mmHg), a population of 56.5% and 77.3%, respectively, showed IR-positive for HES leakage. These findings suggest that using PaO2/FiO2 to define ALI/ARDS patients is not pathophysiologically specific for the syndrome. buy diabetes drugs

Table 1. Clinical data and hydroxyethyl starch leakage (HES) determined for the infrared (IR)-bronchial washing assay

Patientnumber HES Leakage Lung injury score PaO2/FiO2 Patient number HES Leakage Lung injury score PaO2/FiO2
1 + 3.5 84 35 1.25 223
2 + 2.75 215 36 + 2.23 132
3 + 3.5 58 37 + 2.5 152
4 + 2 152 38 + 1.75 170
5 + 3.25 74 39 + 1.75 235
6 + 3.25 72 40 + 1 192
7 + 3.25 86 41 + 1.25 295
8 + 3 124 42* 0.75 354
9 + 2.5 94 43* + 0.75 242
10 + 2.75 55 44 + 1.25 214
11 + 0.75 290 45 + 2.5 74
12* + 0 480 46 + 2.5 96
13 + 0.75 225 47 + 2.5 150
14 + 1 150 48* + 1.5 310
15 1.75 255 49 + 2.25 90
16 + 0.5 283 50* + 1 366
17 1.75 230 51 + 2.25 111
18* 0 452 52 2.25 160
19 2 164 53* + 0.5 320
20 1.75 170 54 + 1 267
21 + 0.33 280 55 + 2 170
22 0.33 275 56 + 2.25 242
23 + 1 218 57 + 2.25 147
24 1.67 113 58 1 268
25* 0.5 406 59* + 0.75 378
26* 0.5 320 60* 1.25 337
27 1.25 155 61 + 0.3 247
28 1.5 136 62 1.5 170
29* + 1.75 370 63 + 2.25 242
30 + 1.33 197 64 + 1.5 220
31 1.7 180 65 + 1.5 155
32 2.67 123 66 + 1.5 292
33 + 1.75 206 67* + 1 350
34 1.3 173

*Patients at risk (n=13). + IR positive for leakage (patients with a probability of PENTASPAN leakage greater than or equal to 50%); – IR negative for leakage (patients with a probability of PENTASPAN leakage less than 50%); PaO2/FiO2 Partial pressure of arterial oxygen/fraction of inspired oxygen

Table 3. PENTASPAN (Du Pont Pharma, Mississauga, Ontario) leakage in the injury population

Group 0<PaO2/FiO2<100 (mmHg) I00<pa02/Fi02<200 (mmHg) 200<Pa0/Fi02<300 (mmHg)
Infrared positive for leakage 10 13 17
Infrared negative for leakage 0 10 5

PaO2/FiO2 Partial pressure of arterial oxygen/fraction of inspired oxygen

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