Increased morbidity with increased pulmonary albumin flux in sepsis-related adult respiratory distress syndrome

OBJECTIVETo determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate and morbidity in adult respiratory distress syndrome (ARDS) patients. DESIGNProspective study. SETTINGUniversity hospital ICUs. PATIENTSThirty-five control volunteers, 19 patients with congestive heart failure, 30 patients with a diagnosis of sepsis. MEASUREMENTS AND MAIN RESULTSAll patients were infused iv with technetium 99m-labeled albumin and underwent computerized gamma-scintigraphic analysis with a portable gamma camera. Lung-to-heart ratio of tracer was calculated and expressed as the slope index. Increase in slope index indicated increased pulmonary albumin flux. Slope index was no different in controls compared with congestive heart failure patients, unless the pulmonary artery occlusion pressure (PAOP) was >30 mm Hg. Patients with a diagnosis of sepsis had an overall increased slope index compared with the other groups. A subgroup of patients in the septic group had a normal slope index. Septic patients with an increased slope index had a significantly (p < .01) longer duration of mechanical ventilation (36 ± 5 vs. 7 ± 1 days), spent longer in the ICU (67 ± 9 vs. 11 ± 1 days), and had a longer hospital stay (113 ± 20 vs. 35 ± 5 days) than septic patients with a normal slope index. CONCLUSIONSGamma scintigraphy successfully differentiated between control volunteers and patients with congestive heart failure with PAOP 2 SD above control mean) had a markedly increased morbidity. (Crit Care Med 1992; 20:28)