Top

Intensive Care Medicine

Published in:

01-09-2006 | Original

Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS

Authors: A. B. Johan Groeneveld, Joanne Verheij

Published in: Intensive Care Medicine | Issue 9/2006

Abstract

Objective

We studied the relationship, and the effect of fluid loading on this, between the ratio of extravascular lung water (EVLW) to intrathoracic/pulmonary blood volumes (ITBV, PBV) and the radionuclide pulmonary leak index (PLI) to protein during sepsis-induced acute lung injury/acute respiratory distress syndrome (ALI/ARDS).

Design and setting

A prospective observational study, in the intensive care unit of a university hospital.

Patients

Twenty-two consecutive mechanically ventilated patients with sepsis-related ALI/ARDS from pneumonia (n = 12) or extrapulmonary sources (n = 10), without elevated cardiac filling pressures.

Intervention

Crystalloid (1700–1800 ml) or colloid (1000–1800 ml) fluid loading until target filling pressures.

Measurements and results

Protein permeability was assessed noninvasively over the lungs with help of ⁶⁷Ga-labeled transferrin and ^99mTc-labeled red blood cells (Pulmonary leak index, upper limit normal 14.1 × 10⁻³ /min) and EVLW and blood volumes by the thermal-dye transpulmonary dilution technique before and after fluid loading. Prior to fluids the pulmonary leak index related to the ratio of EVLW/ITBV and EVLW/PBV (r _s = 0.46) particularly when the pulmonary leak index was below 100 × 10⁻³ /min and in extrapulmonary sepsis (PLI vs. EVLW/PBV r _s = 0.71). Fluid loading did not alter EVLW, EVLW/ITBV, or EVLW/PBV or the relationship to PLI.

Conclusion

The data demonstrate that EVLW/ITBV or EVLW/PBV are imperfect measures of increased protein permeability in mechanically ventilated patients with sepsis-induced ALI/ARDS particularly when the PLI is severely increased and during pneumonia, independent of fluid status.

Sakka SG, Klein M, Reinhart K, Meier-Hellman A (2002) Prognostic value of extravascular lung water in critically ill patients. Chest 122:2080–2086PubMedCrossRef

Piantadosi CA, Schwartz DA (2004) The acute respiratory distresss syndrome. Ann Intern Med 141:460–470PubMed

Martin GS, Eaton S, Mealer M, Moss M (2005) Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care 9:R74–R82PubMedCrossRef

Groeneveld ABJ (1997) Radionuclide assessment of pulmonary microvascular permeability. Eur J Nucl Med 34:449–461

Groeneveld ABJ, Raijmakers PGHM (1997) The ⁶⁷Ga transferrin pulmonary leak index in pneumonia and associated adult respiratory distress syndrome. Clin Sci 92:463–470

Groeneveld ABJ, Raijmakers PGHM (1998) The ⁶⁷gallium-transferrin pulmonary leak index in patients at risk for the acute respiratory distress syndrome. Crit Care Med 26:685–691PubMedCrossRef

Verheij J, Van Lingen A, Raijmakers RGHM, Spijkstra JJ, Girbes ARJ, Jansen EK, Van den Berg FG, Groeneveld ABJ (2005) Pulmonary abnormalities after cardiac surgery are better explained by atelectasis than by increased permeability oedema. Acta Anaesthesiol Scand 49:1302–1310PubMedCrossRef

Groeneveld ABJ, Verheij J, Van den Berg FG, Wisselink W, Rauwerda JA (2006) Increased pulmonary capillary permeability and extravascular lung water after major vascular surgery: effect on radiography and ventilatory variables. Eur J Anaesthesiol 23:36–41PubMedCrossRef

Verheij J, van Lingen A, Raijmakers PGHM, Rijnsburger ER, Veerman DP, Wisselink W, Girbes ARJ, Groeneveld ABJ (2006) Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery. Br J Anaesth 96:21–30PubMedCrossRef

10.

Schuster DP, Haller J (1990) A quantitative correlation of extravascular lung water accumulation with vascular permeability and hydrostatic pressure measurements: a positron emission tomographic study. J Crit Care 5:161–168CrossRef

11.

Goedje O, Peyerl M, Seebauer T, Dewald O, Reichart B (1998) Reproducibility of double indicator dilution measurements of intrathoracic blood volume compartments, extravascular lung water, and liver function. Chest 113:1070–1077CrossRef

12.

Davey-Quinn A, Gedney JA, Whiteley SM, Bellamy MC (1999) Extravascular lung water and acute respiratory distress syndrome-oxygenation and outcome. Anaesth Intensive Care 27:357–362PubMed

13.

Honoré PM, Jacquet LM, Beale RJ, Renauld J-C, Valadi D, Noirhomme P, Goenen M (2001) Effects of normothermia versus hypothermia on extravascular lung water and serum cytokines during cardiopulmonary bypass: a randomized, controlled trial. Crit Care Med 29:1903–1906PubMedCrossRef

14.

Holm C, Tegeler J, Mayr M, Pfeiffer U, Henckel von Donnersmarck G, Mühlbauer W (2002) Effect of crystalloid resuscitation and inhalation injury on extravascular lung water. Chest 121:1956–1962PubMedCrossRef

15.

Boussat S, Jacques T, Levy B, Laurent E, Gache A, Capellier G, Neldhardt A (2002) Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema. Intensive Care Med 28:712–718PubMedCrossRef

16.

Groeneveld AB, Verheij J (2004) Is pulmonary edema associated with a high extravascular thermal volume? Crit Care Med 32:899–901PubMedCrossRef

17.

Matejovic M, Krouzecky A, Rokyha R, Novak I (2004) Fluid challenge in patients at risk for fluid loading-induced pulmonary edema. Acta Anaesthesiol Scand 48:690–673CrossRef

18.

Michard F, Zarka V, Alaya S (2004) Better characterization of acute lung injury/ARDS using lung water. Chest 125:1166PubMedCrossRef

19.

Michard F, Schachtrupp A, Toens C (2005) Factors influencing the estimation of extravascular lung water by transpulmonary thermodilution in critically ill patients. Crit Care Med 33:1243–1247PubMedCrossRef

20.

Roch A, Michelet P, Lambert D, Delliaux S, Saby C, Perrin G, Ghez O, Bregeon F, Thomas P, Carpentier J-P, Papazian L, Auffray J-P (2004) Accuracy of the double indicator method for measurement of extravascular lung water depends on the type of acute lung injury. Crit Care Med 32:811–817PubMedCrossRef

21.

Groeneveld AB, Polderman KH (2005) Acute lung injury, overhydration or both? Crit Care 9:136–137PubMedCrossRef

22.

Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723PubMed

23.

Kirov MY, Kuzkov VV, Kuklin VN, Waerhaug K, Bjertnaes LJ (2004) Extravascular lung water assessed by transpulmonary single thermodilution and postmortem gravimetry in sheep. Crit Care 8:R451–R458PubMedCrossRef

Title: Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS
Authors: A. B. Johan Groeneveld
Joanne Verheij
Publication date: 01-09-2006
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0212-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS

Abstract

Objective

Design and setting

Patients

Intervention

Measurements and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Intervention

Measurements and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2006

Preventing nosocomial sinusitis in the ICU: comment on article by Pneumatikos et al.

Point of care management of heparin administration after heart surgery

Pressure-volume curves with and without muscle paralysis in acute respiratory distress syndrome

Reply to “Organ donation in pediatric traumatic brain injury” by Morris et al.

Electrical impedance tomography: ready for prime time?

Platelet and soluble CD40L in meningococcal sepsis