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Journal of Clinical Monitoring and Computing

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01-02-2019 | Original Research

Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients

Authors: Bernd Saugel, Moritz Wildgruber, Albrecht Staudt, Michael Dieckmeyer, Konstantin Holzapfel, Georgios Kaissis, Mikhail Y. Kirov, Vsevolod V. Kuzkov, Roland M. Schmid, Wolfgang Huber

Published in: Journal of Clinical Monitoring and Computing | Issue 1/2019

Abstract

Extravascular lung water (index) (EVLW(I)) can be estimated using transpulmonary thermodilution (TPTD). Computed tomography (CT) with quantitative analysis of lung tissue density has been proposed to quantify pulmonary edema. We compared variables of pulmonary fluid status assessed using quantitative CT and TPTD in critically ill patients. In 21 intensive care unit patients, we performed TPTD measurements directly before and after chest CT. Based on the density data of segmented CT images we calculated the tissue volume (TV), tissue volume index (TVI), and the mean weighted index of voxel aqueous density (VMWaq). CT-derived TV, TVI, and VMWaq did not predict TPTD-derived EVLWI values ≥ 14 mL/kg. There was a significant moderate positive correlation between VMWaq and mean EVLWI (EVLWI before and after CT) (r = 0.45, p = 0.042) and EVLWI after CT (r = 0.49, p = 0.025) but not EVLWI before CT (r = 0.38, p = 0.086). There was no significant correlation between TV and EVLW before CT, EVLW after CT, or mean EVLW. There was no significant correlation between TVI and EVLWI before CT, EVLWI after CT, or mean EVLWI. CT-derived variables did not predict elevated TPTD-derived EVLWI values. In unselected critically ill patients, variables of pulmonary fluid status assessed using quantitative CT cannot be used to predict EVLWI.

Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015;5:38. https://doi.org/10.1186/s13613-015-0081-9.CrossRefPubMedPubMedCentral

Saugel B, Phillip V, Ernesti C, et al. Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients. J Crit Care. 2013;28:196–201. https://doi.org/10.1016/j.jcrc.2012.05.002.CrossRefPubMed

Huber W, Mair S, Gotz SQ, et al. Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients. Intensive Care Med. 2013;39:146–50. https://doi.org/10.1007/s00134-012-2745-3.CrossRefPubMed

Huber W, Hollthaler J, Schuster T, et al. Association between different indexations of extravascular lung water (EVLW) and PaO2/FiO2: a two-center study in 231 patients. PLoS ONE. 2014;9:e103854. https://doi.org/10.1371/journal.pone.0103854.CrossRefPubMedPubMedCentral

Kushimoto S, Taira Y, Kitazawa Y, et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome. Crit Care. 2012;16:R232. https://doi.org/10.1186/cc11898.CrossRefPubMedPubMedCentral

Kor DJ, Warner DO, Carter RE, et al. Extravascular lung water and pulmonary vascular permeability index as markers predictive of postoperative acute respiratory distress syndrome: a prospective cohort investigation. Crit Care Med. 2015;43:665–73. https://doi.org/10.1097/ccm.0000000000000765.CrossRefPubMed

Garutti I, Sanz J, Olmedilla L, et al. Extravascular lung water and pulmonary vascular permeability index measured at the end of surgery are independent predictors of prolonged mechanical ventilation in patients undergoing liver transplantation. Anesth Analg. 2015;121:736–45. https://doi.org/10.1213/ane.0000000000000875.CrossRefPubMed

Wang H, Cui N, Su L, et al. (2016) Prognostic value of extravascular lung water and its potential role in guiding fluid therapy in septic shock after initial resuscitation. J Crit Care10.1016/j.jcrc.2016.02.011.

Tagami T, Nakamura T, Kushimoto S, et al. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care. 2014;4:27. https://doi.org/10.1186/s13613-014-0027-7.CrossRefPubMedPubMedCentral

10.

Kushimoto S, Endo T, Yamanouchi S, et al. Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition. Crit Care. 2013;17:R132. https://doi.org/10.1186/cc12811.CrossRefPubMedPubMedCentral

11.

Jozwiak M, Silva S, Persichini R, et al. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome. Crit Care Med. 2013;41:472–80. https://doi.org/10.1097/CCM.0b013e31826ab377.CrossRefPubMed

12.

Teboul JL, Saugel B, Cecconi M, et al. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med. 2016;42:1350–9. https://doi.org/10.1007/s00134-016-4375-7.CrossRefPubMed

13.

Monnet X, Anguel N, Osman D, Hamzaoui O, Richard C, Teboul JL. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med. 2007;33:448–53. https://doi.org/10.1007/s00134-006-0498-6.CrossRefPubMed

14.

Morisawa K, Fujitani S, Taira Y, et al. Difference in pulmonary permeability between indirect and direct acute respiratory distress syndrome assessed by the transpulmonary thermodilution technique: a prospective, observational, multi-institutional study. J Intensive Care. 2014;2:24. https://doi.org/10.1186/2052-0492-2-24.CrossRefPubMedPubMedCentral

15.

Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med. 2001;164:1701–11. https://doi.org/10.1164/ajrccm.164.9.2103121.CrossRefPubMed

16.

Kuzkov VV, Suborov EV, Kirov MY, et al. Radiographic lung density assessed by computed tomography is associated with extravascular lung water content. Acta Anaesthesiol Scand. 2010;54:1018–26. https://doi.org/10.1111/j.1399-6576.2010.02272.x.CrossRefPubMed

17.

Saugel B, Holzapfel K, Stollfuss J, et al. Computed tomography to estimate cardiac preload and extravascular lung water. A retrospective analysis in critically ill patients. Scand J Trauma Resusc Emerg Med. 2011;19:31. https://doi.org/10.1186/1757-7241-19-31.CrossRefPubMedPubMedCentral

18.

Zhang F, Li C, Zhang JN, Guo HP, Wu DW. Comparison of quantitative computed tomography analysis and single-indicator thermodilution to measure pulmonary edema in patients with acute respiratory distress syndrome. Biomed Eng Online. 2014;13:30. https://doi.org/10.1186/1475-925x-13-30.CrossRefPubMedPubMedCentral

19.

Saugel B, Kirsche SV, Hapfelmeier A, et al. Prediction of fluid responsiveness in patients admitted to the medical intensive care unit. J Crit Care. 2013;28:537 e531-539. https://doi.org/10.1016/j.jcrc.2012.10.008.CrossRef

20.

Saugel B, Phillip V, Gaa J, et al. Advanced hemodynamic monitoring before and after transjugular intrahepatic portosystemic shunt: implications for selection of patients: a prospective study. Radiology. 2012;262:343–52. https://doi.org/10.1148/radiol.11110043.CrossRefPubMed

21.

Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest. 2002;122:2080–6.CrossRefPubMed

22.

Patroniti N, Bellani G, Maggioni E, Manfio A, Marcora B, Pesenti A. Measurement of pulmonary edema in patients with acute respiratory distress syndrome. Crit Care Med. 2005;33:2547–54.CrossRefPubMed

23.

Tagami T, Kushimoto S, Yamamoto Y, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010;14:R162. https://doi.org/10.1186/cc9250.CrossRefPubMedPubMedCentral

24.

Dres M, Teboul JL, Guerin L, et al. Transpulmonary thermodilution enables to detect small short-term changes in extravascular lung water induced by a bronchoalveolar lavage. Crit Care Med. 2014;42:1869–73. https://doi.org/10.1097/ccm.0000000000000341.CrossRefPubMed

25.

Fernandez-Mondejar E, Rivera-Fernandez R, Garcia-Delgado M, Touma A, Machado J, Chavero J. Small increases in extravascular lung water are accurately detected by transpulmonary thermodilution. J Trauma. 2005;59:1420–3. discussion 1424.CrossRefPubMed

26.

Sakka SG, Ruhl CC, Pfeiffer UJ, et al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000;26:180–7.CrossRefPubMed

27.

Gattinoni L, Marini JJ, Pesenti A, Quintel M, Mancebo J, Brochard L. The “baby lung” became an adult. Intensive Care Med. 2016;42:663–73. https://doi.org/10.1007/s00134-015-4200-8.CrossRefPubMed

Title: Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients
Authors: Bernd Saugel
Moritz Wildgruber
Albrecht Staudt
Michael Dieckmeyer
Konstantin Holzapfel
Georgios Kaissis
Mikhail Y. Kirov
Vsevolod V. Kuzkov
Roland M. Schmid
Wolfgang Huber
Publication date: 01-02-2019
Publisher: Springer Netherlands
Published in: Journal of Clinical Monitoring and Computing / Issue 1/2019
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-018-0144-1

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Springer Medicine

Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients

Abstract

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Springer Medicine

Abstract

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