Association between Different Indexations of Extravascular Lung Water (EVLW) and PaO2/FiO2: A Two-Center Study in 231 Patients

Huber, Wolfgang; Höllthaler, Josef; Schuster, Tibor; Umgelter, Andreas; Franzen, Michael; Saugel, Bernd; Cordemans, Colin; Schmid, Roland M.; Malbrain, Manu L N G

doi:10.1371/journal.pone.0103854

Cited by 29 publications

(41 citation statements)

References 39 publications

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“…These findings suggest, that-particularly in obese patients-BW is rather a confounder than appropriate indexation for GEDV. Similar results have been demonstrated for the indexation of EVLW [15,[18][19][20].…”

Section: Discussionsupporting

confidence: 86%

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A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

Huber

Mair

Götz

et al. 2016

J Clin Monit Comput

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Global end-diastolic volume (GEDV) has been indexed to body surface area (BSA). However, data validating this indexation of GEDV are scarce. Furthermore, it has been suggested to index GEDV to "predicted BSA" based on predicted body weight. Therefore, we aimed to identify biometric parameters independently associated with GEDV. We analyzed a database including 3812 TPTD measurements in 234 patients treated in the ICU of a German university hospital. GEDVI indexed to actual BSA was significantly lower than GEDVI indexed to predicted BSA (748 ± 179 vs. 804 ± 190 mL/m; p < 0.001). GEDV was independently associated with older age, male sex, height, and actual body weight. In a regression model for the estimation of GEDV, age and height were the most important parameters: Each year in age and each cm in height increased GEDV by 9 and 15 mL, respectively. In addition to height and weight also age and sex should be considered for indexation of GEDV.

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Section: Discussionsupporting

confidence: 86%

“…BW) and formulas (e.g. BSA) might improve indexation of volumetric parameters including GEDVI and extravascular lung water index (EVLWI) [16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

Huber

Mair

Götz

et al. 2016

J Clin Monit Comput

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“…This improves accuracy in obese patients and improves correlation with severity of illness and survival in acute lung injury patients [105−107]. Recent data shows that no indexation at all or indexation related to height is better [108], as suggested by others [109,110]. The problem is that there are no good ranges for normal values and such algorithms and decision trees should be used with caution [21, 111].…”

Section: Step 8 Normal Values and Indexationmentioning

confidence: 99%

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

Hofkens¹,

Verrijcken²,

Merveille³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Haemodynamic monitoring with transpulmonary thermodilution (TPTD) is less invasive than a pulmonary artery catheter, and is increasingly used in the Intensive Care Unit and the Operating Room. Optimal treatment of the critically ill patient demands adequate, precise and continuous monitoring of clinical parameters. Little is known about staff knowledge of the basic principles and practical implementation of TPTD measurements at the bedside. The aims of this review are to: 1) present the results of a survey on the knowledge of TPTD measurement among 252 nurses and doctors; and 2) to focus on specific situations and common pitfalls in order to improve patient management in daily practice. Methods: Web-based survey on knowledge of PiCCO technology (Pulsion Medical Systems, Feldkirchen, Germany), followed by PubMed and Medline search with review of the relevant literature regarding the use of TPTD in specific situations. Results: In total, 252 persons participated in the survey: 196 nurses (78%) and 56 medical doctors (22%) of whom 17 were residents in training. Knowledge on the use of TPTD appears to be suboptimal, with an average score of 58.3%. Doctors performed better than nurses (62.7% vs 57.0%, P = 0.012). About 190 out of 252 (75.4%) scored at least 50% but only 45 respondents (17.9%) obtained a score of 70% or more. Having five years of PiCCO experience was present in 15.8% of the participants and this was correlated to passing the test, defined as obtaining a test result of ≥ 50% (P = 0.07) or obtaining a test result of ≥ 70% (P = 0.05). There were no other parameters significantly predictive for obtaining a result above 50% or above 70% such as gender or doctor versus nurse or Belgian versus Dutch residency, or years of ICU experience. High quality education of nursing and medical staff is necessary to perform the technique correctly and to analyse and interpret the information that can be obtained. Visual inspection of thermodilution curves is important as this can point towards specific pathology. Interpretation of the parameters that can be obtained with TPTD in specific conditions is discussed. Finally, a practical approach is given in ten easy steps for nurses and doctors. Conclusion: TPTD has gained its place in the haemodynamic monitoring field, but, as with any technique, its virtue is only fully appreciated with correct use and interpretation.

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“…Even small and rapid changes in EVLW can be measured [40]. The value of EVLW has been regularly demonstrated to be correlated with mortality in critically ill patients [41,42], especially in septic shock [43,44] and ARDS [38,45].…”

Section: Were the Peep-induced Changes In Evlw Due To Artefacts Of Thmentioning

confidence: 99%

Transpulmonary thermodilution detects rapid and reversible increases in lung water induced by positive end-expiratory pressure in acute respiratory distress syndrome

Gavelli

Teboul

Azzolina

et al. 2020

Ann. Intensive Care

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Purpose: It has been suggested that, by recruiting lung regions and enlarging the distribution volume of the cold indicator, increasing the positive end-expiratory pressure (PEEP) may lead to an artefactual overestimation of extravascular lung water (EVLW) by transpulmonary thermodilution (TPTD). Methods:In 60 ARDS patients, we measured EVLW (PiCCO2 device) at a PEEP level set to reach a plateau pressure of 30 cmH 2 O (HighPEEP start ) and 15 and 45 min after decreasing PEEP to 5 cmH 2 O (LowPEEP 15′ and LowPEEP 45′ , respectively). Then, we increased PEEP back to the baseline level (HighPEEP end ). Between HighPEEP start and LowPEEP 15′ , we estimated the degree of lung derecruitment either by measuring changes in the compliance of the respiratory system (Crs) in the whole population, or by measuring the lung derecruited volume in 30 patients. We defined patients with a large derecruitment from the other ones as patients in whom the Crs changes and the measured derecruited volume were larger than the median of these variables observed in the whole population. Results:Reducing PEEP from HighPEEP start (14 ± 2 cmH 2 O) to LowPEEP 15′ significantly decreased EVLW from 20 ± 4 to 18 ± 4 mL/kg, central venous pressure (CVP) from 15 ± 4 to 12 ± 4 mmHg, the arterial oxygen tension over inspired oxygen fraction (PaO 2 /FiO 2 ) ratio from 184 ± 76 to 150 ± 69 mmHg and lung volume by 144 [68-420] mL. The EVLW decrease was similar in "large derecruiters" and the other patients. When PEEP was re-increased to HighPEEP end , CVP, PaO 2 /FiO 2 and EVLW significantly re-increased. At linear mixed effect model, EVLW changes were significantly determined only by changes in PEEP and CVP (p < 0.001 and p = 0.03, respectively, n = 60). When the same analysis was performed by estimating recruitment according to lung volume changes (n = 30), CVP remained significantly associated to the changes in EVLW (p < 0.001). Conclusions:In ARDS patients, changing the PEEP level induced parallel, small and reversible changes in EVLW. These changes were not due to an artefact of the TPTD technique and were likely due to the PEEP-induced changes in CVP, which is the backward pressure of the lung lymphatic drainage.

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Association between Different Indexations of Extravascular Lung Water (EVLW) and PaO2/FiO2: A Two-Center Study in 231 Patients

Cited by 29 publications

References 39 publications

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

Transpulmonary thermodilution detects rapid and reversible increases in lung water induced by positive end-expiratory pressure in acute respiratory distress syndrome

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