Extravascular Lung Water Measured Using Single Transpulmonary Thermodilution Reflects Perioperative Pulmonary Edema Induced by Esophagectomy

Abstract

Pulmonary edema is the most frequent postoperative complication following esophagectomy for thoracic esophageal cancer. We enrolled 23 patients who underwent esophagectomy with extended lymph node dissection for thoracic esophageal cancer in a prospective observational clinical trial. We used the PiCCO device to measure extravascular lung water with the aim of determining whether it correlates with the respiratory index and whether it is predictive of pulmonary complications. Based on constant criteria, the tracheal tubes of 11 patients were removed on the morning of postoperative day 1 (extubation group), while 12 patients remained intubated (intubation group). These two groups significantly differed in that all patients in the extubation group recovered without any pulmonary complications, whereas 4 patients (33%) in the intubation group developed pulmonary complications. The extravascular lung water measured using PiCCO correlated significantly with the respiratory index. In the intubation group, both extravascular lung water and respiratory index were elevated 12 h after surgery and were even higher 24 h after surgery. The extravascular lung water measured using PiCCO reflects the level of postoperative pulmonary edema and predicts the pulmonary complications induced by esophagectomy with extended lymph node dissection.

Respiratory complications after oesophageal surgery

“…Other studies evaluated lung water in the postoperative setting. Extravascular lung water, as assessed by a pulse contour CO system, was higher in patients who could not be extubated [59] and remain elevated for up to 3 days postoperatively [60]. These studies support the idea of increased pulmonary capillary permeability and suggest that, in the future, estimation of lung water may be useful after oesophagectomy.…”

Volume Management and Resuscitation in Thoracic Surgery

“…EVLW has been shown to be an independent predictor of prognosis and survival in critically ill patients [90], and in esophagectomy has been found to correlate with PaO2/FiO2 ratio, pulmonary compliance, lung injury score [91], and pulmonary complications [92]. EVLW is derived by subtracting the pulmonary blood volume (PBV) from the pulmonary thermal volume (PTV); there has, therefore, been concern regarding the use of EVLWI after lung resection, as both PBV and PTV may change [93].…”

Update on minimally invasive hemodynamic monitoring in thoracic anesthesia

“…EVLW is an independent prognostic parameter in patients with ARDS [41]. In patients undergoing esophagectomy, postoperatively measured EVLW is an indicator for the level of postoperative pulmonary edema and predictive for the development of pulmonary complications [42,43]. GEDV and EVLW are therefore useful to guide and improve postoperative hemodynamic management in patients with limited cardiopulmonary reserve undergoing thoracic procedures.…”