Factors influencing the estimation of extravascular lung water by transpulmonary thermodilution in critically ill patients*

Michard, Frédèric; Schachtrupp, A.; Toens, Christian

doi:10.1097/01.ccm.0000164566.23147.35

Cited by 92 publications

(48 citation statements)

References 25 publications

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“…The significant decrease in global lung density further supports this conclusion. Scillia et al 20 revealed a significant correlation between CT derived density and EVLW by means of double indicator dilution in a canine OA model; this was confirmed later by Kuzkov et al 21 The single indicator thermodilution determination of EVLW has been validated clinically against the double indicator dilution method 16,22 and has been substantiated in animal studies against gravimetry. [23][24][25] As the PiCCO calculation of EVLW excludes both blood and tissue volumes, we anticipated lower PiCCO derived EVLW values compared with CT determined lung weights, but we expected EVLW to increase as CT lung weight increased with OA injury.…”

Section: Discussionmentioning

confidence: 86%

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Graham

Gulati

Kha

et al. 2011

Can J Anesth/J Can Anesth

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Objective Resolution of the acute respiratory distress syndrome (ARDS) requires clearance of pulmonary edema. Biologically variable ventilation (BVV) strategies that improve gas exchange, lung mechanics, and inflammatory mediators in ARDS may be beneficial in this regard. We used quantitative computed tomography (CT), a single indicator thermodilution system (PiCCOÒ) to determine extravascular lung water (EVLW), and the change in edema protein concentration over time to compare edema clearance with BVV vs conventional mechanical ventilation (CMV) in a porcine ARDS model. Methods Sixteen pigs with oleic acid lung injury were randomized to four hours of ventilation with either CMV (n = 8) or BVV (n = 8) at identical low tidal volume and minute ventilation over time. Hemodynamic variables, gas exchange, lung mechanics, and PiCCO derived EVLW were determined hourly. Computed tomography images and edema fluid samples were obtained at baseline lung injury and after four hours of ventilation. Wet and dry lung weights were determined postmortem.Results At four hours with BVV, peak airway pressure was decreased significantly and lung compliance improved compared with CMV (P = 0.003; P \ 0.001, respectively). Hemodynamic variables and gas exchange were not different between groups. Also at four hours, computed tomography revealed an increase in total gas volume (P = 0.001) and a decrease in total lung weight and global lung density (P = 0.005; P = 0.04 respectively) with BVV. These findings were associated with a significant increase in the gas volume of normally aerated lung regions (P \ 0.001) and a decrease in the poorly and non-aerated lung regions (P = 0.001). No change in any CT parameter occurred with CMV. The lung weights derived from computed tomography correlated well with postmortem wet weights (R 2 = 0.79; P \ 0.01). The decrease in PiCCO derived EVLW from injury to four hours did not differ significantly between BVV and CMV. Extravascular lung water showed no correlation with postmortem wet weights and significantly underestimated lung water. Average alveolar fluid clearance rates were positive (1.4%Áhr -1 (3%)) with BVV and negative with CMV (-2.0%Áhr -1 (4%)). Conclusions In a comparison between BVV and CMV, computed tomography evidence suggests that BVV facilitates enhanced clearance and/or redistribution of edema fluid with improved recruitment of atelectatic and poorly aerated lung regions; no such evidence was seen with either single thermodilution measurement of EVLW or edema clearance rates. The results of computed tomography provide further evidence of the benefit of BVV over conventional ventilation in ARDS. RésuméObjectif La re´solution d'un syndrome de de´tresse respiratoire aigue¨(SDRA) ne´cessite l'e´limination de

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Section: Discussionmentioning

confidence: 86%

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Graham

Gulati

Kha

et al. 2011

Can J Anesth/J Can Anesth

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“…Although some reports have recommended pointing out pitfalls in EVLW thermodilution assessment when PHT occurs, the sensitivity of the method in this and other studies was adequate (4,29).…”

Section: Methodological Validation For the Assessment Of Evlwmentioning

confidence: 97%

Sildenafil prevents the increase of extravascular lung water and pulmonary hypertension after meconium aspiration in newborn piglets

Silvera

Blasina

Vaamonde

et al. 2011

Braz J Med Biol Res

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“…The PiCCO algorithm allows us to estimate not only "one picture" as cardiac preload (GEDI), but also an effective functional answer (continuous CO monitoring) together with a pulmonary edema quantification (ELWI), 20,21 all of which potentially gives us the opportunity of responding rapidly to stress-related hemodynamic consequences early after SAH. 22,23 The present data demonstrated a significant impact of PiCCO CO optimization based on our goal-directed hemodynamic paradigm on DIND and vasospasm-related cerebral infarction and significantly less cardiopulmonary complications without any significant functional impact on the clinical outcome at 3 months.…”

Section: Discussionmentioning

confidence: 99%

Performance of Bedside Transpulmonary Thermodilution Monitoring for Goal-Directed Hemodynamic Management After Subarachnoid Hemorrhage

Mutoh

Kazumata

Ishikawa

et al. 2009

Stroke

114

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Background and Purpose-Early goal-directed hemodynamic therapy is of particular importance for adequate cerebral circulation of patients with vasospasm after subarachnoid hemorrhage but is often precluded by the invasiveness of established cardiac output determination using a pulmonary artery catheter. This study was undertaken to validate the usefulness of less invasive goal-directed hemodynamic monitoring by transpulmonary thermodilution technique in patients after subarachnoid hemorrhage. Methods-One hundred sixteen patients with subarachnoid hemorrhage who underwent surgical clipping within 24 hours of ictus were investigated. Validation of transpulmonary thermodilution-derived intermittent/continuous cardiac output and cardiac preload (global end diastolic volume) were compared with pulmonary artery catheter-derived reference cardiac output and pulmonary capillary wedge pressure or central venous pressure in 16 patients diagnosed with vasospasm. In a subsequent trial of 100 consecutive cases, clinical results between the new and standard management paradigms were compared. Results-Transpulmonary thermodilution-derived intermittent cardiac output and transpulmonary thermodilution-derived continuous cardiac output showed close agreement to catheter-derived reference cardiac output with high correlation (rϭ0.85 and 0.77) and low percentage error (13.5% and 18.0%). Fluid responsiveness to defined volume loading was predicted better with global end diastolic volume than with pulmonary capillary wedge pressure and central venous pressure for larger receiver operating characteristic curve area. Patients receiving early goal-directed management by transpulmonary thermodilution experienced reduced frequencies of vasospasm and cardiopulmonary complications compared with those managed with standard therapy (PϽ0.05), whereas their functional outcomes at 3 months were not different (Pϭ0.06). Conclusions-Goal-directed hemodynamic management guided by transpulmonary thermodilution appears to have a therapeutic advantage for optimizing the prognosis of patients with subarachnoid hemorrhage with vasospasm over conventional methods.

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Factors influencing the estimation of extravascular lung water by transpulmonary thermodilution in critically ill patients*

Cited by 92 publications

References 25 publications

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Sildenafil prevents the increase of extravascular lung water and pulmonary hypertension after meconium aspiration in newborn piglets

Performance of Bedside Transpulmonary Thermodilution Monitoring for Goal-Directed Hemodynamic Management After Subarachnoid Hemorrhage

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