Transpulmonary Thermodilution Enables to Detect Small Short-Term Changes in Extravascular Lung Water Induced by a Bronchoalveolar Lavage

Dres, Martin; Teboul, Jean‐Louis; Guérin, Laurent; Anguel, Nadia; Amilien, Virginie; Clair, Marie-Philippine; Gruner, A; Richard, Christian; Monnet, Xavier

doi:10.1097/ccm.0000000000000341

Cited by 20 publications

(13 citation statements)

References 20 publications

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“…EVLW measurements determined by transpulmonary thermodilution have been reported to be markedly correlated with lung gravimetric measurements and serve as a standard method for EVLW determination ex vivo . Moreover, studies have shown that even minor alterations in EVLW may be detected . However, transpulmonary thermodilution requires a catheter to be placed and is thus an invasive method.…”

Section: Discussionmentioning

confidence: 99%

Using lung ultrasound to quantitatively evaluate pulmonary water content

Zong

Guo

Liu

et al. 2020

Pediatric Pulmonology

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Background Increases in extravascular lung water (EVLW) can lead to respiratory failure. This study aimed to investigate whether the B‐line score (BLS) was correlated with the EVLW content determined by the lung wet/dry ratio in a rabbit model. Methods A total of 45 New Zealand rabbits were randomly assigned to nine groups. Among the animals, models of various lung water content levels were induced by the infusion of different volumes of warm sterile normal saline (NS) via the endotracheal tube. The arterial blood gas, spontaneous respiratory rate, and PaO2/FiO2 ratio were detected before and after infusion. In addition, the B‐lines were determined before and immediately after infusion in each group. Finally, both lungs were resected to determine the wet/dry ratio. In addition, all lung specimens were analyzed histologically, and EVLW was quantified using the BLS based on the number and confluence of B‐lines in the intercostal space. Results The BLS increased with increasing infusion volume. The BLS was statistically correlated with the wet/dry ratio (r2= .946) and with the PaO2/FiO2 ratio (r2= .916). Furthermore, a repeatability study was performed for the lung ultrasound (LUS) technology (Bland‐Altman plots), and the results suggest that LUS had favorable intraobserver and interobserver reproducibility. Conclusions This study is the first to suggest that the BLS can serve as a sensitive, quantitative, noninvasive, and real‐time indicator of EVLW in a rabbit model of lung water accumulation. Notably, the BLS displayed an obvious correlation with the experimental gravimetry results and could also be used to predict the pulmonary oxygenation status.

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Section: Discussionmentioning

confidence: 99%

Using lung ultrasound to quantitatively evaluate pulmonary water content

Zong

Guo

Liu

et al. 2020

Pediatric Pulmonology

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“…First, it has been validated against transpulmonary thermo-dye dilution in humans [43], and against gravimetry, the reference technique, in animals [45, 46] and humans [47]. Second, experimental [48, 49] and clinical [4, 50] studies demonstrated that the TPTD estimation of EVLW is precise. In an autopsy study in 30 patients, the correlation coefficient between EVLW measured by TPTD and by gravimetry was 0.90 [47].…”

Section: Cardiac Systolic Functionmentioning

confidence: 99%

“…In an autopsy study in 30 patients, the correlation coefficient between EVLW measured by TPTD and by gravimetry was 0.90 [47]. TPTD was able to detect the small and short-term changes in EVLW induced by bronchoalveolar lavage [50]. With TPTD, it is also possible to detect the rapid increase in EVLW that occurs during a weaning-induced pulmonary oedema, sometimes over a few minutes only [51].…”

Section: Cardiac Systolic Functionmentioning

confidence: 99%

Transpulmonary thermodilution: advantages and limits

2017

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Background: For complex patients in the intensive care unit or in the operating room, many questions regarding their haemodynamic management cannot be answered with simple clinical examination. In particular, arterial pressure allows only a rough estimation of cardiac output. Transpulmonary thermodilution is a technique that provides a full haemodynamic assessment through cardiac output and other indices. Main body: Through the analysis of the thermodilution curve recorded at the tip of an arterial catheter after the injection of a cold bolus in the venous circulation, transpulmonary thermodilution intermittently measures cardiac output. This measure allows the calibration of pulse contour analysis. This provides continuous and real time monitoring of cardiac output, which is not possible with the pulmonary artery catheter. Transpulmonary thermodilution provides several variables beyond cardiac output. It estimates the end-diastolic volume of the four cardiac cavities, which is a marker of cardiac preload. It provides an estimation of the systolic function of the combined ventricles. It is more direct than the pulmonary artery catheter, but does not allow the distinct estimation of right and left cardiac function. It is easier and faster to perform than echocardiography, but does not provide a full evaluation of the cardiac structure and function. Transpulmonary thermodilution has the unique advantage of being able to estimate at the bedside extravascular lung water, which quantifies the volume of pulmonary oedema, and pulmonary vascular permeability, which quantifies the degree of a pulmonary capillary leak. Both indices are helpful for guiding fluid strategy, especially in case of acute respiratory distress syndrome. Conclusions: Transpulmonary thermodilution provides a full cardiovascular evaluation that allows one to answer many questions regarding haemodynamic management. It belongs to the category of "advanced" devices that are indicated for the most critically ill and/or complex patients.

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“…Son monitoring par thermodilution transpulmonaire est pourtant fiable et précis [10]. Il permet de réduire la durée de ventilation et de séjour en réanimation [11].…”

Section: Autres Variablesunclassified

“…Par exemple, l'estimation du débit cardiaque par certaines techniques ne saurait être considérée comme fantaisiste si on retrouve une augmentation de ce débit lors d'interventions thérapeutiques caricaturales : augmentation du débit cardiaque et de l'accélération maximale du flux aortique mesurée par Doppler oesophagien lors de l'administration de dobutamine [8,18], diminution et augmentation du débit cardiaque mesuré par analyse du contour de l'onde de pouls lors de pauses télé-inspiratoires et expiratoires chez les patients sous ventilation artificielle [19], etc. Il en va de même, par exemple encore, de la mesure de l'eau pulmonaire par la thermodilution transpulmonaire, capable de détecter la faible augmentation qu'on en attend dans les suites d'un lavage broncho-alvéolaire [10].…”

Section: Autres Variablesunclassified

Devant un état de choc : pourquoi je fais un monitoring cardiovasculaire

Monnet

Teboul

2015

Réanimation

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In the debate between utility and futility, safety and invasiveness, reliability and unreliability of cardiovascular monitoring techniques, several arguments advocate for their use in the most severe patients. First, some physiological evidence and several clinical studies indicate that a number of cardinal hemodynamic variables (heart rate, cardiac preload, systolic heart function or lung water) are not properly estimated by clinical, biological or radiological assessment, while they are by monitoring tools. Then, the rate of complications associated with these techniques is low, if compared to the severity of patients in whom they are used. Moreover,

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Transpulmonary Thermodilution Enables to Detect Small Short-Term Changes in Extravascular Lung Water Induced by a Bronchoalveolar Lavage

Abstract: Transpulmonary thermodilution enabled to detect small short-term changes of indexed extravascular lung water secondary to bronchoalveolar lavage.

Cited by 20 publications

References 20 publications

Using lung ultrasound to quantitatively evaluate pulmonary water content

Using lung ultrasound to quantitatively evaluate pulmonary water content

Transpulmonary thermodilution: advantages and limits

Devant un état de choc : pourquoi je fais un monitoring cardiovasculaire

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