Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water

Katzenelson, Rita; Perel, Azriel; Berkenstadt, Haiim; Preisman, Sergey; Kogan, Samuel; Sternik, Leonid; Segal, Eran

doi:10.1097/01.ccm.0000130995.18334.8b

Cited by 222 publications

(146 citation statements)

References 21 publications

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“…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. However, no correlation between EVLW and either lung weight (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that the PiCCO system in this porcine OA model underestimates lung water in more edematous lungs. Although studies show reasonable correlation between PiCCO EVLW and gravimetry, [23][24][25] two of these investigators 23,24 and Effros et al 26 provide evidence that thermodilution methods may underestimate EVLW when vascular obstruction from microthrombi, OA, or hypoxic pulmonary vasoconstriction limit access of the thermal indicator to the entire extravascular compartment. Additionally, we report baseline EVLW of 10-11 mLÁkg -1 , significantly greater than the reported normal range of 3-7 mLÁkg -1 , 27 suggesting that EVLW may also be overestimated at baseline in this model.…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…In the absence of cardiac dysfunction, EVLW is a good indicator of noncardiogenic pulmonary edema earlier and more sensitive than other parameters such as chest x-ray or OI (17). It has been validated against the gold-standard gravimetric method in animal models and the in vivo double indicator technique (18,19). Interestingly, EVLW is increased in patients suffering from stroke (6) or intracranial trauma (20).…”

Section: Discussionmentioning

confidence: 99%

Hypoxic–ischemic brain damage induces distant inflammatory lung injury in newborn piglets

et al. 2015

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“…Bolus transpulmonary thermodilution measurements are required for the estimation of these haemodynamic and pulmonary variables using the PiCCO. Several studies have investigated the accuracy of these values [17,[20][21][22]], but few have described the precision of this technique [23,24]. Accuracy refers to how close a measurement is to the actual or real value, and precision refers to how close repeated measurements are to each other [25].…”

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confidence: 99%

The precision of PiCCO^® measurements in hypothermic post‐cardiac arrest patients

Tagami

Kushimoto

Tosa³

et al. 2012

Anaesthesia

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SummaryThe aim of the present study was to determine the precision of the PiCCO Ò system for post-cardiac arrest patients who underwent therapeutic hypothermia. The precision of the measurements for cardiac output, global end-diastolic volume, extravascular lung water and the pulmonary vascular permeability index was assessed using the least significant change; this was regarded as precise when less than 15%. A total of 462 measurement sets were prospectively performed on 88 patients following successful resuscitation after cardiac arrest. Using the mean value of three injections for a measurement, the least significant change for the cardiac output, global end-diastolic volume, extravascular lung water and pulmonary vascular permeability index measurements were found to be 7.8%, 8.5%, 7.8% and 12.1%, respectively. No significant differences between hypothermia (n = 150) and non-hypothermia (n = 312) were found. The PiCCO-derived variables were found to be precise for post-cardiac arrest patients even under conditions of varying body temperature.

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Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water

Abstract: Measurement of extravascular lung water using transpulmonary thermodilution with a single indicator is very closely correlated with gravimetric measurement of lung water in both increased permeability and hydrostatic pulmonary edema.

Cited by 222 publications

References 21 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

Hypoxic–ischemic brain damage induces distant inflammatory lung injury in newborn piglets

The precision of PiCCO^® measurements in hypothermic post‐cardiac arrest patients

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Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water

Abstract: Measurement of extravascular lung water using transpulmonary thermodilution with a single indicator is very closely correlated with gravimetric measurement of lung water in both increased permeability and hydrostatic pulmonary edema.

Cited by 222 publications

References 21 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

Hypoxic–ischemic brain damage induces distant inflammatory lung injury in newborn piglets

The precision of PiCCO® measurements in hypothermic post‐cardiac arrest patients

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The precision of PiCCO^® measurements in hypothermic post‐cardiac arrest patients