Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bedside alternatives to the pulmonary artery catheter

Abstract

Isakow, Warren, and Daniel P. Schuster. Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bedside alternatives to the pulmonary artery catheter.

Brain death and its implications for management of the potential organ donor

“…6,83,98,103,113 The goals are to 'normalize' hemodynamic variables 6,83,98 and use of the pulmonary artery catheter (PAC) has been the gold standard, but transpulmonary thermodilution measurements or esophageal Doppler measurements (EDM) are good alternatives. 114 In addition to CO and SVR, transpulmonary thermodilution gives continuous CO by pulse contour analysis and estimates of intrathoracic blood volume (ITBV) and extravascular lung water (EVLW). 114 ITBV is a much better estimate of cardiac pre-load than pulmonary artery occlusion pressure, 115 and EVLW is an indicator of pulmonary edema and capillary leakage.…”

In vivo intravital endoscopic confocal fluorescence microscopy of normal and acutely injured rat lungs

“…ECFM observations correlated easily with the traditional TUNEL or ISEL techniques on ex vivo fixated lung sections. 20,40,43 Lung Microcirculation and Edema Pulmonary edema is another critical feature for monitoring parameters of ALI/ARDS by bedside ICU physicians, 44 although it is often underestimated and difficult to assess. Although the epithelial barrier is less permeable than the endothelium physiologically, the loss of epithelial cells in distal airspaces of ALI/ARDS lungs is common and a cornerstone of the repair processes.…”

“…Although the epithelial barrier is less permeable than the endothelium physiologically, the loss of epithelial cells in distal airspaces of ALI/ARDS lungs is common and a cornerstone of the repair processes. 9,10,[24][25][26]34,35,40 There is growing evidence that lung permeability should be considered as a target for new therapy in ALI/ARDS: current knowledge on catecholamines-induced improved fluid clearance, 10,24,[44][45][46] trends for increase of ventilator-free days with decrease in extravascular lung water, 46 and evidence for reduction of ventilatory needs with conservative vs liberal fluid resuscitation. 47 However, validated and reliable procedures for lung permeability assessment are still lacking, although FITC-dextran 48 and semiquantitative double-isotope imaging technique (using albumin and transferrin) 49 have become popular experimentally, in vivo as well as ex vivo.…”

“…Edema at this time was clinically and macroscopically obvious, however, astonishingly variable and inhomogeneous on a dynamic and microscopic basis. This emerging endomicroscopic technique is able to offer physicians an additional tool to evaluate actual edema status in localized areas, in addition to conventional methods (eg, Piccos, wedge pressure 44 ).…”

Assessment of Perioperative Fluid Balance

“…However, careful interpretation of EVLW data is required in presence of large pulmonary vascular obstruction (e.g., pulmonary emboli), focal lung injury or lung resection. [7,11] Pulse pressure and stroke volume variation. However, the use of these monitoring techniques revealed interesting insights into the hemodynamic pathophysiology of macro-and microcirculation for example in sepsis, where microcirculatory alterations are most likely to occur: Microcirculation improved as a result of a dobutamine infusion unrelated to cardiac output and mean arterial pressure in septic patients.…”