Extravascular lung water predicts progression to acute lung injury in patients with increased risk*

LeTourneau, Jennifer L.; Pinney, Jamie; Phillips, Charles R.

doi:10.1097/ccm.0b013e318236f60e

Cited by 79 publications

(51 citation statements)

References 36 publications

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“…These data suggest that the same pulmonary pathophysiology is taking place before the clinical symptoms of ALI/ARDS are present. Thus it is likely that increased endothelial (76,100) and epithelial (24,76) permeability, surfactant deactivation (56), pulmonary edema (71), and altered alveolar mechanics suggested by chest X-ray and oxygen requirements (73) are all occurring unnoticed before a patient is diagnosed with ALI/ARDS, generating the conditions that will ultimately drive the pathological tetrad.…”

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confidence: 99%

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Nieman

Gatto

Habashi

2015

Journal of Applied Physiology

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Nieman GF, Gatto LA, Habashi NM. Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury. J Appl Physiol 119: 1245-1261. First published October 15, 2015 doi:10.1152/japplphysiol.00659.2015The earliest description of what is now known as the acute respiratory distress syndrome (ARDS) was a highly lethal double pneumonia. Ashbaugh and colleagues (Ashbaugh DG, Bigelow DB, Petty TL, Levine BE Lancet 2: 319-323, 1967) correctly identified the disease as ARDS in 1967. Their initial study showing the positive effect of mechanical ventilation with positive end-expiratory pressure (PEEP) on ARDS mortality was dampened when it was discovered that improperly used mechanical ventilation can cause a secondary ventilator-induced lung injury (VILI), thereby greatly exacerbating ARDS mortality. This Synthesis Report will review the pathophysiology of ARDS and VILI from a mechanical stress-strain perspective. Although inflammation is also an important component of VILI pathology, it is secondary to the mechanical damage caused by excessive strain. The mechanical breath will be deconstructed to show that multiple parameters that comprise the breath-airway pressure, flows, volumes, and the duration during which they are applied to each breath-are critical to lung injury and protection. Specifically, the mechanisms by which a properly set mechanical breath can reduce the development of excessive fluid flux and pulmonary edema, which are a hallmark of ARDS pathology, are reviewed. Using our knowledge of how multiple parameters in the mechanical breath affect lung physiology, the optimal combination of pressures, volumes, flows, and durations that should offer maximum lung protection are postulated. acute lung injury; lung; pathophysiology ventilator; VILI THE POLIO EPIDEMIC OF 1916 inspired many treatment attempts including vitamin C therapy, hydrotherapy, and electrotherapy, but no effective therapy was found until Philip Drinker's group invented negative pressure mechanical ventilation-the iron lung. Their landmark paper, "The use of a new apparatus for the prolonged administration of artificial respiration: I. A fatal case of poliomyelitis," published in 1929, demonstrated the effective clinical use of this device (Fig. 1) (38). The concept of conversion from negative to positive pressure ventilation was based on technical advances that were made during World War II to deliver pressurized oxygen to high-altitude fighter and bomber pilots. Concomitant with these technologic advances in mechanical ventilation was the realization that what was originally thought to be a universally fatal form of double pneumonia was indeed a unique clinical entity that we now call the acute respiratory distress syndrome (ARDS). In a 1967 seminal paper published in The Lancet, Ashbaugh et al. (10) first identified and described ARDS as a collection of pathologic abnormalities that can be caused by many unrelated insults such as sepsis, hemorrhagic shock, pneumonia, and trauma to name a few. The disease and the ventil...

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confidence: 99%

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Nieman

Gatto

Habashi

2015

Journal of Applied Physiology

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“…They also suggested of a trigger point of not less than 10 ml/kg. 52,53 Therefore treatment goals of 3---7 ml/kg as proposed as the normal values may not be appropriate in particular in this group of patients. In summary however, combining measurements of GEDVI and EVLWI with volume loading enables balanced volume therapy, i.e.…”

Section: Discussionmentioning

confidence: 99%

Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: A metaanalysis of the literature

et al. 2012

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Introduction: Hemodynamic parameters such as the global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI), derived by transpulmonary thermodilution, have gained increasing interest for guiding fluid therapy in critically ill patients. The proposed normal values (680---800 ml/m 2 for GEDVI and 3---7 ml/kg for EVLWI) are based on measurements in healthy individuals and on expert opinion, and are assumed to be suitable for all patients. We analyzed the published data for GEDVI and EVLWI, and investigated the differences between a cohort of septic patients (SEP) and patients undergoing major surgery (SURG), respectively. Methods: A PubMed literature search for GEDVI, EVLWI or transcardiopulmonary single/double indicator thermodilution was carried out, covering the period from 1990 to 2010. Intervention: Meta-regression analysis was performed to identify any differences between the surgical (SURG) and non-surgical septic groups (SEP Conclusions:The published data for GEDVI and EVLWI are heterogeneous, particularly in critically ill patients, and often exceed the proposed normal values derived from healthy individuals. In the group of septic patients, GEDVI and EVLWI were significantly higher than in the group of patients undergoing major surgery. This points to the need for defining different therapeutic targets for different patient populations. © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved. PALABRAS CLAVEMonitorización hemodinámica; Precarga; Edema pulmonar; Volumen diastólico final global; Agua pulmonar extravascularComparación de valores del volumen diastólico final global y el algua pulmonar extravascular, medidos mediante termodilución transcardiopulmonar en pacientes críticamente enfermos: metaanálisis bibliográfico Resumen Introducción: Parámetros hemodinámicos como el índice de volumen diastólico final global (GEDVI) y el índice de agua pulmonar extravascular (EVLWI), obtenidos mediante termodilución transpulmonar, suscitan un interés creciente como guía de la terapia de fluidos en pacientes críticamente enfermos. Los valores normales propuestos (680---800 ml/m 2 para el GEDVI y 3-7 ml/kg para el EVLWI) se basan en mediciones realizadas a individuos sanos y en la opinión de expertos, y se asume que son adecuados para todos los pacientes. Analizamos los datos publicados sobre el GEDVI y el EVLWI e investigamos las diferencias entre una cohorte de pacientes septicémicos (SEP) y pacientes sometidos a cirugía mayor (SURG) respectivamente. Métodos: Se realizó una búsqueda bibliográfica en PubMed de GEDVI, EVLWI o termodilución trasncardiopulmonar de indicador único/doble referida al periodo comprendido entre 1990 y 2010. Intervenciones: Se realizó un análisis de metarregresión para identificar las diferencias entre los grupos quirúrgico (SURG) y no quirúrgico septicémico (SEP [6,9; 7,6] frente a SEP 11,0 ml/kg, IC del 95 %: [9,1;13,0], p=0,001). Conclusiones: Los datos publicados del GEDVI y el EVLWI son heterogéneos, especialmente en pacientes críticamente e...

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“…Concerning the CCO monitoring system, previous studies have suggested that EVLWi (>10 mL/kg) should be included in the definition of ARDS (18). Moreover, PVPI was higher in ARDS patients than in patients with hydrostatic pulmonary edema (4.7±1.8 vs. 2.1±0.5) (4).…”

Section: Discussionmentioning

confidence: 99%

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report

Takahashi

Shinohara

et al. 2016

J. Thorac. Dis.

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Sporadic patients with acute respiratory distress syndrome (ARDS) caused by Mycoplasma pneumoniae have been reported. However, knowledge about the pathophysiology and pharmacological treatment of this condition is insufficient. Moreover, the pulmonary vascular permeability in ARDS related to M. pneumoniae infection has not been reported. We report a case of ARDS caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability, which was successfully treated using low-dose short-term hydrocortisone, suggesting that pulmonary infiltration in ARDS caused by Mycoplasma pneumoniae does not match the criteria of permeability edema observed in typical ARDS.

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Extravascular lung water predicts progression to acute lung injury in patients with increased risk*

Cited by 79 publications

References 36 publications

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: A metaanalysis of the literature

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report

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