Quantitative Evaluation of Pulmonary Edema

Tagami, Takashi; Kushimoto, Shigeki

doi:10.1007/978-3-319-03746-2_20

Cited by 2 publications

(3 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The existence and severity of pulmonary edema are generally evaluated based on physical examination, patient history, laboratory examination, and chest radiographic findings [ 2 ]. However, the interpretation of these parameters, including chest X ray, is often affected by subjective factors that may cause interobserver error, even among experts [ 2 , 7 , 8 ▪▪ , 9 ▪▪ ]. Objective diagnosis of pulmonary edema can be made if EVLW is evaluated quantitatively at the bedside using the transpulmonary thermodilution (TPTD) technique [ 1 , 10 ] (Fig.…”

Section: Why Is There a Need To Evaluate Extravascular Lung Water Andmentioning

confidence: 99%

“…Even after the revision of the Berlin criteria, a recent autopsy study found that histopathologic findings of DAD were observed in only 45% of patients identified as having ARDS [ 20 ]. This means that more than half of the patients were suffering from a wide range of respiratory failure symptoms without having DAD [ 7 ].…”

Section: Why Is There a Need To Evaluate Extravascular Lung Water Andmentioning

confidence: 99%

“…Pulmonary vascular permeability index (PVPI) can be measured using the TPTD technique along with EVLW [ 1 , 21 ]. This information may help in assessing the severity of the disease and distinguishing the two types of pulmonary edema quantitatively, which may guide the selection of the correct therapeutic strategy [ 7 ].…”

Section: Why Is There a Need To Evaluate Extravascular Lung Water Andmentioning

confidence: 99%

See 2 more Smart Citations

Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when?

Tagami

Ong

2018

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of reviewIncrease in pulmonary vascular permeability accompanied with accumulation of excess extravascular lung water (EVLW) is the hallmark of acute respiratory distress syndrome (ARDS). Currently, EVLW and pulmonary vascular permeability index (PVPI) can be quantitatively measured using the transpulmonary thermodilution (TPTD) technique. We will clarify why, how, and when EVLW and PVPI measurements should be performed.Recent findingsAlthough the Berlin criteria of ARDS are simple and widely used, several criticisms of them have been published. The last 2 decades have witnessed the introduction and evolution of the TPTD technique for measuring EVLW and PVPI. Several publications have recommended to evaluate EVLW and the PVPI during the treatment of critically ill patients. Accurate and objective diagnoses can be made for ARDS patients using EVLW and PVPI. EVLW more than 10 ml/kg is a reasonable criterion for pulmonary edema, and EVLW more than 15 ml/kg for a severe condition. In addition to EVLW more than 10 mL/kg, PVPI more than three suggests increased vascular permeability (i.e., ARDS), and PVPI less than 2 represent normal vascular permeability (i.e., cardiogenic pulmonary edema).SummaryEVLW and PVPI measurement will open the door to future ARDS clinical practice and research, and have potential to be included in the future ARDS definition.

show abstract

Section: Why Is There a Need To Evaluate Extravascular Lung Water Andmentioning

confidence: 99%

Section: Why Is There a Need To Evaluate Extravascular Lung Water Andmentioning

confidence: 99%

Section: Why Is There a Need To Evaluate Extravascular Lung Water Andmentioning

confidence: 99%

See 1 more Smart Citation

Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when?

Tagami

Ong

2018

Current Opinion in Critical Care

View full text Add to dashboard Cite

show abstract

Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study

Tagami

Tosa²,

Omura³

et al. 2014

j intensive care

View full text Add to dashboard Cite

BackgroundNeutrophil elastase plays an important role in the development and progression of acute respiratory distress syndrome (ARDS). Although the selective elastase inhibitor, sivelestat, is widely used in Japan for treating ARDS patients, its effectiveness remains controversial. The aim of the current study was to investigate the effects of sivelestat in ARDS patients with evidence of increased extravascular lung water by re-analyzing a large multicenter study database.MethodsA post hoc analysis of the PiCCO Pulmonary Edema Study was conducted. This multicenter prospective cohort study included 23 institutions in Japan. Adult mechanically ventilated ARDS patients with an extravascular lung water index of >10 mL/kg were included and propensity score analyses were performed. The endpoints were 28-day mortality and ventilator-free days (VFDs).ResultsPatients were categorized into sivelestat (n = 87) and control (n = 77) groups, from which 329 inverse probability-weighted group patients (162 vs. 167) were generated. The overall 28-day mortality was 31.1% (51/164). There was no significant difference in 28-day mortality between the study groups (sivelestat vs. control; unmatched: 29.9% vs. 32.5%; difference, −2.6%, 95% confidence interval (CI), −16.8 to 14.2; inverse probability-weighted: 24.7% vs. 29.5%, difference, −4.8%, 95% CI, −14.4 to 9.6). Although administration of sivelestat did not alter the number of ventilator-free days (VFDs) in the unmatched (9.6 vs. 9.7 days; difference, 0.1, 95% CI, −3.0 to 3.1), the inverse probability-weighted analysis identified significantly more VFDs in the sivelestat group than in the control group (10.7 vs. 8.4 days, difference, −2.3, 95% CI, −4.4 to −0.2).ConclusionsAlthough sivelestat did not significantly affect 28-day mortality, this treatment may have the potential to increase VFDs in ARDS patients with increased extravascular lung water. Prospective randomized controlled studies are required to confirm the results of the current study.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-014-0067-y) contains supplementary material, which is available to authorized users.

show abstract

Quantitative Evaluation of Pulmonary Edema

Cited by 2 publications

References 57 publications

Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when?

Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when?

Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study

Contact Info

Product

Resources

About