Transpulmonary Thermodilution: Its Role in Assessment of Lung Water and Pulmonary Edema

Assaad, Sherif; Shelley, Benjamin; Perrino, Albert C.

doi:10.1053/j.jvca.2017.02.018

Cited by 16 publications

(16 citation statements)

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“…Several factors have been identified e.g. fluid overload, systemic inflammatory response to surgery, myocardial ischemia, blood product transfusion, etc., all of which contribute to increased fluid transudation and accumulation of extravascular lung water 3 . Management strategies directed at avoiding excessive fluid administration (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Pulmonary Edema: Principles and Practice

Assaad

Kratzert

Shelley

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

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Pulmonary edema increasingly is recognized as a perioperative complication affecting outcome. Several risk factors have been identified, including those of cardiogenic origin, such as heart failure or excessive fluid administration, and those related to increased pulmonary capillary permeability secondary to inflammatory mediators. Effective treatment requires prompt diagnosis and early intervention. Consequently, over the past 2 centuries a concentrated effort to develop clinical tools to rapidly diagnose pulmonary edema and track response to treatment has occurred. The ideal properties of such a tool would include high sensitivity and specificity, easy availability, and the ability to diagnose early accumulation of lung water before the development of the full clinical presentation. In addition, clinicians highly value the ability to precisely quantify extravascular lung water accumulation and differentiate hydrostatic from high permeability etiologies of pulmonary edema. In this review, advances in understanding the physiology of extravascular lung water accumulation in health and in disease and the various mechanisms that protect against the development of pulmonary edema under physiologic conditions are discussed. In addition, the various bedside modalities available to diagnose early accumulation of extravascular lung water and pulmonary edema, including chest auscultation, chest roentgenography, lung ultrasonography, and transpulmonary thermodilution, are examined. Furthermore, advantages and limitations of these methods for the operating room and intensive care unit that are critical for proper modality selection in each individual case are explored.

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Section: Introductionmentioning

confidence: 99%

“…The calculation of EVLW using the TPTD method is beyond the scope of this review. A detailed review of this technique is available in our previous publication3 . As such, clinical measurement of EVLW reflects a morphologic correlate of pulmonary edema83 .…”

mentioning

confidence: 99%

Assessment of Pulmonary Edema: Principles and Practice

Assaad

Kratzert

Shelley

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

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“…As for the choice of monitoring system, clinicians must be aware of the most appropriate modality for each clinical situation, according to the system's advantages and limitations. With regard to quantifying pulmonary edema, the measurement of EVLWI can provide early B C A detection of lung water accumulation, to more optimally guide fluid therapy by differentiating hydrostatic versus increased pulmonary capillary permeability (2), as in this case. Measured EVLWI that is utilized in managing fluid balance in ARDS (10,11) has shown lower cumulative fluid balance, decreased ICU mortality (12), reduced duration of mechanical ventilation, and shorter length of ICU stay (13).…”

Section: Discussionmentioning

confidence: 99%

“…Various monitoring systems are being developed and are available, in addition to conventional hemodynamic variables. The pulse contour analysis (PCA) and indicator dilution techniques [e.g., transpulmonary thermodilution (TPTD)] were introduced in the early 2000s (2). These advanced monitoring systems provide variables such as cardiac output (CO), stroke volume variation (SVV), pulmonary vascular permeability index (PVPI), and global end-diastolic volume (GEDV) using techniques that are less invasive than pulmonary artery catheterization (PAC).…”

Section: Introductionmentioning

confidence: 99%

Are management decisions in critical patients changed with use of hemodynamic parameters from transpulmonary thermodilution technique?

2019

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Background: The assessment of hemodynamic variables is a mainstay in the management of critically ill patients. Hemodynamic variables may help physicians to choose among use of a vasopressor, an inotropic agent, or discontinuation of drugs. In this study, we aimed to investigate the usefulness of advanced hemodynamic variables in clinical decision-making. Methods: Surveys regarding the case were administered to 25 surgeons working in nationally designated trauma centers or on trauma teams, using a voting system at a medical conference. The patient was a 67-year-old male with a crush injury of the left leg after a pedestrian traffic accident, who had aggravated pulmonary edema after leg amputation. Three clinical situations were given and the decision choices were: immediately after amputation, in 8 hours, and on the second day after amputation. Three kinds of variables from hemodynamic monitoring systems were provided for each clinical situation: conventional hemodynamic variables, including central venous pressure; variables from pulse contour analysis (PCA) [cardiac output (CO), stroke volume index, stroke volume variation (SVV), and systemic vascular resistance index); and variables from transpulmonary thermodilution (TPTD) technique (global ejection fraction and extravascular lung water index). The changes in decisions according to each provided hemodynamic variable were investigated and analyzed. Results: The advanced hemodynamic parameters were considered to have a decisive effect on choosing vasopressors and inotropic agents. The decision was changed in 88% (22/25) of physicians using variables from the advanced monitoring systems. Among them, 82% (18/22) of physicians chose hemodynamic variables from the TPTD technique as their reason for change regarding management of a patient with severe pulmonary edema. Conclusions: Advanced monitoring systems might be helpful in decision-making for critically ill patients. Multiple parameters and trends in change could be more important than a single value. Clinicians should select the system most appropriate according to its advantages and limitations, and interpret the variables obtained correctly.

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“…6 Recently, the transpulmonary thermodilution (TPTD) technique, as used by the PiCCO2 monitor and others, has been added to the monitoring armamentarium to provide a panoramic portrayal of the patient's cardiopulmonary status. 7 TPTD affords a means to assess both static and dynamic volumetric status, continuous cardiac index, and, uniquely, a measure of extravascular lung water as an indicator of early development of pulmonary edema.…”

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confidence: 99%