Intensive Care Medicine

, Volume 33, Issue 3, pp 448–453 | Cite as

Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS

  • Xavier Monnet
  • Nadia Anguel
  • David Osman
  • Olfa Hamzaoui
  • Christian Richard
  • Jean-Louis Teboul
Original

Abstract

Objective

To test whether assessing pulmonary permeability by transpulmonary thermodilution enables to differentiate increased permeability pulmonary edema (ALI/ARDS) from hydrostatic pulmonary edema.

Design

Retrospective review of cases.

Setting

A 24-bed medical intensive care unit of a university hospital.

Patients

Forty-eight critically ill patients ventilated for acute respiratory failure with bilateral infiltrates on chest radiograph, a PaO2/FiO2 ratio < 300 mmHg and extravascular lung water indexed for body weight ≥ 12 ml/kg.

Intervention

We assessed pulmonary permeability by two indexes obtained from transpulmonary thermodilution: extravascular lung water/pulmonary blood volume (PVPI) and the ratio of extravascular lung water index over global end-diastolic volume index. The cause of pulmonary edema was determined a posteriori by three experts, taking into account medical history, clinical features, echocardiographic left ventricular function, chest radiography findings, B-type natriuretic peptide serum concentration and the time-course of these findings with therapy. Experts were blind for pulmonary permeability indexes and for global end-diastolic volume.

Measurements and results

ALI/ARDS was diagnosed in 36 cases. The PVPI was 4.7 ± 1.8 and 2.1 ± 0.5 in patients with ALI/ARDS and hydrostatic pulmonary edema, respectively (p < 0.05). The extravascular lung water index/global end-diastolic volume index ratio was 3.0 × 10−2 ± 1.2 × 10−2 and 1.4 × 10−2 ± 0.4 × 10−2 in patients with ALI/ARDS and with hydrostatic pulmonary edema, respectively (p < 0.05). A PVPI ≥ 3 and an extravascular lung water index/global end-diastolic index ratio ≥ 1.8 × 10−2 allowed the diagnosis of ALI/ARDS with a sensitivity of 85% and specificity of 100%.

Conclusion

These results suggest that indexes of pulmonary permeability provided by transpulmonary thermodilution may be useful for determining the mechanism of pulmonary edema in the critically ill.

Keywords

Pulmonary permeability index ARDS Pulmonary edema Transpulmonary thermodilution 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Xavier Monnet
    • 1
  • Nadia Anguel
    • 1
  • David Osman
    • 1
  • Olfa Hamzaoui
    • 1
  • Christian Richard
    • 1
  • Jean-Louis Teboul
    • 1
  1. 1.Service de réanimation médicaleCentre hospitalier universitaire de BicêtreLe Kremlin-BicêtreFrance

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