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Journal of Clinical Monitoring and Computing

, Volume 33, Issue 1, pp 5–12 | Cite as

Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients

  • Bernd Saugel
  • Moritz Wildgruber
  • Albrecht Staudt
  • Michael Dieckmeyer
  • Konstantin Holzapfel
  • Georgios Kaissis
  • Mikhail Y. Kirov
  • Vsevolod V. Kuzkov
  • Roland M. Schmid
  • Wolfgang Huber
Original Research

Abstract

Extravascular lung water (index) (EVLW(I)) can be estimated using transpulmonary thermodilution (TPTD). Computed tomography (CT) with quantitative analysis of lung tissue density has been proposed to quantify pulmonary edema. We compared variables of pulmonary fluid status assessed using quantitative CT and TPTD in critically ill patients. In 21 intensive care unit patients, we performed TPTD measurements directly before and after chest CT. Based on the density data of segmented CT images we calculated the tissue volume (TV), tissue volume index (TVI), and the mean weighted index of voxel aqueous density (VMWaq). CT-derived TV, TVI, and VMWaq did not predict TPTD-derived EVLWI values ≥ 14 mL/kg. There was a significant moderate positive correlation between VMWaq and mean EVLWI (EVLWI before and after CT) (r = 0.45, p = 0.042) and EVLWI after CT (r = 0.49, p = 0.025) but not EVLWI before CT (r = 0.38, p = 0.086). There was no significant correlation between TV and EVLW before CT, EVLW after CT, or mean EVLW. There was no significant correlation between TVI and EVLWI before CT, EVLWI after CT, or mean EVLWI. CT-derived variables did not predict elevated TPTD-derived EVLWI values. In unselected critically ill patients, variables of pulmonary fluid status assessed using quantitative CT cannot be used to predict EVLWI.

Keywords

Extravascular lung water Pulmonary vascular permeability Tissue volume Pulmonary edema 

Notes

Compliance with ethical standards

Conflict of interest

Bernd Saugel, Mikhail Kirov, and Wolfgang Huber collaborate with Pulsion Medical Systems SE (Feldkirchen, Germany) as members of the Medical Advisory Board and have received honoraria for giving lectures and refunds of travel expenses from Pulsion Medical Systems SE. All other authors have no conflict of interest to disclose.

Research involving human participants and/or animals

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee (Ethikkommission der Fakultät für Medizin der Technischen Universität München).

Informed consent

Written informed consent was obtained from all patients or their legal representatives.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Bernd Saugel
    • 1
    • 2
  • Moritz Wildgruber
    • 3
    • 4
  • Albrecht Staudt
    • 1
  • Michael Dieckmeyer
    • 3
  • Konstantin Holzapfel
    • 3
    • 5
  • Georgios Kaissis
    • 3
  • Mikhail Y. Kirov
    • 6
  • Vsevolod V. Kuzkov
    • 6
  • Roland M. Schmid
    • 1
  • Wolfgang Huber
    • 1
  1. 1.II. Medizinische Klinik und PoliklinikKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany
  2. 2.Department of Anesthesiology, Center of Anesthesiology and Intensive Care MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Institut für diagnostische und interventionelle RadiologieKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany
  4. 4.Institut für Klinische RadiologieUniversitätsklinikum MünsterMünsterGermany
  5. 5.Institut für RadiologieKrankenhaus Landshut-AchdorfLandshutGermany
  6. 6.Department of Anesthesiology and Intensive Care MedicineNorthern State Medical UniversityArkhangelskRussia

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