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.
Extravascular lung water Pulmonary vascular permeability Tissue volume Pulmonary edema
This is a preview of subscription content, log in to check access.
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).
Written informed consent was obtained from all patients or their legal representatives.
Kushimoto S, Taira Y, Kitazawa Y, et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome. Crit Care. 2012;16:R232. https://doi.org/10.1186/cc11898.CrossRefGoogle Scholar
Garutti I, Sanz J, Olmedilla L, et al. Extravascular lung water and pulmonary vascular permeability index measured at the end of surgery are independent predictors of prolonged mechanical ventilation in patients undergoing liver transplantation. Anesth Analg. 2015;121:736–45. https://doi.org/10.1213/ane.0000000000000875.CrossRefGoogle Scholar
Wang H, Cui N, Su L, et al. (2016) Prognostic value of extravascular lung water and its potential role in guiding fluid therapy in septic shock after initial resuscitation. J Crit Care10.1016/j.jcrc.2016.02.011.Google Scholar
Morisawa K, Fujitani S, Taira Y, et al. Difference in pulmonary permeability between indirect and direct acute respiratory distress syndrome assessed by the transpulmonary thermodilution technique: a prospective, observational, multi-institutional study. J Intensive Care. 2014;2:24. https://doi.org/10.1186/2052-0492-2-24.CrossRefGoogle Scholar
Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest. 2002;122:2080–6.CrossRefGoogle Scholar
Patroniti N, Bellani G, Maggioni E, Manfio A, Marcora B, Pesenti A. Measurement of pulmonary edema in patients with acute respiratory distress syndrome. Crit Care Med. 2005;33:2547–54.CrossRefGoogle Scholar
Fernandez-Mondejar E, Rivera-Fernandez R, Garcia-Delgado M, Touma A, Machado J, Chavero J. Small increases in extravascular lung water are accurately detected by transpulmonary thermodilution. J Trauma. 2005;59:1420–3. discussion 1424.CrossRefGoogle Scholar
Sakka SG, Ruhl CC, Pfeiffer UJ, et al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000;26:180–7.CrossRefGoogle Scholar