Abstract
OBJECTIVE: We studied the relationship, and the effect of fluid loading on this, between the ratio of extravascular lung water (EVLW) to intrathoracic/pulmonary blood volumes (ITBV, PBV) and the radionuclide pulmonary leak index (PLI) to protein during sepsis-induced acute lung injury/acute respiratory distress syndrome (ALI/ARDS).
DESIGN AND SETTING: A prospective observational study, in the intensive care unit of a university hospital.
PATIENTS: Twenty-two consecutive mechanically ventilated patients with sepsis-related ALI/ARDS from pneumonia (n = 12) or extrapulmonary sources (n = 10), without elevated cardiac filling pressures.
INTERVENTION: Crystalloid (1700-1800 ml) or colloid (1000-1800 ml) fluid loading until target filling pressures.
MEASUREMENTS AND RESULTS: Protein permeability was assessed noninvasively over the lungs with help of 67Ga-labeled transferrin and 99mTc-labeled red blood cells (Pulmonary leak index, upper limit normal 14.1 x 10(-3)/min) and EVLW and blood volumes by the thermal-dye transpulmonary dilution technique before and after fluid loading. Prior to fluids the pulmonary leak index related to the ratio of EVLW/ITBV and EVLW/PBV (r(s) = 0.46) particularly when the pulmonary leak index was below 100 x 10(-3)/min and in extrapulmonary sepsis (PLI vs. EVLW/PBV r(s) = 0.71). Fluid loading did not alter EVLW, EVLW/ITBV, or EVLW/PBV or the relationship to PLI.
CONCLUSION: The data demonstrate that EVLW/ITBV or EVLW/PBV are imperfect measures of increased protein permeability in mechanically ventilated patients with sepsis-induced ALI/ARDS particularly when the PLI is severely increased and during pneumonia, independent of fluid status.
Original language | English |
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Pages (from-to) | 1315-21 |
Number of pages | 7 |
Journal | Intensive care medicine |
Volume | 32 |
Issue number | 9 |
DOIs | |
Publication status | Published - Sept 2006 |
Keywords
- Aged
- Blood Volume
- Capillary Leak Syndrome/diagnosis
- Capillary Permeability
- Erythrocytes
- Extravascular Lung Water
- Female
- Gallium Radioisotopes/pharmacokinetics
- Humans
- Intensive Care Units
- Male
- Middle Aged
- Organometallic Compounds
- Prospective Studies
- Respiration, Artificial
- Respiratory Distress Syndrome/etiology
- Risk Factors
- Sepsis/complications
- Technetium Compounds/pharmacokinetics
- Thermodilution
- Transferrin/pharmacokinetics