Transpulmonary dilution-derived extravascular lung water as a measure of lung edema.

Transpulmonary dilution-derived extravascular lung water as a measure of lung edema.
Curr Opin Crit Care. 2007 Jun

Khan S,
Trof RJ,
Groeneveld AJ.
Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.

PURPOSE OF REVIEW: This review highlights current insights concerning the (measurement of) extravascular lung water as an index of pulmonary edema, by transpulmonary dilution techniques. The focus is on the applicability of the technique at the bedside in monitoring critically ill patients.

RECENT FINDINGS: Several (animal) studies have been performed to validate the technique by postmortem gravimetry in different conditions. Moreover, recent clinical data emphasize the utility of the thermodilution-derived extravascular lung water, its contribution to the clinical manifestations of acute lung injury/acute respiratory distress syndrome, its response to treatment aimed at edema prevention or resolution, and as a prognostic parameter.

SUMMARY: The thermodilution-derived extravascular lung water is a useful adjunct to assess lung vascular injury, cardiogenic edema and overhydration and to guide treatment in critically ill patients. The effects on morbidity and mortality of this approach need to be studied further.

PMID: 17468563 [PubMed - in process]

Inhaled nitric oxide does not prevent postpneumonectomy pulmonary edema in pigs

Inhaled nitric oxide does not prevent postpneumonectomy pulmonary edema in pigs
2007 The American Association for Thoracic Surgery

Marc Filaire, MDa, Elie Fadel, MDb, Benoît Decanteb, Frédéric Seccatoreb, Guy-Michel Mazmanian, MDb, Philippe Hervé, MDb,*
a CHU Clermont-Ferrand, Service de Chirurgie Générale et Thoracique, Hôpital Gabriel Montpied, and Université d’Auvergne, Laboratoire d’Anatomie, Clermont-Ferrand, Franceb Experimental Surgery Laboratory and Department of Thoracic and Vascular Surgery and Heart-Lung transplantation, Centre Chirurgical Marie Lannelongue, Paris-Sud University, Le Plessis-Robinson, France.

Received for publication May 11, 2006; revisions received July 22, 2006; accepted for publication September 5, 2006.

* Address for reprints: Philippe Hervé, MD, Centre Chirurgical Marie Lannelongue, Paris-Sud University, Le Plessis-Robinson, France. (Email: pherve@ccml.com)

Objective: Increase in lung permeability is an inevitable consequence of pneumonectomy in relation to inflammatory injury and increased perfusion flow. We tested whether inhaled nitric oxide, a potent vasodilatator and anti-inflammatory agent, prevents postpneumonectomy edema in the first 24 hours after pneumonectomy in pigs.

Methods: We assessed hemodynamics, gas exchange, extravascular lung water estimated with the double-indicator dilution method, and lung neutrophil sequestration measured on the basis of lung myeloperoxidase activity at 1 and 24 hours after left pneumonectomy in 14 pigs randomly assigned to inhaled nitric oxide (10 ppm) or control groups.

Results: Extravascular lung water content markedly increased at 1 and 24 hours after pneumonectomy, with no difference between the 2 groups. Hemodynamics did not differ between the 2 groups. Myeloperoxidase activity was higher and PaO 2 values were lower in the nitric oxide group compared with in the control group.

Conclusions: Over the 24 hours after pneumonectomy, intraoperative inhaled nitric oxide levels neither improved gas exchange nor attenuated accumulation of lung water. On the contrary, they were associated with an increase in lung neutrophil sequestration and deterioration of arterial oxygenation, suggesting the occurrence of an early and toxic effect of nitric oxide.

Abbreviations and Acronyms: CI = cardiac index; EVLW = extravascular lung water; FIO 2 = inspired oxygen fraction; MPAP = mean pulmonary artery pressure; MPO = myeloperoxidase; MSAP = mean systemic artery resistance; NO = nitric oxide; PBV = pulmonary blood volume; SVRI = indexed value of systemic vascular resistance