Limits...
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.

Kushimoto S, Taira Y, Kitazawa Y, Okuchi K, Sakamoto T, Ishikura H, Endo T, Yamanouchi S, Tagami T, Yamaguchi J, Yoshikawa K, Sugita M, Kase Y, Kanemura T, Takahashi H, Kuroki Y, Izumino H, Rinka H, Seo R, Takatori M, Kaneko T, Nakamura T, Irahara T, Saito N, Watanabe A, PiCCO Pulmonary Edema Study Gro - Crit Care (2012)

Bottom Line: The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO2 ratio ≤ 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals.Pulmonary edema was defined as EVLWI ≥ 10 ml/kg.UMIN-CTR ID UMIN000003627.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is characterized by features other than increased pulmonary vascular permeability. Pulmonary vascular permeability combined with increased extravascular lung water content has been considered a quantitative diagnostic criterion of ALI/ARDS. This prospective, multi-institutional, observational study aimed to clarify the clinical pathophysiological features of ALI/ARDS and establish its quantitative diagnostic criteria.

Methods: The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO2 ratio ≤ 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals. Pulmonary edema was defined as EVLWI ≥ 10 ml/kg. Three experts retrospectively determined the pathophysiological features of respiratory insufficiency by considering the patients' history, clinical presentation, chest computed tomography and radiography, echocardiography, EVLWI and brain natriuretic peptide level, and the time course of all preceding findings under systemic and respiratory therapy.

Results: Patients were divided into the following three categories on the basis of the pathophysiological diagnostic differentiation of respiratory insufficiency: ALI/ARDS, cardiogenic edema, and pleural effusion with atelectasis, which were noted in 207 patients, 26 patients, and 33 patients, respectively. EVLWI was greater in ALI/ARDS and cardiogenic edema patients than in patients with pleural effusion with atelectasis (18.5 ± 6.8, 14.4 ± 4.0, and 8.3 ± 2.1, respectively; P < 0.01). PVPI was higher in ALI/ARDS patients than in cardiogenic edema or pleural effusion with atelectasis patients (3.2 ± 1.4, 2.0 ± 0.8, and 1.6 ± 0.5; P < 0.01). In ALI/ARDS patients, EVLWI increased with increasing pulmonary vascular permeability (r = 0.729, P < 0.01) and was weakly correlated with intrathoracic blood volume (r = 0.236, P < 0.01). EVLWI was weakly correlated with the PaO2/FiO2 ratio in the ALI/ARDS and cardiogenic edema patients. A PVPI value of 2.6 to 2.85 provided a definitive diagnosis of ALI/ARDS (specificity, 0.90 to 0.95), and a value < 1.7 ruled out an ALI/ARDS diagnosis (specificity, 0.95).

Conclusion: PVPI may be a useful quantitative diagnostic tool for ARDS in patients with hypoxemic respiratory failure and radiographic infiltrates.

Trial registration: UMIN-CTR ID UMIN000003627.

Show MeSH

Related in: MedlinePlus

Extravascular lung water index and pulmonary vascular permeability index/intrathoracic blood volume correlation in non-ALI/ARDS patients. Correlation between extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) and that between EVLWI and intrathoracic blood volume (ITBV) in patients with non-acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). For this analysis, cardiogenic edema and pleural effusion with atelectasis patients were combined as non-ALI/ARDS. EVLWI had a moderate correlation with PVPI (r = 0.464, P < 0.01) (A) and with ITBV (r = 0.493, P < 0.01) (B). EVLWI-0, extravascular lung water index on the day of enrollment; PVPI-0, pulmonary vascular permeability index on the day of enrollment; ITBV-0, intrathoracic blood volume on the day of enrollment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3672621&req=5

Figure 5: Extravascular lung water index and pulmonary vascular permeability index/intrathoracic blood volume correlation in non-ALI/ARDS patients. Correlation between extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) and that between EVLWI and intrathoracic blood volume (ITBV) in patients with non-acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). For this analysis, cardiogenic edema and pleural effusion with atelectasis patients were combined as non-ALI/ARDS. EVLWI had a moderate correlation with PVPI (r = 0.464, P < 0.01) (A) and with ITBV (r = 0.493, P < 0.01) (B). EVLWI-0, extravascular lung water index on the day of enrollment; PVPI-0, pulmonary vascular permeability index on the day of enrollment; ITBV-0, intrathoracic blood volume on the day of enrollment.

Mentions: In the ALI/ARDS patients, a strong correlation between EVLWI and PVPI (r = 0.729, P < 0.01) and a weak correlation between EVLWI and ITBV (r = 0.236, P < 0.01) were noted on the day of enrollment (Figure 4). In the non-ALI/ARDS patients, moderate correlations between EVLWI and PVPI (r = 0.464, P < 0.01) and between EVLWI and ITBV (r = 0.493, P < 0.01) were noted (Figure 5).


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.

Kushimoto S, Taira Y, Kitazawa Y, Okuchi K, Sakamoto T, Ishikura H, Endo T, Yamanouchi S, Tagami T, Yamaguchi J, Yoshikawa K, Sugita M, Kase Y, Kanemura T, Takahashi H, Kuroki Y, Izumino H, Rinka H, Seo R, Takatori M, Kaneko T, Nakamura T, Irahara T, Saito N, Watanabe A, PiCCO Pulmonary Edema Study Gro - Crit Care (2012)

Extravascular lung water index and pulmonary vascular permeability index/intrathoracic blood volume correlation in non-ALI/ARDS patients. Correlation between extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) and that between EVLWI and intrathoracic blood volume (ITBV) in patients with non-acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). For this analysis, cardiogenic edema and pleural effusion with atelectasis patients were combined as non-ALI/ARDS. EVLWI had a moderate correlation with PVPI (r = 0.464, P < 0.01) (A) and with ITBV (r = 0.493, P < 0.01) (B). EVLWI-0, extravascular lung water index on the day of enrollment; PVPI-0, pulmonary vascular permeability index on the day of enrollment; ITBV-0, intrathoracic blood volume on the day of enrollment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672621&req=5

Figure 5: Extravascular lung water index and pulmonary vascular permeability index/intrathoracic blood volume correlation in non-ALI/ARDS patients. Correlation between extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) and that between EVLWI and intrathoracic blood volume (ITBV) in patients with non-acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). For this analysis, cardiogenic edema and pleural effusion with atelectasis patients were combined as non-ALI/ARDS. EVLWI had a moderate correlation with PVPI (r = 0.464, P < 0.01) (A) and with ITBV (r = 0.493, P < 0.01) (B). EVLWI-0, extravascular lung water index on the day of enrollment; PVPI-0, pulmonary vascular permeability index on the day of enrollment; ITBV-0, intrathoracic blood volume on the day of enrollment.
Mentions: In the ALI/ARDS patients, a strong correlation between EVLWI and PVPI (r = 0.729, P < 0.01) and a weak correlation between EVLWI and ITBV (r = 0.236, P < 0.01) were noted on the day of enrollment (Figure 4). In the non-ALI/ARDS patients, moderate correlations between EVLWI and PVPI (r = 0.464, P < 0.01) and between EVLWI and ITBV (r = 0.493, P < 0.01) were noted (Figure 5).

Bottom Line: The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO2 ratio ≤ 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals.Pulmonary edema was defined as EVLWI ≥ 10 ml/kg.UMIN-CTR ID UMIN000003627.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is characterized by features other than increased pulmonary vascular permeability. Pulmonary vascular permeability combined with increased extravascular lung water content has been considered a quantitative diagnostic criterion of ALI/ARDS. This prospective, multi-institutional, observational study aimed to clarify the clinical pathophysiological features of ALI/ARDS and establish its quantitative diagnostic criteria.

Methods: The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO2 ratio ≤ 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals. Pulmonary edema was defined as EVLWI ≥ 10 ml/kg. Three experts retrospectively determined the pathophysiological features of respiratory insufficiency by considering the patients' history, clinical presentation, chest computed tomography and radiography, echocardiography, EVLWI and brain natriuretic peptide level, and the time course of all preceding findings under systemic and respiratory therapy.

Results: Patients were divided into the following three categories on the basis of the pathophysiological diagnostic differentiation of respiratory insufficiency: ALI/ARDS, cardiogenic edema, and pleural effusion with atelectasis, which were noted in 207 patients, 26 patients, and 33 patients, respectively. EVLWI was greater in ALI/ARDS and cardiogenic edema patients than in patients with pleural effusion with atelectasis (18.5 ± 6.8, 14.4 ± 4.0, and 8.3 ± 2.1, respectively; P < 0.01). PVPI was higher in ALI/ARDS patients than in cardiogenic edema or pleural effusion with atelectasis patients (3.2 ± 1.4, 2.0 ± 0.8, and 1.6 ± 0.5; P < 0.01). In ALI/ARDS patients, EVLWI increased with increasing pulmonary vascular permeability (r = 0.729, P < 0.01) and was weakly correlated with intrathoracic blood volume (r = 0.236, P < 0.01). EVLWI was weakly correlated with the PaO2/FiO2 ratio in the ALI/ARDS and cardiogenic edema patients. A PVPI value of 2.6 to 2.85 provided a definitive diagnosis of ALI/ARDS (specificity, 0.90 to 0.95), and a value < 1.7 ruled out an ALI/ARDS diagnosis (specificity, 0.95).

Conclusion: PVPI may be a useful quantitative diagnostic tool for ARDS in patients with hypoxemic respiratory failure and radiographic infiltrates.

Trial registration: UMIN-CTR ID UMIN000003627.

Show MeSH
Related in: MedlinePlus