Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS

• Published in: Intensive care medicine 2006-09, Vol.32 (9), p.1315-1321
• Main Authors: JOHAN GROENEVELD, A. B, VERHEIJ, Joanne
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood; Blood Volume; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Capillary Leak Syndrome - diagnosis; Capillary Leak Syndrome - physiopathology; Capillary Permeability; Edema; Emergency and intensive respiratory care; Erythrocytes; Extravascular Lung Water; Female; Gallium Radioisotopes - pharmacokinetics; Humans; Hypotension; Intensive care; Intensive care medicine; Intensive Care Units; Male; Medical sciences; Middle Aged; Organometallic Compounds; Permeability; Pneumonia; Prospective Studies; Proteins; Pulmonary arteries; Respiration, Artificial; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - physiopathology; Risk Factors; Sepsis; Sepsis - complications; Surgery; Technetium Compounds - pharmacokinetics; Thermodilution; Transferrin - pharmacokinetics; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-006-0212-8

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). A prospective observational study, in the intensive care unit of a university hospital. 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. Crystalloid (1700-1800 ml) or colloid (1000-1800 ml) fluid loading until target filling pressures. 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. 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.