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Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients

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Abstract

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.

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References

  1. Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015;5:38. https://doi.org/10.1186/s13613-015-0081-9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Saugel B, Phillip V, Ernesti C, et al. Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients. J Crit Care. 2013;28:196–201. https://doi.org/10.1016/j.jcrc.2012.05.002.

    Article  PubMed  Google Scholar 

  3. Huber W, Mair S, Gotz SQ, et al. Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients. Intensive Care Med. 2013;39:146–50. https://doi.org/10.1007/s00134-012-2745-3.

    Article  PubMed  Google Scholar 

  4. Huber W, Hollthaler J, Schuster T, et al. Association between different indexations of extravascular lung water (EVLW) and PaO2/FiO2: a two-center study in 231 patients. PLoS ONE. 2014;9:e103854. https://doi.org/10.1371/journal.pone.0103854.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kor DJ, Warner DO, Carter RE, et al. Extravascular lung water and pulmonary vascular permeability index as markers predictive of postoperative acute respiratory distress syndrome: a prospective cohort investigation. Crit Care Med. 2015;43:665–73. https://doi.org/10.1097/ccm.0000000000000765.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

  9. Tagami T, Nakamura T, Kushimoto S, et al. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care. 2014;4:27. https://doi.org/10.1186/s13613-014-0027-7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kushimoto S, Endo T, Yamanouchi S, et al. Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition. Crit Care. 2013;17:R132. https://doi.org/10.1186/cc12811.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jozwiak M, Silva S, Persichini R, et al. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome. Crit Care Med. 2013;41:472–80. https://doi.org/10.1097/CCM.0b013e31826ab377.

    Article  PubMed  Google Scholar 

  12. Teboul JL, Saugel B, Cecconi M, et al. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med. 2016;42:1350–9. https://doi.org/10.1007/s00134-016-4375-7.

    Article  PubMed  Google Scholar 

  13. Monnet X, Anguel N, Osman D, Hamzaoui O, Richard C, Teboul JL. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med. 2007;33:448–53. https://doi.org/10.1007/s00134-006-0498-6.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med. 2001;164:1701–11. https://doi.org/10.1164/ajrccm.164.9.2103121.

    Article  CAS  PubMed  Google Scholar 

  16. Kuzkov VV, Suborov EV, Kirov MY, et al. Radiographic lung density assessed by computed tomography is associated with extravascular lung water content. Acta Anaesthesiol Scand. 2010;54:1018–26. https://doi.org/10.1111/j.1399-6576.2010.02272.x.

    Article  CAS  PubMed  Google Scholar 

  17. Saugel B, Holzapfel K, Stollfuss J, et al. Computed tomography to estimate cardiac preload and extravascular lung water. A retrospective analysis in critically ill patients. Scand J Trauma Resusc Emerg Med. 2011;19:31. https://doi.org/10.1186/1757-7241-19-31.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhang F, Li C, Zhang JN, Guo HP, Wu DW. Comparison of quantitative computed tomography analysis and single-indicator thermodilution to measure pulmonary edema in patients with acute respiratory distress syndrome. Biomed Eng Online. 2014;13:30. https://doi.org/10.1186/1475-925x-13-30.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Saugel B, Kirsche SV, Hapfelmeier A, et al. Prediction of fluid responsiveness in patients admitted to the medical intensive care unit. J Crit Care. 2013;28:537 e531-539. https://doi.org/10.1016/j.jcrc.2012.10.008.

    Article  Google Scholar 

  20. Saugel B, Phillip V, Gaa J, et al. Advanced hemodynamic monitoring before and after transjugular intrahepatic portosystemic shunt: implications for selection of patients: a prospective study. Radiology. 2012;262:343–52. https://doi.org/10.1148/radiol.11110043.

    Article  PubMed  Google Scholar 

  21. Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest. 2002;122:2080–6.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Tagami T, Kushimoto S, Yamamoto Y, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010;14:R162. https://doi.org/10.1186/cc9250.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dres M, Teboul JL, Guerin L, et al. Transpulmonary thermodilution enables to detect small short-term changes in extravascular lung water induced by a bronchoalveolar lavage. Crit Care Med. 2014;42:1869–73. https://doi.org/10.1097/ccm.0000000000000341.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  CAS  PubMed  Google Scholar 

  27. Gattinoni L, Marini JJ, Pesenti A, Quintel M, Mancebo J, Brochard L. The “baby lung” became an adult. Intensive Care Med. 2016;42:663–73. https://doi.org/10.1007/s00134-015-4200-8.

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. Bernd Saugel

    Present address: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

  2. Konstantin Holzapfel

    Present address: Institut für Radiologie, Krankenhaus Landshut-Achdorf, Landshut, Germany

  3. Bernd Saugel and Moritz Wildgruber contributed equally to the work.

Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany

    Bernd Saugel, Albrecht Staudt, Roland M. Schmid & Wolfgang Huber

  2. Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany

    Moritz Wildgruber, Michael Dieckmeyer, Konstantin Holzapfel & Georgios Kaissis

  3. Institut für Klinische Radiologie, Universitätsklinikum Münster, Münster, Germany

    Moritz Wildgruber

  4. Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia

    Mikhail Y. Kirov & Vsevolod V. Kuzkov

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  1. Bernd Saugel
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Corresponding author

Correspondence to Bernd Saugel.

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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).

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Written informed consent was obtained from all patients or their legal representatives.

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Saugel, B., Wildgruber, M., Staudt, A. et al. Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients. J Clin Monit Comput 33, 5–12 (2019). https://doi.org/10.1007/s10877-018-0144-1

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  • DOI: https://doi.org/10.1007/s10877-018-0144-1

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