Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury

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Abstract

Objective:

To find out if the extravascular lung water index (EVLWI) and the derived permeability indexes determined by the single transpulmonary thermodilution technique are associated with markers of acute lung injury in human septic shock.

Design:

Prospective, observational study.

Setting:

Mixed intensive care unit of a 900-bed university hospital.

Patients:

Thirty-eight consecutive adult patients with septic shock and acute lung injury.

Interventions:

None.

Measurements and Main Results:

The variables were assessed over a 72-hr period and included hemodynamics, EVLWI, and pulmonary vascular permeability indexes determined with the single indicator transpulmonary thermodilution technique, lung compliance, oxygenation ratio (Pao2/Fio2), lung injury score, cell counts, and the plasma concentration of endothelin-1. At day 1, EVLWI was elevated (≥7 mL/kg) in 28 (74%) patients and correlated with lung compliance (r = −.48, p = .002), Pao2/Fio2 (r = −.50, p = .001), lung injury score (r = .46, p = .004), roentgenogram quadrants (r = .39, p = .02), and platelet count (r = −.43, p = .007). At day 3, EVLWI correlated with compliance (r = −.51, p = .002), Pao2/Fio2 (r = −.49, p = .006), and lung injury score (r = .53, p = .003). At day 3, EVLWI and pulmonary vascular permeability indexes were higher in nonsurvivors (p< .05). The plasma concentration of endothelin-1 (mean ± sd) was significantly higher in patients with elevated EVLWI (≥7 mL/kg) (3.85 ± 1.40 vs. 2.07 ± 0.38 pg/mL, respectively). Twenty-two (59%) patients died before day 28.

Conclusions:

In human septic shock, EVLWI demonstrated moderate correlation with markers of acute lung injury, such as lung compliance, oxygenation ratio, roentgenogram quadrants, and lung injury score. In nonsurvivors, EVLWI and permeability indexes were significantly increased at day 3. Thus, EVLWI might be of value as an indicator of prognosis and severity of sepsis-induced acute lung injury.

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