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Erschienen in:
01.09.2006 | Original
Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS
Erschienen in: Intensive Care Medicine | Ausgabe 9/2006
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Objective
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).
Design and setting
A prospective observational study, in the intensive care unit of a university hospital.
Patients
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.
Intervention
Crystalloid (1700–1800 ml) or colloid (1000–1800 ml) fluid loading until target filling pressures.
Measurements and results
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 × 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 × 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.
Conclusion
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.