Thermal Dye Measurements of Extravascular Lung Water in Critically III Patients: Intravascular Starling Forces and Extravascular Lung Water in the Adult Respiratory Distress Syndrome

doi:10.1378/chest.87.5.585

Chest

Volume 87, Issue 5, May 1985, Pages 585-592

https://doi.org/10.1378/chest.87.5.585 Get rights and content

To assess the concurrent influence on extravascular lung water (EVLW) content of the intravascular Starling forces, the pulmonary capillary wedge pressure (PCWP), and the colloid osmotic pressure (COP), we measured EVLW by the thermal green dye technique in 174 patients with and without radiographically defined pulmonary edema; in the former group, patients with cardiac (CPE) and noncardiac (NCPE) causes of pulmonary edema were compared (study A). In 119 patients, EVLW was again measured one to three days later (study B). Patients with CPE demonstrated a significantly lower EVLW (9.3 ± 3.9 ml/kg) (mean ± SD) than patients with NCPE (14.5 ± 4.9 ml/kg; p<0.05), despite a higher mean PCWP in the former group (20 ± 7 mm Hg) than in the latter (12 ± 6 mm Hg; p<0.05). In patients potentially with only a hydrostatic cause of pulmonary edema in study A, regression analysis demonstrated the following: EVLW = 3.2 + 0.30 PCWP (r² = 0.38; p<0.005); and in patients with NCPE, EVLW = 10.9 + 0.304 PCWP (r² = 0.17; p<0.01). In study B the change (△) in EVLW between the two studies was described as follows: △EVLW=-0.25 + 0.173 △PCWP (p<0.01) +0.663 group NCPE (p, not significant)+ 0.236 group NCPE × △PCWP (p<0.01). This latter equation indicated that the EVLW content manifested a greater change with concurrent alterations in the PCWP in patients with NCPE than was found in patients with only a hydrostatic influence to EVLW formation. Therefore, NCPE is characterized by a greater measurable thermal green dye EVLW than is observed in CPE at any given PCWP, and the PCWP synergistically influences EVLW accumulation in both CPE and NCPE.

Section snippets

Patient Population

We measured thermal green dye EVLW in 174 patients admitted to the Critical Care/Trauma Unit of Victoria Hospital (study A); in 119 of these patients, EVLW was again measured from one to three days (mean, 1.2 ± 1.6 days) after the initial measurement (study B). The ability to repeat EVLW measurements was defined only by the fact that in study B the thermal dye lung water catheter had been left in situ following the first measurement (study A). This thereby permitted an analysis of the influence

Study A

Retrospective analysis confirmed the prospective appropriateness of clinical designation to the different groups of patients (eg, groups 1 to 4) (Table 2). Group 2, the cardiac patients, demonstrated a lower mean cardiac index (Cl) and SVI, and a higher mean SVRI than the other three groups of patients. Similarly, both the mean PCWP and the calculated Pmv were greater in group 2 than in the other patient groups; since the calculated mean COP was similar between groups, the PCWP-COP gradient was

DISCUSSION

We have examined the influence of the intravascular Starling forces on EVLW content in patients with CPE and NCPE, when EVLW was measured by the thermal green dye technique. In addition to confirming the previously described influence⁸ of an increase in permeability of the pulmonary microvasculature on EVLW content, we also found in this study a positive association between the PCWP and EVLW content in patients with ARDS.

The term, ARDS, refers to a disease complex characterized by a primary

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Supported by Physicians Services Inc. Foundation and the Medical Research Council of Canada (M1I1A4).

Manuscript received August 24; revision accepted November 12.

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Chest

Thermal Dye Measurements of Extravascular Lung Water in Critically III Patients: Intravascular Starling Forces and Extravascular Lung Water in the Adult Respiratory Distress Syndrome

Section snippets

Patient Population

Study A

DISCUSSION

Chest

Clin Chest Med

J Surg Res

J Surg Res

Lung edema due to increased vascular permeability

Documentation of pulmonary capillary permeability in the adult respiratory distress syndrome accompanying human sepsis

Am Rev Respir Dis

Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients

Chest

Clinical correlates of the spectrum of lung microvascular injury in human noncardiac edema

Crit Care Med

Pulmonary microvascular clearance of radiotracers in human cardiac and non-cardiac pulmonary edema

J Appl Physiol

Bedside measurement of lung water

J Surg Res

Changes in lung water and capillary permeability following sepsis and fluid overload

J Surg Res

Correlations between the chest film and hemodynamics in acute myocardial infarction

Circulation

Effect of positive pressure breathing on lung lymph flow and water content in sheep

Circ Res

Pulmonary capillary pressure and filtration coefficient in the isolated perfused lung

Am J Physiol

Fluid and protein movement across the pulmonary microcirculation

Pulmonary wedge catheterization during positive end-expiratory pressure ventilation in the dog

Anesthesiology

The oxygen deficit of arterial blood caused by non ventilating parts of the lung

Acta Physiol Scan

An accurate and rapid method for the determination of protein in small amounts of blood, serum, and plasma

Am J Clin Pathol

Exchange of substances through capillary walls