Radioisotope albumin flux measurement of microvascular lung permeability: an independent parameter in acute respiratory failure?
OBJECTIVE
To evaluate the extent to which single measurements of microvascular lung permeability may be relevant as an additional parameter in a heterogenous clinical patient collective with Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS).


METHODS
In 36 patients with pneumonia (13), non pneumogenic sepsis (9) or trauma (14) meeting the consensus conference criteria of ALI or ARDS double-isotope protein flux measurements (51Cr erythrocytes as intravascular tracer, Tc-99m human albumin as diffusible tracer) of microvascular lung permeability were performed using the Normalized Slope Index (NSI). The examination was to determine whether there is a relationship between the clinical diagnosis of ALI/ARDS, impaired permeability and clinical parameters, that is the underlying disease, oxygenation, duration of mechanical ventilation and mean pulmonary-artery pressure (PAP).


RESULTS
At the time of study, 25 patients presented with increased permeability (NSI > 1 x 10(-3) min-1) indicating on exudative stage of disease, and 11 patients with normal permeability. The permeability impairment correlated with the underlying disease (p > 0.05). With respect to survival, there was a negative correlation to PAP (p < 0.01). Apart from that no correlations between the individual parameters were found. Especially no correlation was found between permeability impairment and oxygenation, duration of disease or PAP.


CONCLUSIONS
In ALI and ARDS, pulmonary capillary permeability is a diagnostic parameter which is independent from clinical variables. Permeability measurement makes a stage classification (exudative versus non exudative phase) of ALI/ARDS possible based on a measurable pathophysiological correlate.
Hoegerle
S
S
Division of Nuclear Medicine, Albert-Ludwigs-University, Freiburg, Germany. hoegerle@ukl.uni-freiburg.de
Benzing
A
A
Nitzsche
E U
EU
Moenting
J S
JS
Reinhardt
M J
MJ
Geiger
K
K
Moser
E
E
D000328:Adult; D001794:Blood Pressure; D002199:Capillary Permeability; D002860:Chromium Radioisotopes; D005260:Female; D006439:Hemodynamics; D006801:Humans; D055370:Lung Injury; D008297:Male; D008833:Microcirculation / Q000503:physiopathology*; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000503:physiopathology; D011651:Pulmonary Artery; D011652:Pulmonary Circulation / Q000502:physiology*; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018805:Sepsis / Q000000981:diagnostic imaging / Q000503:physiopathology; D013668:Technetium Tc 99m Aggregated Albumin
D002860:Chromium Radioisotopes; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin