Effect of crystalloid resuscitation and inhalation injury on extravascular lung water: clinical implications.
OBJECTIVE
Arterial thermal dilution with an integrated fiberoptic monitoring system (COLD Z-021; Pulsion Medical Systems; Munich, Germany) allows measurement of extravascular lung water (EVLW) and pulmonary permeability index (PPI). The aim of this study was to evaluate the widespread clinical assumption that early respiratory failure following burn and inhalation injury is due to interstitial fluid accumulation in the lung.


METHODS
Clinical, prospective study.


METHODS
ICU of a university referral center of burn care.


METHODS
Thirty-five severely burned adults (> 20% of body surface area).


METHODS
Resuscitation therapy was guided by the results of hemodynamic monitoring using the intrathoracic blood volume (ITBV) as a cardiac preload indicator. The resuscitation goals included a normalization of preload (ITBV > 850 mL/m(2)) and cardiac index (> 3.5 L/min/m(2)) within 24 h after ICU admission. Fluid loading was implemented to reach these goals.


RESULTS
One hundred forty lung water measurements were performed at 0 h, 12 h, 24 h, and 48 h after admission to the ICU. Significant elevation of EVLW and PPI was found in three measurements (2%) at 48 h after ICU admission, and was in one patient associated with inhalation injury. EVLW and PPI were not significantly different between patients with and without inhalation injury. No correlation was found between resuscitation volume and EVLW (r(2) = 0.02) or between the alveolar-arterial oxygen pressure difference and EVLW (r(2) = 0.017). Chest radiograph abnormalities were found in 2 of 22 patients with inhalation injury; these were not associated with increased values of EVLW.


CONCLUSIONS
Early fluid accumulation in the lung in burned patients is very uncommon, even in the presence of inhalation injury. There is no evidence that thermal injury causes an increase in pulmonary capillary membrane permeability.
Holm
Charlotte
C
Department of Plastic and Handsurgery, Burn Unit, Klinikum Bogenhausen, Technical University Munich, Munich, Germany. wmuehlbauer@t-online.de
Tegeler
Julia
J
Mayr
Martina
M
Pfeiffer
Ullrich
U
Henckel von Donnersmarck
Guido
G
Mühlbauer
Wolfgang
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D002059:Burns, Inhalation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003102:Colloids; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology; D012151:Resuscitation
D003102:Colloids