Detecting lung injury in patients with pulmonary edema.
OBJECTIVE
Current entry rules for clinical trials of acute lung injury (ALI) depend on clinical criteria and arterial blood gas measurements. The objective of this study was to determine whether estimates of pulmonary vascular permeability could be used to more accurately identify patients with ALI for this purpose.


METHODS
Cross-sectional study in a university hosptial in a large metropolitan city.


METHODS
21 patients with noncardiogenic pulmonary edema, 7 patients with hydrostatic forms of pulmonary edema, and 10 healthy volunteers.


METHODS
Positron emission tomographic (PET) imaging with (68)Ga-labeled transferrin, or gamma-camera scintigraphy (gamma-S) with (99m)Tc-labeled albumin. All patients were studied within 24 h of onset, and all were selected exclusively on the basis of radiographic, not clinical, criteria. PET estimates of PTCER were used as a "gold standard."


RESULTS
Radioactivity data were analyzed to compute the pulmonary transcapillary escape rate (PTCER) and the normalized slope index. PTCER by gamma-S was more strongly correlated to PTCER(PET) than normalized slope index by gamma-S. Although PTCER(gamma) was significantly correlated with PaO2/FIO2, it did not distinguish patients with noncardiogenic pulmonary edema from those with hydrostatic pulmonary edema.


CONCLUSIONS
These data cast doubt on whether the gamma-S method can be used as a screening tool in clinical trials of ALI.
Schuster
Daniel P
DP
Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 631110, USA. schusted@msnotes.wustl.edu
Stark
Timothy
T
Stephenson
Jason
J
Royal
Henry
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002199:Capillary Permeability; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000150:complications* / Q000503:physiopathology; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014055:Tomography, Emission-Computed