title: Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water.
abstract: OBJECTIVE
  Pulmonary edema is a severe and often life-threatening condition. The diagnosis of pulmonary edema and its quantification have great clinical significance and yet can be difficult. A new technique based on thermodilution measurement using a single indicator has recently been developed (PiCCO, Pulsion Medical Systems, AG Germany). This method allows the measurement of extravascular lung water and thus can quantify degree of pulmonary edema. The technique has not been compared with a gold standard, gravimetric measurement of extravascular lung water. Therefore, the objective of this study was to determine the ability of extravascular lung water measurement with the PiCCO to reflect the extravascular lung water as measured with a gravimetric technique in a dog model of pulmonary edema.
  
  
  METHODS
  Prospective, randomized animal study.
  
  
  METHODS
  A university animal research laboratory.
  
  
  METHODS
  Fifteen mongrel dogs (n = 5/group) weighing 20-30 kg.
  
  
  METHODS
  The dogs were anesthetized and mechanically ventilated. Five dogs served as controls; in five dogs hydrostatic pulmonary edema was induced using inflation of a left atrial balloon combined with fluid administration to maintain a high pulmonary artery occlusion pressure; and in five dogs pulmonary edema was induced by intravenous injection of oleic acid. After a period of stabilization in a state of pulmonary edema, extravascular lung water was measured with the PiCCO monitor. The animals were then killed, and extravascular lung water was measured using a gravimetric technique.
  
  
  RESULTS
  There was a very close (r =.967, p <.001) relationship between transpulmonary thermodilution and gravimetric measurements. The measurement with the PiCCO was consistently higher, by 3.01 +/- 1.34 mL/kg, than the gravimetric measurement.
  
  
  CONCLUSIONS
  Measurement of extravascular lung water using transpulmonary thermodilution with a single indicator is very closely correlated with gravimetric measurement of lung water in both increased permeability and hydrostatic pulmonary edema.
authors.affiliation: Department of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Rita
authors.initials: R
authors.lastname: Katzenelson
authors.forename: Azriel
authors.initials: A
authors.lastname: Perel
authors.forename: Haiim
authors.initials: H
authors.lastname: Berkenstadt
authors.forename: Sergei
authors.initials: S
authors.lastname: Preisman
authors.forename: Samuel
authors.initials: S
authors.lastname: Kogan
authors.forename: Leonid
authors.initials: L
authors.lastname: Sternik
authors.forename: Eran
authors.initials: E
authors.lastname: Segal
mesh_terms: D000818:Animals; D004285:Dogs; D015633:Extravascular Lung Water; D019301:Oleic Acid / Q000633:toxicity; D011654:Pulmonary Edema / Q000139:chemically induced / Q000145:classification* / Q000175:diagnosis; D015203:Reproducibility of Results; D013815:Thermodilution / Q000379:methods
chemical_list: D019301:Oleic Acid