Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS.
OBJECTIVE
We studied the relationship, and the effect of fluid loading on this, between the ratio of extravascular lung water (EVLW) to intrathoracic/pulmonary blood volumes (ITBV, PBV) and the radionuclide pulmonary leak index (PLI) to protein during sepsis-induced acute lung injury/acute respiratory distress syndrome (ALI/ARDS).


METHODS
A prospective observational study, in the intensive care unit of a university hospital.


METHODS
Twenty-two consecutive mechanically ventilated patients with sepsis-related ALI/ARDS from pneumonia (n = 12) or extrapulmonary sources (n = 10), without elevated cardiac filling pressures.


METHODS
Crystalloid (1700-1800 ml) or colloid (1000-1800 ml) fluid loading until target filling pressures.


RESULTS
Protein permeability was assessed noninvasively over the lungs with help of 67Ga-labeled transferrin and 99mTc-labeled red blood cells (Pulmonary leak index, upper limit normal 14.1 x 10(-3)/min) and EVLW and blood volumes by the thermal-dye transpulmonary dilution technique before and after fluid loading. Prior to fluids the pulmonary leak index related to the ratio of EVLW/ITBV and EVLW/PBV (r(s) = 0.46) particularly when the pulmonary leak index was below 100 x 10(-3)/min and in extrapulmonary sepsis (PLI vs. EVLW/PBV r(s) = 0.71). Fluid loading did not alter EVLW, EVLW/ITBV, or EVLW/PBV or the relationship to PLI.


CONCLUSIONS
The data demonstrate that EVLW/ITBV or EVLW/PBV are imperfect measures of increased protein permeability in mechanically ventilated patients with sepsis-induced ALI/ARDS particularly when the PLI is severely increased and during pneumonia, independent of fluid status.
Groeneveld
A B Johan
AB
Department Intensive Care, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. johan.groeneveld@vumc.nl
Verheij
Joanne
J
D000368:Aged; D001810:Blood Volume; D019559:Capillary Leak Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D002199:Capillary Permeability; D004912:Erythrocytes; D015633:Extravascular Lung Water; D005260:Female; D005710:Gallium Radioisotopes / Q000493:pharmacokinetics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000503:physiopathology*; D012307:Risk Factors; D018805:Sepsis / Q000150:complications*; D017556:Technetium Compounds / Q000493:pharmacokinetics; D013815:Thermodilution; D014168:Transferrin / Q000493:pharmacokinetics
D005710:Gallium Radioisotopes; D009942:Organometallic Compounds; D017556:Technetium Compounds; D014168:Transferrin; C069724:gallium-transferrin complex