Extravascular lung water measurement using transpulmonary thermodilution in children.
OBJECTIVE
Measurement of extravascular lung water (EVLW) may be useful in the treatment of critically ill children and can be performed at the bedside using the transpulmonary thermodilution technique (TPTD). There are currently no data to verify the accuracy of these measurements in (small) children. We compared the results of TPTD measurement with the clinical gold standard transpulmonary double indicator dilution (TPDD) measurement in young children.


METHODS
Prospective clinical study in children.


METHODS
Catheterization laboratory of a university hospital.


METHODS
Twelve children (<2 yrs or <12 kg) under general anesthesia.


METHODS
None.


RESULTS
Measurements were performed using injections of ice-cold indicator (saline or dye) through a central venous catheter. Mean cardiac index was 3.91 L/min/m, mean intrathoracic blood volume index (ITBVITPDD) was 614.9 mL/m, and mean extravascular lung water index (EVLWITPDD) was 11.7 mL/kg. The correlation coefficient between EVLWITPDD and EVLWITPTD is 0.96 (95% confidence interval: 0.87-0.99; p < 0.0001). Bland-Altman analysis for EVLW measurements showed a mean bias of 2.34 mL/kg (18.13%) and limits of agreement +/-2.97 mL/kg (19.78%). The difference between measurements via the right atrium compared with the femoral vein was 2.8% for cardiac output, 8.2% for global end-diastolic volume, and 0.1% for EVLW.


CONCLUSIONS
Clinical measurement of EVLW in young children can be performed using the TPTD with the injection catheter inserted in the femoral vein. Further studies are needed to clarify the clinical value of these measurements.
Lemson
Joris
J
Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. j.lemson@ic.umcn.nl
Backx
Ad P
AP
van Oort
Anton M
AM
Bouw
Tijn P W J M
TP
van der Hoeven
Johannes G
JG
D001834:Body Water; D006328:Cardiac Catheterization; D006801:Humans; D007223:Infant; D008168:Lung / Q000378:metabolism*; D011446:Prospective Studies; D013815:Thermodilution / Q000379:methods*