Transpulmonary thermodilution enables to detect small short-term changes in extravascular lung water induced by a bronchoalveolar lavage.
OBJECTIVE
To take the opportunity of a bronchoalveolar lavage to challenge the transpulmonary thermodilution for detecting the time course of changes in extravascular lung water.


METHODS
Observational study.


METHODS
Medical ICU.


METHODS
Mechanically ventilated patients in whom a bronchoalveolar lavage by bronchoscopy was performed.


METHODS
Transpulmonary thermodilution before and after bronchoalveolar lavage.


RESULTS
Before and at different times after bronchoalveolar lavage, transpulmonary thermodilution was performed to record the value of indexed extravascular lung water. For each measurement, the values of three thermodilution measurements were averaged at the following steps: before bronchoalveolar lavage, after bronchoalveolar lavage, and 1 hour, 2 hours, 4 hours, and 6 hours after bronchoalveolar lavage. The amount of saline infusion left in the lungs after bronchoalveolar lavage was also recorded. Twenty-five patients with suspicion of pneumonia were included. Twenty-eight bronchoalveolar lavages were finally analyzed. On average, 200 mL (180-200 mL) of saline were injected and 130 mL (100-160 mL) were left in the lungs. Between before and immediately after bronchoalveolar lavage, indexed extravascular lung water significantly increased from 12 ± 4 to 15 ± 5 mL/kg, respectively, representing a 169 ± 166 mL increase in nonindexed extravascular lung water. After bronchoalveolar lavage, the value of indexed extravascular lung water was significantly different from the baseline value until 2 hours after bronchoalveolar lavage and became similar to the baseline value thereafter.


CONCLUSIONS
Transpulmonary thermodilution enabled to detect small short-term changes of indexed extravascular lung water secondary to bronchoalveolar lavage.
1EA4533, Université Paris-Sud, Le Kremlin-Bicêtre, France. 2Service de réanimation médicale, Hôpital de Bicêtre, Hôpitaux universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
Martin
M
Dres
Jean-Louis
JL
Teboul
Laurent
L
Guerin
Nadia
N
Anguel
Virginie
V
Amilien
Marie-Philippine
MP
Clair
Aurélie
A
Grüner
Christian
C
Richard
Xavier
X
Monnet
D000368:Aged; D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods*; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000209:etiology*; D012121:Respiration, Artificial; D013815:Thermodilution / Q000379:methods; D013997:Time Factors