Reproducibility of Transpulmonary Thermodilution Measurements in Patients With Burn Shock and Hypothermia

Abstract Background In acute respiratory distress syndrome (ARDS), extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) measured by transpulmonary thermodilution reflect the degree of lung injury. Whether EVLWi and PVPI are different between non-COVID-19 ARDS and the ARDS due to COVID-19 has never been reported. We aimed at comparing EVLWi, PVPI, respiratory mechanics and hemodynamics in patients with COVID-19 ARDS vs. ARDS of other origin. Methods Between March and October 2020, in an observational study conducted in intensive care units from three university hospitals, 60 patients with COVID-19-related ARDS monitored by transpulmonary thermodilution were compared to the 60 consecutive non-COVID-19 ARDS admitted immediately before the COVID-19 outbreak between December 2018 and February 2020. Results Driving pressure was similar between patients with COVID-19 and non-COVID-19 ARDS, at baseline as well as during the study period. Compared to patients without COVID-19, those with COVID-19 exhibited higher EVLWi, both at the baseline (17 (14–21) vs. 15 (11–19) mL/kg, respectively, p = 0.03) and at the time of its maximal value (24 (18–27) vs. 21 (15–24) mL/kg, respectively, p = 0.01). Similar results were observed for PVPI. In COVID-19 patients, the worst ratio between arterial oxygen partial pressure over oxygen inspired fraction was lower (81 (70–109) vs. 100 (80–124) mmHg, respectively, p = 0.02) and prone positioning and extracorporeal membrane oxygenation (ECMO) were more frequently used than in patients without COVID-19. COVID-19 patients had lower maximal lactate level and maximal norepinephrine dose than patients without COVID-19. Day-60 mortality was similar between groups (57% vs. 65%, respectively, p = 0.45). The maximal value of EVLWi and PVPI remained independently associated with outcome in the whole cohort. Conclusion Compared to ARDS patients without COVID-19, patients with COVID-19 had similar lung mechanics, but higher EVLWi and PVPI values from the beginning of the disease. This was associated with worse oxygenation and with more requirement of prone positioning and ECMO. This is compatible with the specific lung inflammation and severe diffuse alveolar damage related to COVID-19. By contrast, patients with COVID-19 had fewer hemodynamic derangement. Eventually, mortality was similar between groups. Trial registration number and date of registration ClinicalTrials.gov (NCT04337983). Registered 30 March 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04337983.

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Validation of cardiac output monitoring using radial artery waveform with transpulmonary thermodilution technique during off-pump coronary artery bypass grafting

European Journal of Anaesthesiology ◽

10.1097/00003643-201306001-00143 ◽

2013 ◽

Vol 30 ◽

pp. 46-47

Author(s):

A. Hussain ◽

V. Zakharov ◽

A. Smetkin ◽

V. Kuzkov ◽

M. Kirov

Keyword(s):

Cardiac Output ◽

Transpulmonary Thermodilution ◽

Artery Bypass ◽

Cardiac Output Monitoring ◽

Bypass Grafting ◽

Thermodilution Technique ◽

Off Pump ◽

Transpulmonary Thermodilution Technique ◽

Output Monitoring ◽

Pump Coronary Artery Bypass

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Pediatric burn resuscitation: past, present, and future

Burns & Trauma ◽

10.1186/s41038-017-0091-y ◽

2017 ◽

Vol 5 ◽

Cited By ~ 15

Author(s):

Kathleen S. Romanowski ◽

Tina L. Palmieri

Keyword(s):

Fluid Resuscitation ◽

Burn Injury ◽

Total Body Surface Area ◽

Burn Shock ◽

Basic Principles ◽

Future Directions ◽

Number Of Children ◽

History Of ◽

Adults And Children ◽

Total Body

Abstract Burn injury is a leading cause of unintentional death and injury in children, with the majority being minor (less than 10%). However, a significant number of children sustain burns greater than 15% total body surface area (TBSA), leading to the initiation of the systemic inflammatory response syndrome. These patients require IV fluid resuscitation to prevent burn shock and death. Prompt resuscitation is critical in pediatric patients due to their small circulating blood volumes. Delays in resuscitation can result in increased complications and increased mortality. The basic principles of resuscitation are the same in adults and children, with several key differences. The unique physiologic needs of children must be adequately addressed during resuscitation to optimize outcomes. In this review, we will discuss the history of fluid resuscitation, current resuscitation practices, and future directions of resuscitation for the pediatric burn population.

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