scholarly journals The Significance of Global End-diastolic Volume (GEDV), Intra-thoracic Blood Volume (ITBV), Extravascular Lung Water (EVLW) and Pulmonary Vascular Permeability (PVPI) Measured by the Transpulmonary Thermodilution Technique (TPTD) in Critically Ill Patients

2013 ◽  
Vol 33 (2) ◽  
pp. 254-262
Author(s):  
Yasuhiko TAIRA ◽  
Yuka TAKAMATSU ◽  
Mumon TAKITA ◽  
Kenichiro MORISAWA ◽  
Machi YANAI ◽  
...  
Keyword(s):  
Vascular Permeability ◽  
Blood Volume ◽  
Critically Ill Patients ◽  
Extravascular Lung Water ◽  
Transpulmonary Thermodilution ◽  
Lung Water ◽  
Thermodilution Technique ◽  
Pulmonary Vascular Permeability ◽  
End Diastolic Volume ◽  
Transpulmonary Thermodilution Technique

scholarly journals Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution

2019 ◽  
Author(s):  
René López ◽  
Rodrigo Pérez ◽  
Álvaro Salazar ◽  
Ana L Ulloa ◽  
Cecilia Vial ◽  
...  
Keyword(s):  
Vascular Permeability ◽  
Transpulmonary Thermodilution ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Capillary Leak ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
End Diastolic Volume ◽  
Hemodynamic Pattern ◽  
Hemodynamic Impairment

Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE) and shock that leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that has not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD; 5 on MV, 3 on ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association to PE. The main findings were reduced stroke volume, global ejection fraction (GEF) and preload parameters associated to increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction and increased permeability PE. Lung water correlated positively with heart rate (HR, r=0.20) and negatively with mean arterial pressure (r=-0.27) and GEF (r=-0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (r=0.31) and negatively with cardiac index (r=-0.49), end-diastolic volume (r=-0.48) and GEF (r=-0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggests that in HCPS patients, increased permeability leads to PE, hypovolemia and circulatory impairment.

scholarly journals Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution

Viruses ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 900
Author(s):  
René López ◽  
Rodrigo Pérez-Araos ◽  
Álvaro Salazar ◽  
Ana L. Ulloa ◽  
Cecilia Vial ◽  
...  
Keyword(s):  
Vascular Permeability ◽  
Transpulmonary Thermodilution ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Capillary Leak ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
End Diastolic Volume ◽  
Hemodynamic Pattern ◽  
Hemodynamic Impairment

Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE), and shock, which leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that have not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD: eight on MV, three required ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association with PE. The main findings were reduced stroke volume, global ejection fraction (GEF), and preload parameters associated with increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction, and increased permeability PE. Lung water correlated positively with heart rate (HR, r = 0.20) and negatively with mean arterial pressure (r = −0.27) and GEF (r = −0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (r = 0.31) and negatively with cardiac index (r = −0.49), end-diastolic volume (r = −0.48), and GEF (r = −0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggest that in HCPS patients, increased permeability leads to PE, hypovolemia, and circulatory impairment.

scholarly journals COVID-19 ARDS is characterized by higher extravascular lung water than non-COVID-19 ARDS: the PiCCOVID study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Rui Shi ◽  
Christopher Lai ◽  
Jean-Louis Teboul ◽  
Martin Dres ◽  
Francesca Moretto ◽  
...  
Keyword(s):  
Extravascular Lung Water ◽  
Transpulmonary Thermodilution ◽  
Diffuse Alveolar Damage ◽  
Lung Mechanics ◽  
Arterial Oxygen ◽  
Prone Positioning ◽  
University Hospitals ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Water Index

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.

scholarly journals Increased extravascular lung water index (EVLWI) reflects rapid inflammatory oedema and mortality in COVID-19 associated ARDS

2020 ◽  
Author(s):  
Sebastian Rasch ◽  
Paul Schmidle ◽  
Senguel Sancak ◽  
Alexander Herner ◽  
Christina Huberle ◽  
...  
Keyword(s):  
Pulmonary Oedema ◽  
Extravascular Lung Water ◽  
Transpulmonary Thermodilution ◽  
Control Group ◽  
Intensive Care Treatment ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Pulmonary Vascular Permeability Index ◽  
Extravascular Lung Water Index ◽  
Water Index

OBJECTIVE: Nearly 5 % of the patients with COVID-19 develop an acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to controls and whether EVLWI has the potential to monitor disease progression. METHODS: From the day of intubation, EVLWI, cardiac function were monitored by transpulmonary thermodilution in n=25 patients with COVID-19 and compared to a control group of 49 non-COVID-19 ARDS-patients. RESULTS: EVLWI in COVID-19-patients was noticeably elevated and significantly higher than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p<0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p=0.003) suggest inflammatory oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and mortality (23.2±6.7% vs. 30.3±6.0%, p=0.025). CONCLUSIONS: Compared to the control group, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 associated ARDS and could serve as parameter to monitor ARDS progression.

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