open access

Vol 86, No 6 (2018)
ORIGINAL PAPERS
Published online: 2018-12-30
Submitted: 2018-10-06
Accepted: 2018-12-07
Get Citation

Comparing transpulmonary thermodilution monitoring to lung ultrasound during pneumonia: an observational study

Konrad Leszek Mendrala, Dariusz Gajniak, Tomasz Cyzowski, Tomasz Czober, Danuta Gierek, Ewa Kucewicz-Czech
DOI: 10.5603/ARM.a2018.0045
·
Pubmed: 30594994
·
Adv Respir Med 2018;86(6):275-281.

open access

Vol 86, No 6 (2018)
ORIGINAL PAPERS
Published online: 2018-12-30
Submitted: 2018-10-06
Accepted: 2018-12-07

Abstract

Introduction: Monitoring lung function during pneumonia is essential for the evaluation of the effectiveness of therapy in ICU patients. Among various bedside techniques, two particularly interesting are the lung ultrasound and the transpulmonary thermodilution technique. In this observational single center study we want to assess the correlation between the lung ultrasound examination (LUS) and transpulmonary thermodilution volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).

Material and methods: We analyzed data obtained from medical history of twelve patients requiring mechanical ventilation and hemodynamics monitoring with PICCO catheter due to newly diagnosed pneumonia. We compared lung ultrasound examination performed on the first and third day of new antimicrobial therapy with results of transpulmonary thermodilution examination made on same day. We also calculate the difference between values obtained on first and third day to compare the trends.

Results: We did not find any association between tested variables, except a correlation between PVPI and EVLWI, both measured at the same day (Rho = 0.3; 95%CI –0.02–0.59; p = 0.03), and trends in the period of 3 days (Rho = 0.6; 95%CI 0.2–0.8; p = 0.005).

Conclusions: The results of the study indicate that volumetric values achieved using the PiCCO method as well as lung ultrasound should be interpreted with care and related to the clinical state of a patient, keeping in mind that no correlation between the result achieved and the actual state of inflammatory changes in the lungs may be possible.

Abstract

Introduction: Monitoring lung function during pneumonia is essential for the evaluation of the effectiveness of therapy in ICU patients. Among various bedside techniques, two particularly interesting are the lung ultrasound and the transpulmonary thermodilution technique. In this observational single center study we want to assess the correlation between the lung ultrasound examination (LUS) and transpulmonary thermodilution volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).

Material and methods: We analyzed data obtained from medical history of twelve patients requiring mechanical ventilation and hemodynamics monitoring with PICCO catheter due to newly diagnosed pneumonia. We compared lung ultrasound examination performed on the first and third day of new antimicrobial therapy with results of transpulmonary thermodilution examination made on same day. We also calculate the difference between values obtained on first and third day to compare the trends.

Results: We did not find any association between tested variables, except a correlation between PVPI and EVLWI, both measured at the same day (Rho = 0.3; 95%CI –0.02–0.59; p = 0.03), and trends in the period of 3 days (Rho = 0.6; 95%CI 0.2–0.8; p = 0.005).

Conclusions: The results of the study indicate that volumetric values achieved using the PiCCO method as well as lung ultrasound should be interpreted with care and related to the clinical state of a patient, keeping in mind that no correlation between the result achieved and the actual state of inflammatory changes in the lungs may be possible.

Get Citation

Keywords

pneumonia; transpulmonary thermodilution; lung ultrasound

About this article
Title

Comparing transpulmonary thermodilution monitoring to lung ultrasound during pneumonia: an observational study

Journal

Advances in Respiratory Medicine

Issue

Vol 86, No 6 (2018)

Pages

275-281

Published online

2018-12-30

DOI

10.5603/ARM.a2018.0045

Pubmed

30594994

Bibliographic record

Adv Respir Med 2018;86(6):275-281.

Keywords

pneumonia
transpulmonary thermodilution
lung ultrasound

Authors

Konrad Leszek Mendrala
Dariusz Gajniak
Tomasz Cyzowski
Tomasz Czober
Danuta Gierek
Ewa Kucewicz-Czech

References (23)
  1. Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015; 5(1): 38.
  2. Tagami T, Sawabe M, Kushimoto S, et al. Quantitative diagnosis of diffuse alveolar damage using extravascular lung water. Crit Care Med. 2013; 41(9): 2144–2150.
  3. Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis. 2010; 51 Suppl 1: S131–S135.
  4. Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med. 2003; 31(3): 676–682.
  5. Molnár Z, Szakmány T, Heigl P. Microalbuminuria does not reflect increased systemic capillary permeability in septic shock. Intensive Care Med. 2003; 29(3): 391–395.
  6. Lichtenstein D, Goldstein I, Mourgeon E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004; 100(1): 9–15.
  7. Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010; 38(1): 84–92.
  8. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014; 4(1): 1.
  9. De Pascale G, Bello G, Tumbarello M, et al. Severe pneumonia in intensive care: cause, diagnosis, treatment and management: a review of the literature. Curr Opin Pulm Med. 2012; 18(3): 213–221.
  10. Mattu A, Martinez JP, Kelly BS. Modern management of cardiogenic pulmonary edema. Emerg Med Clin North Am. 2005; 23(4): 1105–1125.
  11. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Crit Care. 2012; 16(2): 212.
  12. Lang SA, Duncan PG, Shephard DA, et al. Pulmonary oedema associated with airway obstruction. Can J Anaesth. 1990; 37(2): 210–218.
  13. Tagami T, Kushimoto S, Yamamoto Y, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010; 14(5): R162.
  14. Kuzkov VV, Suborov EV, Kirov MY, et al. Extravascular lung water after pneumonectomy and one-lung ventilation in sheep. Crit Care Med. 2007; 35(6): 1550–1559.
  15. Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patients. Chest. 2002; 122(6): 2080–2086.
  16. Chung FT, Lin HC, Kuo CH, et al. Extravascular lung water correlates multiorgan dysfunction syndrome and mortality in sepsis. PLoS One. 2010; 5(12): e15265.
  17. Mitchell JP, Schuller D, Calandrino FS, et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis. 1992; 145(5): 990–998.
  18. Kushimoto S, Taira Y, Kitazawa Y, et al. PiCCO Pulmonary Edema Study Group. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome. Crit Care. 2012; 16(6): R232.
  19. Davids J, Turton E, Raubenheimer J. Comparison of lung ultrasound with transpulmonary thermodilution in assessing extra-vascular lung water. Southern African Journal of Anaesthesia and Analgesia. 2016; 22(6): 170–174.
  20. Anile A, Russo J, Castiglione G, et al. A simplified lung ultrasound approach to detect increased extravascular lung water in critically ill patients. Crit Ultrasound J. 2017; 9(1): 13.
  21. Volpicelli G, Skurzak S, Boero E, et al. Lung ultrasound predicts well extravascular lung water but is of limited usefulness in the prediction of wedge pressure. Anesthesiology. 2014; 121(2): 320–327.
  22. Bataille B, Rao G, Cocquet P, et al. Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome. J Clin Monit Comput. 2015; 29(1): 169–176.
  23. Huber W, Mair S, Götz SQ, et al. Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients. Intensive Care Med. 2013; 39(1): 146–150.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl