scholarly journals Measurement of extravascular lung water to diagnose severe reperfusion lung injury following pulmonary endarterectomy: a prospective cohort clinical validation study

Anaesthesia ◽  
2019 ◽  
Vol 74 (10) ◽  
pp. 1282-1289 ◽  
Author(s):  
A. G. Butchart ◽  
V. Zochios ◽  
S. S. Villar ◽  
N. L. Jones ◽  
S. Curry ◽  
...  
Keyword(s):  
Lung Injury ◽  
Validation Study ◽  
Extravascular Lung Water ◽  
Prospective Cohort ◽  
Clinical Validation ◽  
Pulmonary Endarterectomy ◽  
Lung Water

Type of lung injury influences the thermal-dye estimation of extravascular lung water

1984 ◽  
Vol 57 (3) ◽  
pp. 680-685 ◽  
Author(s):  
P. V. Carlile ◽  
B. A. Gray
Keyword(s):  
Lung Injury ◽  
Extravascular Lung Water ◽  
Base Line ◽  
Shunt Fraction ◽  
Lung Water ◽  
Animal Group ◽  
Group I ◽  
Injury Group ◽  
Anesthetized Dogs ◽  
Group Ii

To determine the effect of the type of lung injury on the thermodilution estimation of extravascular lung water, we produced pulmonary edema in 25 anesthetized dogs by injection of alloxan or alpha-naphthylthiourea (ANTU) into the pulmonary circulation or by instillation of hydrochloric acid (HCI) into the airway. HCl injury was bilateral, unilateral with tidal volume equal in each lung, or unilateral with equal airway pressure. Extravascular thermal volume (ETV) was measured at base line and 4 h after lung injury, and the final measurement was compared with the postmortem determination of extravascular lung mass (ELM). In 11 of 15 animals with HCl injury final ETV was less than the base-line measurement. The ratio of final ETV to ELM for all HCl animal (group I) averaged 0.31 +/- 0.14, which was different from the value for animals with alloxan or ANTU injury (group II), 1.04 +/- 0.14 (P less than 0.01). Extravascular lung water per gram of blood-free dry tissue was not different for the two groups (8.1 +/- 1.2 and 8.7 +/- 2.6 for I and II, respectively), indicating equally severe lung injury; however, shunt fraction was less in group I (P less than 0.01). ETV/ELM correlated with the shunt fraction for group I (r = 0.70) but not for group II (r = 0.32). These findings indicate that ETV underestimates lung water after HCl injury due to the redistribution of pulmonary blood flow away from edematous areas.

scholarly journals Management of Phosgene-Induced Acute Lung Injury (ALI) by Personalized Protective PEEP-ECMO: What Can We Learn from Animal Bioassays?

2019 ◽  
pp. 1-9
Author(s):  
Chunli Yang ◽  
Chunli Yang ◽  
Yang Xiaogang ◽  
Zhaohui He
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Dead Space ◽  
Extravascular Lung Water ◽  
Lung Mechanics ◽  
Lung Edema ◽  
Lung Water ◽  
Extravascular Lung Water Index ◽  
Water Index ◽  
Arterial Blood

Background: Phosgene (carbonyl dichloride) gas is an indispensable chemical intermediate used in numerous industrial processes. Acute lung injury (ALI) caused by accidental inhalation exposure to phosgene is characterized pulmonary edema being phenotypically manifested after an asymptomatic or more precisely phrased “clinical occult” period. Opposite to common clinical practice, protective treatment should be given preference to curative treatment. Treatment initiated already during the asymptomatic phase shortly after exposure requires prognostic endpoints preceding the lung edema for triage and re-triage. Treatment strategies need to be personalized and exposure-dose related. The objective of this post-hoc analysis of published data is to assess prognostic value of ventilation dead-space (Vd/Vt) and extravascular lung water index (EVLWI) to guide treatment by protective PEEP supplemented by venovenous (vv) ECMO. Methods: This paper aims to compare the overarching published framework from systematic toxicological research of phosgene in animal bioassays with the clinical evidence from four accidentally phosgenepoisoned workers admitted to hospital with life-threatening lung edema. Treatment focused on a combination of protective PEEP and ECMO to reverse phosgene-induced deterioration in lung mechanics by personalized mechanical ventilation. Endpoints selected for titration PEEP focused on endpoints indicative of decoupling cardiopulmonary and vascular functions. To better understand any cardiogenic and vascular disturbances, titration endpoints included calculated ventilation dead-space (Vd/Vt), measured extravascular lung water index (EVLWI), arterial blood gases and acid-base status, systemic vascular resistance index (SVRI), and cardiac index (CI). EVLWI and APACHE II criteria guided the course of treatment in adjusting plateau pressure (Pplat), positive end-expiratory pressure (PEEP), and driving pressure (ΔP). Results: Remarkable equivalence of human data and those from controlled inhalation studies with phosgene on rats and dogs was found. The endpoint of choice guiding PEEP ventilation and implementation of ECMO was EVLWI. This maker of lung edema precisely reflects the increased wet lung weights in animals. Conclusions: ECMO-supplemented PEEP not only mitigates hypoxemia at conditions of severe ARDS and it also provides a means to reduce driving and plateau pressures minimizing ventilatorassociated lung injury.

Extravascular lung water after pneumonectomy followed by ventilator-induced lung injury

2006 ◽  
Vol 23 (Supplement 37) ◽  
pp. 72-73 ◽  
Author(s):  
V. Kuzkov ◽  
E. Suborov ◽  
V. Kuklin ◽  
M. Sobhkhez ◽  
K. Waerhaug ◽  
...  
Keyword(s):  
Lung Injury ◽  
Extravascular Lung Water ◽  
Lung Water ◽  
Ventilator Induced Lung Injury

Ibuprofen reduces ethchlorvynol lung injury: possible role of blood flow distribution

1992 ◽  
Vol 72 (3) ◽  
pp. 1156-1165 ◽  
Author(s):  
K. Yagi ◽  
L. J. Baudendistel ◽  
T. E. Dahms
Keyword(s):  
Blood Flow ◽  
Lung Injury ◽  
Extravascular Lung Water ◽  
Gas Transfer ◽  
Venous Admixture ◽  
Lung Water ◽  
Edema Formation ◽  
Edema Fluid ◽  
Pretreated Group

The role of cyclooxygenase products in acute lung injury was determined by pretreatment of dogs with ibuprofen before injury with intravenous ethchlovynol (ECV). In animals given ECV only, lung injury resulted in extravascular lung water of 18.9 ml/kg after 2 h, which was significantly higher than the 14.8 ml/kg in the group pretreated with ibuprofen. The comparison of gravimetric and indicator-dilution measurements of edema fluid indicates that edema fluid could not be reliably detected after treatment with ibuprofen because of diversion of flow from injured areas. Venous admixture increased from 6% at baseline to 32% 120 min after ECV in the vehicle-pretreated group compared with an increase from 4% at baseline to 7% in the ibuprofen-pretreated group. The regression analysis of the relationship between venous admixture and extravascular lung water indicated that, at any level of edema, venous admixture was significantly less in the group treated with ibuprofen than in the untreated group. Measurement of plasma and bronchoalveolar lavage fluid indicated that ibuprofen inhibited cyclooxygenase activity without affecting lipoxygenase activity. These results suggest that in intact dogs ibuprofen has a protective effect on both pulmonary gas transfer and pulmonary edema formation in ECV-injured lungs, which is consistent with limiting blood flow to injured segments of the lung.

scholarly journals Comparison of thermodilution measured extravascular lung water with chest radiographic assessment of pulmonary oedema in patients with acute lung injury

2013 ◽  
Vol 3 (1) ◽  
pp. 25 ◽  
Author(s):  
Lisa M Brown ◽  
Carolyn S Calfee ◽  
James P Howard ◽  
Thelma R Craig ◽  
Michael A Matthay ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Pulmonary Oedema ◽  
Extravascular Lung Water ◽  
Radiographic Assessment ◽  
Lung Water
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