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Transpulmonary Determination of Extravascular Lung Water: What You See Is What You Get and It's Useful
| Content Provider | Scilit |
|---|---|
| Author | Easley, R. Blaine Simon, Brett A. |
| Copyright Year | 2010 |
| Description | Journal: Anesthesiology We appreciate the interest of Drs. Phillips and Perel in our recent article.1 However, they seem to have focused on whether there exists a numeric equivalence between extravascular lung water (EVLW) measured by computed tomography tissue volume and the transpulmonary thermodilution method $(EVLW^{TPT}$). Any such equivalence between these values is as much coincidence as anything else, because it has been shown by Kirov et al. 2 that a species-specific correction is required to calibrate the $EVLW^{TPT}$measurement to accurately reflect gravimetric EVLW. We used the unmodified values from the PiCCO® device (Pulsion Medical Systems, Munich, Germany) because no validated canine correction factors are available. However, because this correction is linear, we believed that the changes in $EVLW^{TPT}$would be reasonable to follow, and, as we described, the changes in each of these measures after lipopolysaccharide administration were very different. Our goal, however, was not to perform yet another validation of $EVLW^{TPT}$but to gain insight into the pathophysiologic mechanisms that might impact the reliability of the measured $EVLW^{TPT}$. Phillips and Perel apparently agree that the $EVLW^{TPT}$increased after lipopolysaccharide while EVLW measured by computed tomography did not. Even if lipopolysaccharide administration caused an increase in the actual EVLW in the short time between administration and imaging, they offer no explanation as to why this was not evident on whole lung computed tomography imaging, which despite their objections is widely accepted as a sensitive and specific measure of lung mass.3,4 On the basis of the changing perfusion distribution observed, we interpreted this divergence of the two measurements to reflect an acute change in the perfused thermal mass, resulting in an artifactual increase in the $EVLW^{TPT}$. |
| Related Links | http://anesthesiology.pubs.asahq.org/data/journals/jasa/931095/0000542-201006000-00044.pdf http://anesthesiology.pubs.asahq.org/data/Journals/JASA/931095/0000542-201006000-00044.pdf |
| Ending Page | 1542 |
| Page Count | 2 |
| Starting Page | 1541 |
| ISSN | 00033022 |
| e-ISSN | 15281175 |
| DOI | 10.1097/aln.0b013e3181dc59b9 |
| Journal | Anesthesiology |
| Issue Number | 6 |
| Volume Number | 112 |
| Language | English |
| Publisher | Ovid Technologies (Wolters Kluwer Health) |
| Publisher Date | 2010-06-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Anesthesiology Respiratory System Lipopolysaccharide Computed Tomography |
| Content Type | Text |
| Resource Type | Article |
| Subject | Anesthesiology and Pain Medicine |
