Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients
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Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients. / Saugel, Bernd; Phillip, Veit; Ernesti, Christina; Messer, Marlena; Meidert, Agnes S; Schmid, Roland M; Huber, Wolfgang.
in: J CRIT CARE, Jahrgang 28, Nr. 2, 01.04.2013, S. 196-201.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients
AU - Saugel, Bernd
AU - Phillip, Veit
AU - Ernesti, Christina
AU - Messer, Marlena
AU - Meidert, Agnes S
AU - Schmid, Roland M
AU - Huber, Wolfgang
N1 - Copyright © 2013 Elsevier Inc. All rights reserved.
PY - 2013/4/1
Y1 - 2013/4/1
N2 - PURPOSE: The purpose of this study was to investigate the impact of large-volume thoracentesis (>1000 mL) on transpulmonary thermodilution (TPTD)-derived cardiopulmonary parameters with special regard to extravascular lung water index (EVLWI).MATERIALS AND METHODS: Retrospective analysis of a prospectively maintained database including TPTD measurements of patients treated in a medical intensive care unit of a German university hospital between January 2009 and September 2010. Data of 17 patients treated with large-volume thoracentesis were analyzed.RESULTS: A median of 1350 (25%-75% interquartile range [IQR], 1200-1590) mL of pleural fluid was removed. Extravascular lung water index was statistically significantly higher after thoracentesis compared with baseline (9.0 [IQR, 8.0-13.0] vs 8.0 [IQR, 7.0-13.0] mL/kg) (P = .039). Pulmonary vascular permeability index (PVPI) also increased significantly after thoracentesis (1.7 [IQR, 1.3-2.4] vs 1.4 [IQR, 1.1-2.1]) (P = .019). When determined 2 and 6 hours after thoracentesis, EVLWI and PVPI even further increased. Six hours after removal of pleural fluid, we observed a median EVLWI of 11.0 (IQR, 8.0-15.0) mL/kg (P = .048 compared with baseline) and a median PVPI of 2.0 (IQR, 1.5-2.7) (P = .040 compared with baseline).CONCLUSIONS: Large-volume thoracentesis results in a statistically significant increase in TPTD-derived EVLWI. Because EVLWI was higher after removal of pleural fluid, we conclude that pleural effusions do not take part in single-indicator TPTD as a part of the pulmonary thermovolume and do not increase TPTD-derived EVLWI.
AB - PURPOSE: The purpose of this study was to investigate the impact of large-volume thoracentesis (>1000 mL) on transpulmonary thermodilution (TPTD)-derived cardiopulmonary parameters with special regard to extravascular lung water index (EVLWI).MATERIALS AND METHODS: Retrospective analysis of a prospectively maintained database including TPTD measurements of patients treated in a medical intensive care unit of a German university hospital between January 2009 and September 2010. Data of 17 patients treated with large-volume thoracentesis were analyzed.RESULTS: A median of 1350 (25%-75% interquartile range [IQR], 1200-1590) mL of pleural fluid was removed. Extravascular lung water index was statistically significantly higher after thoracentesis compared with baseline (9.0 [IQR, 8.0-13.0] vs 8.0 [IQR, 7.0-13.0] mL/kg) (P = .039). Pulmonary vascular permeability index (PVPI) also increased significantly after thoracentesis (1.7 [IQR, 1.3-2.4] vs 1.4 [IQR, 1.1-2.1]) (P = .019). When determined 2 and 6 hours after thoracentesis, EVLWI and PVPI even further increased. Six hours after removal of pleural fluid, we observed a median EVLWI of 11.0 (IQR, 8.0-15.0) mL/kg (P = .048 compared with baseline) and a median PVPI of 2.0 (IQR, 1.5-2.7) (P = .040 compared with baseline).CONCLUSIONS: Large-volume thoracentesis results in a statistically significant increase in TPTD-derived EVLWI. Because EVLWI was higher after removal of pleural fluid, we conclude that pleural effusions do not take part in single-indicator TPTD as a part of the pulmonary thermovolume and do not increase TPTD-derived EVLWI.
KW - Aged
KW - Extravascular Lung Water
KW - Female
KW - Hemodynamics
KW - Hospitals, University
KW - Humans
KW - Intensive Care Units
KW - Male
KW - Middle Aged
KW - Pleural Effusion
KW - Pulmonary Circulation
KW - Retrospective Studies
KW - Thermodilution
U2 - 10.1016/j.jcrc.2012.05.002
DO - 10.1016/j.jcrc.2012.05.002
M3 - SCORING: Journal article
C2 - 22765875
VL - 28
SP - 196
EP - 201
JO - J CRIT CARE
JF - J CRIT CARE
SN - 0883-9441
IS - 2
ER -