Application of PiCCO monitoring in patients with neurogenic pulmonary edema

Abstract

To evaluate the application of pulse induced contour cardiac output (PiCCO) monitoring in patients with neurogenic pulmonary edema (NPE), and to assess the accuracy of capacity parameters such as intra thoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) and pressure parameters such as central venous pressure (CVP) in estimating severity of NPE, and to assess the prognostic significance of extravascular lung water index (EVLWI) on patients with NPE. In this prospective study, 36 patients with NPE in the department of neurological intensive care unit (NICU) underwent PiCCO monitoring, including mean arterial pressure (MAP), cardiac index (CI), CVP, ITBVI, GEDVI, EVLWI, pulmonary vascular permeability index (PVPI). The correlation between ITBVI, GEDVI, CVP and EVLWI was assessed. According to the outcome, these patients were divided into nonsurvivor group and survivor group. The change in EVLWI before and after treatment was compared between two groups. ITBVI, GEDVI were significantly and positively correlated with EVLWI, for the former r =0.54, P<0.001, and for the latter r=0.62, P<0.0001, but there was no significant correlation between CVP and EVLWI, r= 0.12, P>0.05. PVPI, EVLWI were significantly and negatively correlated with oxygenation index (PaO2 / FiO2), for the former r=-0.55, P< 0.001, and for the latter r=-0.48, P<0.05. The difference in EVLWI level before treatment between survivor group and nonsurvivor group was not statistically significant (8.6±2.6 ml/kg vs. 9.4±1.8 ml/kg, P>0.05). In survivor group, EVLWI level obviously declined after treatment (6.92±1.64 ml/kg vs. 8.64±2.62 ml/kg, P<0.05), EVLWI level of survivor group was significantly lower than that of nonsurvivor group (6.92±1.64 ml/kg vs. 9.88±2.44 ml/kg, P<0.05). Capacity parameters such as GEDVI, ITBVI can assess EVLWI of NPE patients accurately and reliably. In NPE patients, the higher the PVPI and EVLWI, the lower the PaO2 / FiO2. By dynamic observation of the trends of EVLWI in NPE patients, we are able to assess the prognosis of these patients.