Abstract
BackgroundAssessment of pulmonary edema is a key factor in monitoring and guidance of therapy in critically ill patients. To date, methods available at the bedside for estimating the physiologic correlate of pulmonary edema, extravascular lung water, often are unreliable or require invasive measurements. The aim of the present study was to develop a novel approach to reliably assess extravascular lung water by making use of the functional imaging capabilities of electrical impedance tomography.MethodsThirty domestic pigs were anesthetized and randomized to three different groups. Group 1 was a sham group with no lung injury. Group 2 had acute lung injury induced by saline lavage. Group 3 had vascular lung injury induced by intravenous injection of oleic acid. A novel, noninvasive technique using changes in thoracic electrical impedance with lateral body rotation was used to measure a new metric, the lung water ratioEIT, which reflects total extravascular lung water. The lung water ratioEIT was compared with postmortem gravimetric lung water analysis and transcardiopulmonary thermodilution measurements.ResultsA significant correlation was found between extravascular lung water as measured by postmortem gravimetric analysis and electrical impedance tomography (r = 0.80; p < 0.05). Significant changes after lung injury were found in groups 2 and 3 in extravascular lung water derived from transcardiopulmonary thermodilution as well as in measurements derived by lung water ratioEIT.ConclusionsExtravascular lung water could be determined noninvasively by assessing characteristic changes observed on electrical impedance tomograms during lateral body rotation. The novel lung water ratioEIT holds promise to become a noninvasive bedside measure of pulmonary edema.
Highlights
Assessment of pulmonary edema is a key factor in monitoring and guidance of therapy in critically ill patients
Lavage and oleic acid infusion resulted in statistically significant changes in lung water ratioEIT, from −0.209 ± 0.098 to 0.0679 ± 0.174 and from −0.189 ± 0.078 to 0.110 ± 0.120, respectively (Fig. 3 and Table 2)
This study demonstrates that Electrical impedance tomography (EIT) can be used for noninvasive quantification of pulmonary edema in acute experimental lung injury
Summary
Assessment of pulmonary edema is a key factor in monitoring and guidance of therapy in critically ill patients. Assessing a patient’s pulmonary edema is a key factor for guidance of therapy, in critically ill patients. A computed tomographic scan can be used to reliably estimate pulmonary fluid content [9, 10] but is not available at the bedside. It is associated with a transport trauma of the critically ill patient [11] as well as a radiation exposure that surmounts that of a standard chest x-ray by 100- to 400fold [12].
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