[Clinical investigation of extravascular lung water index and pulmonary vascular permeability index in diagnosis and continuous monitoring of lung edema]

Li-Jun Ma, Ying-Zhi Qin
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, Chinese Critical Care Medicine, Zhongguo Weizhongbing Jijiuyixue 2008, 20 (2): 111-4

OBJECTIVE: To study the clinical value of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in the diagnosis and continuous monitoring of lung edema.

METHODS: To retrospectively analyze pulse index continuous cardiac output (PiCCO) monitoring in 40 patients with lung edema. They were divided into two groups: acute cardiac pulmonary edema (ACPE) group (ACPE group, 15 cases) and acute respiratory distress syndrome (ARDS) group (ARDS group, 25 cases), according to their case history, symptoms, physical signs, results of auxiliary examinations and cardiac index (CI) on admission. Parameters such as EVLWI and intrathoracic blood volume index (ITBVI) on admission were recorded, correlation analysis was performed, and PVPI was calculated at 0, 24, and 72 hours after tracheal intubation.

RESULTS: (1) PVPI in ARDS group was significantly higher than that in ACPE patients (P<0.01) at 0 hour after tracheal intubation. (2) PVPI had no correlation with oxygenation index (PaO(2)/FiO(2)), acute physiology and chronic health evaluation II (APACHEII) score, EVLWI, ITBVI, and central venous pressure (CVP) in ACPE group (all P>0.05), while it showed significant correlation with EVLWI (r=0.904, P<0.01), as well as with APACHEII and PaO(2)/FiO(2) (r=0.390, P<0.05, r=-0.554, P<0.01) in ARDS group. EVLWI in ACPE group was significantly correlated with PaO(2)/FiO(2) (r=-0.672, P<0.01) and correlated with APACHEII (r=0.412, P<0.05). There was some correlation between EVLWI and PaO(2)/FiO(2) (r=-0.602, P<0.01), APACHEII, ITLWI in the two groups (r=0.457, P<0.05; r=0.636, P<0.05). (3) Protracted receiver operating characteristic curve(ROC) of PVPI was plotted, and area under the curve (AUC) was 0.956+/-0.019 (P<0.01). When 2.23, which was one of the cut-off points of PVPI, was selected, the sensitivity was 92.0%, and the specificity was 93.3%. (4) When the patients were divided into survivor group and non-survivor group, EVLWI was found to be decreased gradually in the survivor group (ACPE group: P<0.05; ARDS group: P<0.01), and PVPI of ACPE patients increased in non-survivor group (P<0.01).

CONCLUSION: EVLWI and PVPI monitoring is of clinical value to some degree in early diagnosis of hydrostatic pulmonary edema and permeability pulmonary edema.

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