Document Detail

Accuracy of the double indicator method for measurement of extravascular lung water depends on the type of acute lung injury.
MedLine Citation:
PMID:  15090967     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The double indicator method is sensitive to alterations in the distribution of pulmonary blood flow. This distribution is influenced by the type of lung injury. The aim of this study was to compare measurements of lung water by the double indicator method with measurements obtained by gravimetry in a direct lung injury model induced by tracheal instillation of hydrochloric acid and in an indirect lung injury model induced by the intravenous injection of oleic acid. DESIGN: Prospective, randomized laboratory study. SETTING: Animal research laboratory. SUBJECTS: Forty-two female pigs (28+/-3 kg). INTERVENTIONS: Pigs were anesthetized and ventilated and were allocated into three groups: control (n = 6), hydrochloric acid (4 mL/kg intratracheally, n = 24), or oleic acid (0.1 mL/kg intravenously, n = 12). MEASUREMENTS AND MAIN RESULTS: Hydrochloric acid instillation or oleic acid injection resulted in a similar hypoxemia and induced a two- to three-fold increase in extravascular lung water (EVLW) by gravimetry (EVLWG) at 3 hrs compared with controls. In the oleic acid group, there was a significant correlation between EVLWG and EVLW by double indicator method (EVLWDI; r =.88, p <.0001). The bias for EVLWDI - EVLWG measurements was -5.2 mL/kg (95% confidence interval, -5.7 to -4.7 mL/kg) with 95% limits of agreement of -7 to -3.4 mL/kg. In the hydrochloric acid group, there was no significant correlation between EVLWDI and EVLWG values, and the double indicator method failed to detect pulmonary edema in 65% of the animals (EVLWDI <8 mL/kg). The bias was -7.9 mL/kg (95% confidence interval, -9.3 to -6.5 mL/kg) with 95% limits of agreement of -14.4 to -1.4 mL/kg. CONCLUSIONS: The double indicator method is useful for evaluation of pulmonary edema in indirect lung injury, as induced by oleic acid, but produces misleading values in direct lung injury, as produced by hydrochloric instillation.
Antoine Roch; Pierre Michelet; Dominique Lambert; Stéphane Delliaux; Christophe Saby; Gilles Perrin; Olivier Ghez; Fabienne Bregeon; Pascal Thomas; Jean-Pierre Carpentier; Laurent Papazian; Jean-Pierre Auffray
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  32     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-04-19     Completed Date:  2004-04-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  811-7     Citation Subset:  AIM; IM    
Service de Réanimation Polyvalente, Hôpitaux Sud, Marseille, France.
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MeSH Terms
Analysis of Variance
Disease Models, Animal
Extravascular Lung Water / metabolism*
Hydrochloric Acid / administration & dosage
Indicator Dilution Techniques*
Oleic Acid / administration & dosage
Prospective Studies
Pulmonary Edema / diagnosis*,  etiology,  pathology
Random Allocation
Respiratory Distress Syndrome, Adult / diagnosis*,  etiology,  pathology
Respiratory Mechanics
Reg. No./Substance:
112-80-1/Oleic Acid; 7647-01-0/Hydrochloric Acid
Comment In:
Crit Care Med. 2004 Mar;32(3):899-901   [PMID:  15090991 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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