Document Detail


Determining the aetiology of pulmonary oedema by the oedema fluid-to-plasma protein ratio.
MedLine Citation:
PMID:  19741024     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We hypothesised that the oedema fluid-to-plasma protein (EF/PL) ratio, a noninvasive measure of alveolar capillary membrane permeability, can accurately determine the aetiology of acute pulmonary oedema. 390 mechanically ventilated patients with acute pulmonary oedema were enrolled. A clinical diagnosis of acute lung injury (ALI), cardiogenic pulmonary oedema or a mixed aetiology was based on expert medical record review at the end of hospitalisation. The EF/PL ratio was measured from pulmonary oedema fluid and plasma samples collected at intubation. 209 patients had a clinical diagnosis of ALI, 147 had a diagnosis of cardiogenic pulmonary oedema and 34 had a mixed aetiology. The EF/PL ratio had an area under the receiver-operating curve of 0.84 for differentiating ALI from cardiogenic pulmonary oedema. Using a predefined cut-off of 0.65, the EF/PL ratio had a sensitivity of 81% and a specificity of 81% for the diagnosis of ALI. An EF/PL ratio >/=0.65 was also associated with significantly higher mortality and fewer ventilator-free days. Noninvasive measurement of the EF/PL ratio is a safe and reliable bedside method for rapidly determining the aetiology of acute pulmonary oedema that can be used at the bedside in both developed and developing countries.
Authors:
L B Ware; R D Fremont; J A Bastarache; C S Calfee; M A Matthay
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-09-09
Journal Detail:
Title:  The European respiratory journal     Volume:  35     ISSN:  1399-3003     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-11-16     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  331-7     Citation Subset:  IM    
Affiliation:
Division of Allergy, Pulmonary and Critical Care Medicine, Dept of Medicine, Vanderbilt University School of Medicine, T1218 MCN, 1161 21st Avenue S, Nashville, TN 37232-2650, USA. lorraine.ware@vanderbilt.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Proteins / analysis*
Cohort Studies
Female
Humans
Male
Middle Aged
Oxygen / metabolism
Permeability
Pulmonary Alveoli / metabolism
Pulmonary Edema / blood,  diagnosis*,  etiology*
ROC Curve
Respiratory Distress Syndrome, Adult / blood,  diagnosis*,  etiology*
Grant Support
ID/Acronym/Agency:
HL 081332/HL/NHLBI NIH HHS; HL 51856/HL/NHLBI NIH HHS; HL090833/HL/NHLBI NIH HHS; K23 HL090833/HL/NHLBI NIH HHS; K24 HL103836/HL/NHLBI NIH HHS; R37 HL051856-14/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Blood Proteins; 7782-44-7/Oxygen
Comments/Corrections

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


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