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Critical Care Medicine:
doi: 10.1097/01.CCM.0000265739.51887.2B
Laboratory Investigations

Extravascular lung water after pneumonectomy and one-lung ventilation in sheep

Kuzkov, Vsevolod V. MD, PhD; Suborov, Evgeny V. MD; Kirov, Mikhail Y. MD, PhD; Kuklin, Vladimir N. MD, PhD; Sobhkhez, Mehrdad MSci; Johnsen, Solveig MD; Waerhaug, Kristine MD; Bjertnaes, Lars J. MD, PhD

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Abstract

Objective: To compare the single thermodilution and the thermal-dye dilution techniques with postmortem gravimetry for assessment of changes in extravascular lung water after pneumonectomy and to explore the evolution of edema after injurious ventilation of the left lung.

Design: Experimental study.

Setting: University laboratory.

Subjects: A total of 30 sheep weighing 35.6 ± 4.6 kg. The study included two parts: a pneumonectomy study (n = 18) and an injurious ventilation study (n = 12).

Methods: Sheep were anesthetized and mechanically ventilated with an Fio2 of 0.5, tidal volume of 6 mL/kg, and positive end-expiratory pressure of 2 cm H2O. In the pneumonectomy study, sheep were assigned to right-sided pneumonectomy (n = 7), left-sided pneumonectomy (n = 7), or lateral thoracotomy only (sham operation, n = 4). In the injurious ventilation study, right-sided pneumonectomy was followed by ventilation with a tidal volume of 12 mL/kg and positive end-expiratory pressure of 0 cm H2O (n = 6) or by ventilation with a tidal volume of 6 mL/kg and positive end-expiratory pressure of 2 cm H2O for 4 hrs (n = 6). Volumetric variables, including extravascular lung water index (EVLWI), were measured with single thermodilution (STD; EVLWISTD) and thermal-dye dilution (TDD; EVLWITDD) techniques. We monitored pulmonary hemodynamics and respiratory variables. After the sheep were killed, EVLWI was determined for each lung by gravimetry (EVLWIG).

Results: In total, the study yielded strong correlations of EVLWISTD and EVLWITDD with EVLWIG (n = 30; r = .83 and .94, respectively; p < .0001). After pneumonectomy, both the left- and the right-sided pneumonectomy groups displayed significant decreases in EVLWISTD and EVLWITDD. The injuriously ventilated sheep demonstrated significant increases in EVLWI that were detected by both techniques. The mean biases (±2 sd) compared with EVLWIG were 3.0 ± 2.6 mL/kg for EVLWISTD and 0.4 ± 1.6 mL/kg for EVLWITDD.

Conclusions: After pneumonectomy and injurious ventilation of the left lung, TDD and STD displayed changes in extravascular lung water with acceptable accuracy when compared with postmortem gravimetry. Ventilator-induced lung injury seems to be a crucial mechanism of pulmonary edema after pneumonectomy.

© 2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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