Electrical Impedance Tomography in the Assessment of Extravascular Lung Water in Noncardiogenic Acute Respiratory Failure: Results

In: Respiratory Failure

30 Sep 2014

Two independent observers blinded for the EVLW measurements by the TDD analyzed the EIT measurements. Interobserver variation was studied by calculating Pearson’s correlation coefficient. Receiver operator characteristic (ROC) analysis was used to assess the optimal cutoff level of the IR to diagnose an increased amount of EVLW (> 10 mL/kg). The ROC curve shows the calculated sensitivity and specificity for a test over a range of cutoff points and can be used to determine the best cutoff point. The closer the area under the curve to 1, the better the diagnostic performance of a test. To investigate whether the IR has a relation with the severity of the disease, Pearson’s correlation analysis was used to investigate the relation between the LIS and the EVLW content and the IR. To underline the assumption that the IR is independent of the level of PEEP, the relation between PEEP and the EVLW content assessed by TDD and the IR was investigated by Pearson’s correlation analysis. Also, in three patients, two levels of PEEP were applied to a constant amount of EVLW. First, EIT measurements were performed at the level of PEEP necessary according to clinical conditions. Then, EIT measurements were performed after 10 min at zero PEEP. Because the variability of PEEP and LIS in the daily measurements made on the same subject will probably be small, only the day 1 measurements were used in both analyses in order to avoid any clusters of points. A p value < 0.05 was considered as statistically significant. canadian neighbor pharmacy com

Results
Patients
Eight patients were classified as having ARDS (LIS > 2.5), whereas six patients had ALI (LIS < 2.5). All patients had ARF resulting from sepsis: six after an abdominal operation, two due to a trauma, five following a severe pneumococcal pneumonia, and one following a urinary tract infection. The general characteristics of the patients are reported in Table 1. Two of the 14 patients (14%) died during their stay in the ICU. Both deaths occurred in the ARDS group (mortality, 25%). One patient (patient 7) died within 3 days after the onset of ARF. Another patient died within 6 days after the onset of ARF (patient 8). The remaining 12 patients could be extubated and discharged from the ICU and were considered as survivors.
Table 1—Characteristics of the Patients

Patient Age, yr Sex Etiology of ARF Pao2/Flo2, mm Hg Compliance, cm H2O/mL PEEP, cm H2O X-ray LIS PCWP, mm Hg Survival
1 59 Female Sepsis pneumonia 63 16 6 2 2.75 14 yes
2 68 Male Abdominal sepsis 152 48 5 2 1.75 8 yes
3 75 Male Sepsis pneumonia 316 45 5 3 1.25 12 yes
4 39 Male Trauma 254 60 5 2 1 5 yes
5 74 Male Trauma 103 32 12 3 3 11 yes
6 76 Female Sepsis pneumonia 115 58 8 2 2 18 yes
7 57 Male Abdominal sepsis 162 28 12 4 3.25 4 no
8 42 Female Sepsis pneumonia 133 12 12 2 3 9 no
9 68 Male Abdominal sepsis 238 50 5 4 1.75 11 yes
10 26 Male Abdominal sepsis 165 35 10 3 2.75 14 yes
11 41 Male Abdominal sepsis 95 22 12 4 3.5 10 yes
12 59 Male Abdominal sepsis 71 17 8 2 2.75 12 yes
13 30 Male Urinary sepsis 106 29 11 3 2.75 8 yes
14 36 Male Sepsis pneumonia 283 40 10 3 2 12 yes

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