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Extra vascular lung water but not lung ultrasound predicts grade 3 pulmonary graft dysfunction and utilization of rescue therapies for severe hypoxemia after lung transplantation
Intensive Care Medicine Experimental volume 3, Article number: A233 (2015)
Intr
Primary graft dysfunction (PGD) is the result of pulmonary edema following lung transplantation. The definition [1] is based on Pa02/Fi02 and the presence of lung infiltrates on chest X-ray. Lung ultrasonography (LUS) and the extravascular lung water index (EVLWi) are reliable methods for quantification of lung edema [2, 3].
Objectives
We tested if LUS and EVLWi were associated with grade 3 PGD.
Methods
We prospectively included patients who underwent lung transplantation in one university teaching hospital over a 14-month period. LUS scores and EVLWi were assessed at ICU admission and during the following 48 hours period. We compared patients with grade 3 PGD with the others.
Results
36 patients were included. Among them, 13 (36 %) had grade 3 PGD. EVLWi was significantly higher in the grade 3 PGD group at ICU admission, day one and at day 2.
A cut-off value of 14 ml/kg of EVLWi at admission predicts the progression to grade 3 PGD with a sensitivity of 82% and a specificity of 77% and was significantly associated with the need for rescue therapy for severe hypoxemia.
Less than a half of patients had all their LUS windows available. LUS scores did not discriminate patients with grade 3 PGD from the others.
Conclusions
Contrary to LUS scores, EVLWi is a promising tool for early assessment of grade 3 PGD after lung transplantation.
References
Christie JD, Carby M, Bag R, Corris P, Hertz M, Weill D: Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2005, 24 (10): 1454-1459. 10.1016/j.healun.2004.11.049.
Agricola E, Bove T, Oppizzi M, et al: “ultrasound comet-tail images”: A marker of pulmonary edema*: a comparative study with wedge pressure and extravascular lung water. Chest. 2005, 127 (5): 1690-1695. 10.1378/chest.127.5.1690.
Katzenelson R, Perel A, Berkenstadt H, et al: Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit Care Med. 2004, 32 (7): 1550-1554. 10.1097/01.CCM.0000130995.18334.8B.
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Guervilly, C., Lehingue, S., Dizier, S. et al. Extra vascular lung water but not lung ultrasound predicts grade 3 pulmonary graft dysfunction and utilization of rescue therapies for severe hypoxemia after lung transplantation. ICMx 3 (Suppl 1), A233 (2015). https://doi.org/10.1186/2197-425X-3-S1-A233
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DOI: https://doi.org/10.1186/2197-425X-3-S1-A233