Diagnostic value of transpulmonary thermodilution measurements for acute respiratory distress syndrome in a pig model of septic shock

Journal of Translational Medicine

Research

Takashi Tagami¹  Yoshio Kawamura²  Kenjiro Miyoshi²  Taku Miyasho²  Kanako Endo³  Ryosuke Takegawa³  Lance B. Becker⁴  Kei Hayashida⁵  Yusuke Endo⁶ 

[1] Department of Emergency Medicine and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan;School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan;The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, 11030, Manhasset, NY, USA;The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, 11030, Manhasset, NY, USA;Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA;The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, 11030, Manhasset, NY, USA;Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA;Department of Emergency Medicine, South Shore University Hospital, Northwell Health, Bay Shore, NY, USA;The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, 11030, Manhasset, NY, USA;School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan;

关键词: Pulmonary vascular permeability index;    ARDS;    Extravascular lung water;    Diagnostic criteria;    Large animal study;   

DOI  :  10.1186/s12967-022-03793-x

 received in 2022-08-31, accepted in 2022-11-24,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundNo direct approach assessing pulmonary vascular permeability exists in the current therapeutic strategy for patients with acute respiratory distress syndrome (ARDS). Transpulmonary thermodilution measures hemodynamic parameters such as pulmonary vascular permeability index and extravascular lung water, enabling clinicians to assess ARDS severity. The aim of this study is to explore a precise transpulmonary thermodilution-based criteria for quantifying the severity of lung injury using a clinically relevant septic-ARDS pig model.MethodsThirteen female pigs (weight: 31 ± 2 kg) were intubated, mechanically ventilated under anesthesia, and either assigned to septic shock-induced ARDS or control group. To confirm the development of ARDS, we performed computed tomography (CT) imaging in randomly selected animals. The pulmonary vascular permeability index, extravascular lung water, and other hemodynamic parameters were consecutively measured during the development of septic lung injury. Lung status was categorized as normal (partial pressure of oxygen/fraction of inspired oxygen ≥ 400), or injured at different degrees: pre-ARDS (300–400), mild-to-moderate ARDS (100–300), or severe ARDS (< 100). We also measured serum inflammatory cytokines and high mobility group box 1 levels during the experiment to explore the relationship of the pulmonary vascular permeability index with these inflammatory markers.ResultsUsing CT image, we verified that animals subjected to ARDS presented an extent of consolidation in bilateral gravitationally dependent gradient that expands over time, with diffuse ground-glass opacification. Further, the post-mortem histopathological analysis for lung tissue identified the key features of diffuse alveolar damage in all animals subjected to ARDS. Both pulmonary vascular permeability index and extravascular lung water increased significantly, according to disease severity. Receiver operating characteristic analysis demonstrated that a cut-off value of 3.9 for the permeability index provided optimal sensitivity and specificity for predicting severe ARDS (area under the curve: 0.99, 95% confidence interval, 0.98–1.00; sensitivity = 100%, and specificity = 92.5%). The pulmonary vascular permeability index was superior in its diagnostic value than extravascular lung water. Furthermore, the pulmonary vascular permeability index was significantly associated with multiple parameters reflecting clinicopathological changes in animals with ARDS.ConclusionThe pulmonary vascular permeability index is an effective indicator to measure septic ARDS severity.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 1

Fig. 3

Fig. 6

41408_2022_764_Article_IEq31.gif

41408_2022_764_Article_IEq28.gif

40249_2022_1045_Article_IEq14.gif

Fig. 8