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Am J Physiol Lung Cell Mol Physiol (August 4, 2006). doi:10.1152/ajplung.00277.2006
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Submitted on July 22, 2006
Accepted on July 28, 2006

Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bed-side alternatives to the pulmonary artery catheter

Warren Isakow1 and Daniel P. Schuster2*

1 Internal Medicine, Washington University, St. Louis, Missouri, United States
2 Internal Medicine, Washington University, St. Louis, Missouri, United States; Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States

* To whom correspondence should be addressed. E-mail: daniel.schuster{at}wustl.edu.

The recently completed Fluid and Catheter Treatment Trial conducted by the National Institutes of Health ARDSNetwork casts doubt on the value of routine pulmonary artery catheterization for hemodynamic management of the critically ill. Several alternatives are available, and in this review, we evaluate the theoretical, validation, and empirical databases for two of these: transpulmonary thermodilution measurements (yielding estimates of cardiac output, intra-thoracic blood volume, and extravascular lung water) that do not require a pulmonary artery catheter, and hemodynamic measurements (including estimates of cardiac output and ejection time, a variable sensitive to intra-vascular volume) obtained by esophageal Doppler analysis of blood flow through the descending aorta. We conclude that both deserve serious consideration as a means of acquiring useful hemodynamic data for managing shock and fluid resuscitation in the critically ill, especially in those with acute lung injury and pulmonary edema, but that additional study, including carefully performed, prospective clinical trials demonstrating outcome benefit, are needed.




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