Extravascular lung water monitoring for thoracic and lung transplant surgeries

• Published in: Current opinion in anaesthesiology Vol. 32; no. 1; pp. 29 - 38
• Main Authors: Assaad, Sherif, Kratzert, Wolf B, Perrino, Jr, Albert C
• Format: Journal Article
• Language: English
• Published: United States 01-02-2019
• Subjects: Critical Care; Extravascular Lung Water - diagnostic imaging; Humans; Intensive Care Units; Lung - diagnostic imaging; Lung - surgery; Lung Neoplasms - surgery; Lung Transplantation - adverse effects; Monitoring, Physiologic; Perioperative Care - methods; Pneumonectomy - adverse effects; Predictive Value of Tests; Preoperative Care - methods; Pulmonary Edema - diagnosis; Pulmonary Edema - etiology; Pulmonary Edema - prevention & control; Sensitivity and Specificity; Thermodilution - methods; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
• ISSN: 0952-7907; 1473-6500
• DOI: 10.1097/ACO.0000000000000683

Excessive accumulation of extravascular lung water (EVLW) resulting in pulmonary edema is the most feared complication following thoracic surgery and lung transplant. ICUs have long relied on chest radiography to monitor pulmonary status postoperatively but the increasing recognition of the limitations of bedside plain films has fueled development of newer technologies, which offer earlier detection, quantitative assessments, and can aide in preoperative screening of surgical candidates. In this review, we focus on the emergence of transpulmonary thermodilution (TPTD) and lung ultrasound with a focus on the clinical integration of these modalities into current intraoperative and critical care practices.
Recent studies demonstrate transpulmonary thermodilution and lung ultrasound provide greater sensitivity and earlier detection of lung water accumulation and are useful to guide clinical management. Assessments from these techniques have predictive value of postoperative outcome. Further, EVLW assessment shows promise as a preoperative screening tool in lung transplant patients.
Monitoring EVLW in the perioperative period offers clinicians a powerful tool to guide fluid therapy and manage pulmonary edema. Both TPTD and lung ultrasound have unique attributes in the care of thoracic surgery and lung transplant patients.