Extravascular lung water in reperfusion lung injury
Research type
Research Study
Full title
Extravascular lung water as an early predictor and marker of the severity of reperfusion lung injury in pulmonary endarterectomy: A prospective cohort study
IRAS ID
189057
Contact name
Nicola Jones
Contact email
Sponsor organisation
Papwworth Hospital R&D
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Background: Patients undergoing pulmonary endarterectomy (PEA - surgical treatment for pulmonary arterial hypertension) are at risk of developing reperfusion lung injury following surgery. This represents a form of lung oedema (in up to 40% of patients) which is associated with poor clinical outcomes including increases in duration of respiratory support, length of intensive care unit stay and death. Extravascular lung water (EVLW) is the fluid in the lung that is not within the vascular or pleural spaces. EVLW can be measured by transplulmonary thermodilution which is based on injection of cold saline through a central vein. An arterial thermister placed in the femoral artery measures the change in blood temperature in the lungs and plots it against time. From these measurements EVLW can be calculated. EVLW indexed to predicted body weight (EVLWi) has been proposed as a predictor of perioperative lung oedema and a marker of disease severity.
Objective: The primary aim of this prospective study is to evaluate EVLW as a predictor of clinically significant lung reperfusion injury in the context of PEA. Clinically significant reperfusion injury is defined as: acute pulmonary infiltrates on chest X-ray, low oxygen levels and need for respiratory support. Our hypothesis is that PEA patients with high perioperative EVLWi values are more likely to develop clinically significant reperfusion lung oedema.
Methods: After ethical approval is granted we will study a cohort of 51 patients undergoing PEA, estimated to provide 80% (a=0.05) power to detect correlations and differences. Patients requiring mechanical cardiovascular support will be excluded. All patients will be anaesthetised and monitored according to a standard protocol. The value of EVLWi considered as normal will be <7ml/kg of predicted body weight. The relationship of these indices to early diagnosis and severity of reperfusion injury and mortality will be studied using the appropriate statistical tests.
REC name
East Midlands - Nottingham 2 Research Ethics Committee
REC reference
15/EM/0486
Date of REC Opinion
26 Oct 2015
REC opinion
Favourable Opinion