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    Surfactant deactivation in a pediatric model induces hypovolemia and fluid shift to the extravascular lung compartment
    (2012)
    FRANCO JAVIER DIAZ RUBIO
    ;
    Benjamín Erranz
    ;
    Alejandro Donoso
    ;
    CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL  
    ;
    Tatiana Salomón
    Surfactant deficiency is the pivotal abnormality in Neonatal and Acute Respiratory Distress Syndrome. Surfactant deactivation can produce hypoxemia, loss of lung compliance, and pulmonary edema, but its circulatory consequences are less understood. Objective To describe the sequential hemodynamic changes and pulmonary edema formation after surfactant deactivation in piglets. Methods: Surfactant deactivation was induced by tracheal instillation of polysorbate 20 in 15 anesthetized and mechanically ventilated Large White piglets. The hemodynamic consequences of surfactant deactivation were assessed at 30, 120, and 240 min by transpulmonary thermodilution and traditional methods. Results: Surfactant deactivation caused hypoxemia, reduced lung compliance, and progressively increased lung water content (P < 0.01). Early hypovolemia was observed, with reductions of the global end-diastolic volume and stroke volume (P < 0.05). Reduced cardiac output was observed at the end of the study (P < 0.05). Standard monitoring was unable to detect these early preload alterations. Surprisingly, the bronchoalveolar protein content was greatly increased at the end of the study compared with baseline levels (P < 0.01). This finding was inconsistent with the notion that the pulmonary edema induced by surfactant deactivation was exclusively caused by high surface tension. Conclusions: Hypovolemia develops early after surfactant deactivation, in part due to the resulting fluid shift from the intravascular compartment to the lungs
    Scopus© Citations 5  4
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    Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis
    (2022)
    Francesco Gavelli
    ;
    Rui Shi
    ;
    Jean-Louis Teboul
    ;
    Danila Azzolina
    ;
    Pablo Mercado
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients. </jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], <jats:italic>p</jats:italic> &lt; 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of −4.97 mL/kg (95% CI [−6.54; −3.41], <jats:italic>p</jats:italic> &lt; 0.001). The results regarding OR and mean differences were consistent in subgroup analyses.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence.</jats:p> <jats:p><jats:italic>Trial registration</jats:italic> the study protocol was prospectively registered on PROSPERO: CRD42019126985.</jats:p> </jats:sec>
    Scopus© Citations 27  1