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Vascular pedicle width in acute lung injury : correlation with intravascular pressures and ability to discriminate fluid status . INTRODUCTION Conservative fluid management in patients with acute lung injury ( ALI ) increases time alive and free from mechanical ventilation . Vascular pedicle width ( VPW ) is a non-invasive measurement of intravascular volume status . The VPW was studied in ALI patients to determine the correlation between VPW and intravascular pressure measurements and whether VPW could predict fluid status . METHODS This retrospective cohort study involved 152 patients with ALI enrolled in the Fluid and Catheter Treatment Trial ( FACTT ) from five NHLBI ARDS ( Acute Respiratory Distress Syndrome ) Network sites . VPW and central venous pressure ( CVP ) or pulmonary artery occlusion pressure ( PAOP ) from the first four study days were correlated . The relationships between VPW , positive end-expiratory pressure ( PEEP ) , cumulative fluid balance , and PAOP were also evaluated . Receiver operator characteristic ( ROC ) curves were used to determine the ability of VPW to detect PAOP < 8 mmHg and PAOP ≥ 18 mm Hg . RESULTS A total of 71 and 152 patients provided 118 and 276 paired VPW/PAOP and VPW/CVP measurements , respectively . VPW correlated with PAOP ( r = 0.41 ; P < 0.001 ) and less well with CVP ( r = 0.21 ; P = 0.001 ) . In linear regression , VPW correlated with PAOP 1.5-fold better than cumulative fluid balance and 2.5-fold better than PEEP . VPW discriminated achievement of PAOP < 8 mm Hg ( AUC = 0.73 ; P = 0.04 ) with VPW ≤67 mm demonstrating 71 % sensitivity ( 95 % CI 30 to 95 % ) and 68 % specificity ( 95 % CI 59 to 75 % ) . For discriminating a hydrostatic component of the edema ( that is , PAOP ≥ 18 mm Hg ) , VPW ≥ 72 mm demonstrated 61.4 % sensitivity ( 95 % CI 47 to 74 % ) and 61 % specificity ( 49 to 71 % ) ( area under the curve ( AUC ) 0.69 ; P = 0.001 ) . CONCLUSIONS VPW correlates with PAOP better than CVP in patients with ALI . Due to its only moderate sensitivity and specificity , the ability of VPW to discriminate fluid status in patients with acute lung injury is limited and should only be considered when intravascular pressures are unavailable .
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Intervention_Pharmacological
Conservative fluid management
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Intervention_Physical
mechanical ventilation
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Intervention_Physical
Vascular pedicle width ( VPW )
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Outcome_Physical
Vascular pedicle width ( VPW )
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Outcome_Physical
VPW and central venous pressure ( CVP ) or pulmonary artery occlusion pressure ( PAOP )
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Outcome_Physical
relationships between VPW , positive end-expiratory pressure ( PEEP ) , cumulative fluid balance , and PAOP
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Outcome_Physical
VPW