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Curr Opin Anaesthesiol. 2019 Feb;32(1):29-38. doi: 10.1097/ACO.0000000000000683.

Extravascular lung water monitoring for thoracic and lung transplant surgeries.

Author information

1
Department of Anesthesiology, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT.
2
David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.

Abstract

PURPOSE OF REVIEW:

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 FINDINGS:

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.

SUMMARY:

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.

PMID:
30507676
DOI:
10.1097/ACO.0000000000000683
[Indexed for MEDLINE]

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