Radioisotope albumin flux measurement of microvascular lung permeability: an independent parameter in acute respiratory failure?

Summary

Aim: To evaluate the extent to which single measurements of microvascular lung permeability may be relevant as an additional parameter in a heterogenous clinical patient collective with Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). Methods: In 36 patients with pneumonia (13), non pneumogenic sepsis (9) or trauma (14) meeting the consensus conference criteria of ALI or ARDS double-isotope protein flux measurements (⁵¹Cr erythrocytes as intravascular tracer, Tc-99m human albumin as diffusible tracer) of microvascular lung permeability were performed using the Normalized Slope Index (NSI). The examination was to determine whether there is a relationship between the clinical diagnosis of ALI/ARDS, impaired permeability and clinical parameters, that is the underlying disease, oxygenation, duration of mechanical ventilation and mean pulmonary-artery pressure (PAP). Results: At the time of study, 25 patients presented with increased permeability (NSI > 1 × 10^-3 min¹) indicating an exudative stage of disease, and 11 patients with normal permeability. The permeability impairment correlated with the underlying disease (p >0.05). With respect to survival, there was a negative correlation to PAP (p <0.01). Apart from that no correlations between the individual parameters were found. Especially no correlation was found between permeability impairment and oxygenation, duration of disease or PAP. Conclusion: In ALI and ARDS, pulmonary capillary permeability is a diagnostic parameter which is independent from clinical variables. Permeability measurement makes a stage classification (exudative versus non exudative phase) of ALI/ARDS possible based on a measurable pathophysiological correlate.

Zusammenfassung

Ziel: Es sollte evaluiert werden, inwieweit Einzelmessungen der mikrovaskulären Lungenpermeabilität als zusätzlicher Parameter bei einem heterogenen klinischen Patientenkollektiv mit Acute Lung Injury (ALI) und akutem Lungenversagen (ARDS) sinnvoll sind. Methoden: Bei 36 Patienten mit Pneumonie (13), nicht pneumogener Sepsis (9) oder Trauma (14), die die Konsensus-Kriterien des AU oder ARDS erfüllten, wurden Permeabilitätsmessungen der Lunge durchgeführt. Zum Einsatz kam eine Doppelisotopenmethode (Cr-51 Erythrozyten als intravaskulärer Tracer, Tc-99m Humanalbumin als diffusibler Tracer) unter Verwendung des Normalized Slope Index. Durch Regressionsanalysen wurde bestimmt, ob ein Zusammenhang besteht zwischen der klinischen Diagnose eines ALI/ARDS, einer erhöhten Permeabilität und klinischen Parametern wie Grunderkrankung, Oxygenierung, Erkrankungsdauer bis zur Messung und mittlerem pulmonal-arteriellen Druck (PAP). Ergebnisse: Zum Zeitpunkt der Permeabilitätsmessung wiesen 25 Patienten eine erhöhte Kapillarpermeabilität (NSI > 1 × 10^-3 min-¹) als Zeichen einer exsudativen Krankheitsphase auf, während bei 11 Patienten eine normale Permeabilität vorlag. Die Permeabilitätserhöhung korrelierte mit der Grunderkrankung (p <0,05). Bezüglich des Überlebens fand sich eine negative Korrelation zum PAP (p <0,01). Weitere Korrelationen zwischen den Einzelparametern fanden sich nicht. Insbesondere zeigte der Ausprägungsgrad der Permeabilitätsstörung keine Korrelation zur Oxygenierung, der Erkrankungsdauer oder dem PAP. Schlussfolgerung: Die Kapillarpermeabilität ist ein unabhängiger Parameter, dessen Messung die Differenzierung von Krankheitsstadien mit normaler und erhöhter Permeabilität ermöglicht.

Keywords

Acute lung injury - acute respiratory distress syndrome - lung permeability - albuminflux measurement - normalized slope index - Cr-51 erythrocytes - Tc-99m human albumin

Schlüsselwörter

Acute lung injury - akutes Lungenversagen - Lungenpermeabilität - Albuminflux-Messung - normalized slope index - Cr-51 Erythrozyten - Tc-99m Humanalbumin

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