Chest
Volume 88, Issue 5, November 1985, Pages 649-652
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Clinical Investigations
Evaluation of the Portable Chest Roentgenogram for Quantitating Extravascular Lung Water in Critically Ill Adults

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The diagnosis of pulmonary edema is frequently made from characteristic findings on the chest roentgenogram that suggest an increase in lung water. Optimal radiographic technique depends on a cooperative upright patient, which is not possible with most critically ill patients. These patients may also have multiple radiographic abnormalities that make interpretation of the chest roentgenogram difficult. The ability of portable chest roentgenograms to accurately identify the presence of excess lung water and monitor changes in lung water has not previously been evaluated in critically ill adults who are intubated and ventilated and in the supine position when the films are exposed. In 12 patients the pulmonary edema seen on portable chest roentgenograms was given a score (0 to 390 points), which was then compared with a determination of extravascular lung water using the thermal-dye indicator dilution technique. A linear correlation was observed (r=0.51; p<0.05; n=73). Evaluation of a change in radiographic score vs a change in lung water showed no linear correlation (r=0.1; p>0.05). While portable chest roentgenograms exposed under the conditions described were a useful technique for demonstrating pulmonary edema, they were not accurate in monitoring modest changes in lung water in critically ill patients.

Section snippets

Materials and Methods

TWelve patients admitted to the intensive care unit with a diagnosis of respiratory failure were studied. All patients were intubated and mechanically ventilated at the time of entry into this study. The study was approved by the Stanford University Human Subjects Committee, and informed consent was obtained. A 16 ga central venous catheter or a 7F triple-lumen pulmonary artery catheter (Edwards Laboratory model 93A) was placed via the right internal jugular vein using a modified Seldinger

Results

Measurements of extravascular lung water (n=73) were compared with portable chest radiographic scores in 12 patients who were supine at the time of filming (Table 1). Chest roentgenograms were monitored and measurements of extravascular lung water were taken for two to six days for each patient. Extravascular lung water measured from 3.9 ml/kg to 44 ml/kg. Portable chest radiograph scores ranged from 120 points to 390 points. The average change in lung water was 2.2 ml/kg between successive

Discussion

This study sought to evaluate the accuracy of portable chest roentgenograms as a readily obtainable noninvasive monitor of extravascular lung water. The accuracy of the technique for measurement of lung water and the reliability of the radiographic scoring system was critical for this analysis. For the purpose of this study, careful attention was paid to a consistent quality of the portable chest roentgenograms, so that the radiographic technique would not interfere with the evaluation of any

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Presented in part at the annual meeting of the American Society of Anesthesiologists, Atlanta, Oct 12, 1983.

Manuscript received December 27; revision accepted May 7.

Fellow, Critical Care Medicine

Assodate Professor of Anesthesia (Clinical)

§

Assistant Professor of Anesthesia

Resident, Diagnostic Radiology.

Assistant Professor of Radiology.

**

Professor of Radiology.

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