EFFECT OF POSITIVE-END EXPIRATORY PRESSURE ON ACCURACY OF THERMAL-DYE MEASUREMENTS OF LUNG WATER

The thermal-dye indicator dilution technique of measuring extravascular lung water (EVLW-TD) correlated well with gravimetric measurement of lung water (EVLW-GR) when no positive-end expiratory pressure (PEEP) was used in normal and edematous lungs. PEEP is often used to raise arterial O2 tension in acute respiratory failure. Whether PEEP had an effect on the accuracy of the EVLW measurement by thermal dye was investigated. Mongrel dogs (16) were anesthetized and intubated. Arterial and PA [pulmonary artery] catheters were placed. They were divided into 3 groups and ventilated at PEEP levels of 5, 10 or 15 cm H2O. Fluids were given to minimize decrease in cardiac output with institution of PEEP. They were maintained for 5 h with measurement of vital signs made hourly and measurement of blood gases and EVLW-TD made at baseline, 1, 3 and 5 h. After final measurements, gravimetric determinaton of EVLW was done. Correlation between EVLWTD and EVLWGR remained good when low levels of PEEP were used. AT 5 cm H2O PEEP, EVLWTD was 7.5 .+-. 0.9 and EVLWGR was 5.4 .+-. 0.3. At 10 cm H2O PEEP, they were 10.0 .+-. 0.9 and 6.5 .+-. 0.3. The correlations were 0.87 and 0.97, respectively. However, at 15 cm H2O PEEP, EVLWTD was 11.4 .+-. 1.3 and EVLWGR was 7.5 .+-. 0.6, with a correlation of only 0.59. The correlation between the 2 techniques seems to break down with higher levels of PEEP in dogs with normal lungs.