Measurement of extravascular lung water during hemodialysis in patients with acute renal and respiratory failure

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 20; no. 9; pp. 673 - 678
• Main Authors: Haraguchi, Yoshikura, Shimada, Kazuaki, Hoshino, Masami, Nagata, Den, Wakabayashi, Toshishige, Okada, Kazuo
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1987
• Subjects: ARDS; MOF
• ISSN: 0911-5889; 1884-6211
• DOI: 10.4009/jsdt1985.20.673

Extravascular lung water (EVLW) was measured in six patients (11 times) in whom both acute respiratory and renal failure existed and hemodialysis (HD) was performed. EVLW was measured using two indicator methods (dye and cooled infusion fluid), developed by Edwards Co. Parameters simultaneously measured included pulmonary arterial pressure (especially PAEDP), cardiac index (C. I.) and arterial blood gases (especially PaO2). These parameters were measured during four different stages, that is, just before HD, during HD, soon after termination of HD and about 12 hours after HD, and then each were compared. Results: EVLW had already increased eight times (73%) before HD. This increase was more marked in patients whose condition was extremely poor. During HD, EVLW decreased in comparison with that before HD in most of the patients. However, EVLW had a tendency to show a gradual increase after termination of HD. Changes in other parameters during and after HD were as follows: 1) both PaO2 and CI diminished during HD, and recovered after HD in many patients. 2) PAEDP was variable. Our results supported the opinion that increased permeability of pulmonary capillary vessels is the most important mechanism causing respiratory failure in patients with renal failure. However, during HD, EVLW decreased in many patients, even though hypoxia became worse. Therefore, factors other than worsening of vascular permeability should be considered, i.e. cardiac suppression, and margination of leukocytes in pulmonary vasculature. On the other hand, it has been thought that many factors influence EVLW. Among them removal of toxic substances by HD might play an important role in decreasing EVLW during and soon after the termination of HD.