Evaluation of Correlation between Vascular Pedicle Width and Intravascular Volume Status in Thai Critically Ill Patients
Sanit Wichansawakul MD*, Warakarn Vilaichone MD**, Surat Tongyoo MD**, Chairat Permpikul MD**, Suwimol Wonglaksanapimol MD***, Kantima Daengnim RN****, Girapong Suwanboonrit MD**
Affiliation : * Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Department of Nursing, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate the correlation between vascular pedicle widths (VPW) measured from portable chest roentgenogram
(CXR) and intravascular volume status in Thai critically ill patients.
Material and Method: A prospective cohort study included the critically ill patients in whom pulmonary artery catheter was
placed in the Medical Intensive Care Units of Siriraj Hospital, Mahidol University between June 2009 and January 2010. The
patient’s baseline characteristics, hemodynamic data measured from pulmonary artery catheter (PAC) and CXR parameters
were collected.
Results : From thirty-four patients, thirteen (38.2%) had high pulmonary artery occlusive pressure (PAOP >18 mmHg). The
patients with high PAOP were older (69.8 + 8.8 years vs. 59.2 + 15.4 years, p = 0.02), taller (163.2 + 5.3 cm vs. 157.0 + 10.4
cm, p = 0.03) and higher weight (67.4 + 12.9 kg vs. 57.1 + 7.8 kg, p = 0.007) than the low PAOP group. The correlations
between PAOP and VPW (r = 0.68, p < 0.001) as well as between PAOP and cardiothoracic ratio (CTR) (r = 0.23, p = 0.03)
were significant. From the receiver operating characteristic (ROC) curve, VPW > 68 mm is the best parameter to predict
PAOP > 18 mmHg (the area under the curve (AUC) = 0.853, p < 0.001, sensitivity = 92.3%, specificity = 85.7%). The CTR
> 0.58 can be used to predict elevated PAOP > 18 mmHg with acceptable sensitivity = 85.74% and specificity = 76.9% (AUC
= 0.727, p = 0.03). The peribronchial cuffing (PBC) was detected at a higher percentage among high PAOP group than in the
low PAOP group (76.9% vs. 33.3%, p = 0.03).
Conclusion : The VPW > 68 mm, CTR > 0.58 and the present of PBC can be used together to predict elevation of PAOP > 18
mmHg among the Thai critically ill patients. By using these CXR parameters, the PAC insertion may be avoided especially in
patients with contraindication.
Keywords : Intravascular volume, Chest x-ray, Vascular pedicle width critically ill patients, Cardiothoracic ratio, Pulmonary atery ccclusive pressure
