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Methods This retrospective cohort study involved 152 patients with ALI enrolled in the Fluid and Catheter Treatment Trial (FACTT) from five NHLBI ARDS (Acute Respiratory Distress Syndrome) Network sites. VPW and central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) from the first four study days were correlated. The relationships between VPW, positive end-expiratory pressure (PEEP), cumulative fluid balance, and PAOP were also evaluated.

Receiver operator characteristic (ROC) curves were used to determine the ability of VPW to detect PAOP. Results A total of 71 and 152 patients provided 118 and 276 paired VPW/PAOP and VPW/CVP measurements, respectively. VPW correlated with PAOP (r = 0.41; P. The NIH NHLBI ARDS Network Fluid and Catheter Treatment Trial (FACTT) demonstrated that fluid management for patients with acute lung injury (ALI) using a protocol guided by intravascular pressure measurements from a central venous catheter (CVC) resulted in similar clinical outcomes compared to fluid management directed by measurements from a pulmonary artery catheter (PAC) [ ]. The PAC group experienced significantly more nonfatal complications, mostly in the form of arrhythmias. These results, combined with previous studies demonstrating either lack of benefit or increased harm, have led many experts to discourage the routine use of the PAC in patients with ALI [, ]. Regardless of the type of catheter, a conservative fluid management strategy in ALI patients increased the number of days alive and free from mechanical ventilation [ ].

Central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) was used to generate instructions and function as targets for the fluid management strategies in this trial. It remains unknown if such invasive measurements are required for management of critically ill patients or if non-invasive measurements would suffice. Portable chest x-rays (CXR) are obtained frequently in patients with ALI. In previous studies, the vascular pedicle width (VPW), either alone or in conjunction with the cardiothoracic ratio (CTR), which are both easily measured on most portable CXRs [ ], has correlated with intravascular volume status in both critically ill and non-critically ill patients [ – ]. Lal kitab kundli free. Despite these data, monitoring of VPW is not part of standard practice.

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The purpose of this study was to investigate the relationship between non-invasive measures of intravascular volume status, namely the VPW and CTR and invasive intravascular pressure measurements, namely CVP and/or PAOP, in ALI patients enrolled in the FACTT study at five Acute Respiratory Distress Syndrome (ARDS) Network sites. In addition, the ability of VPW to discriminate when the edema had a hydrostatic component or when conservative fluid management goals were achieved was also investigated. Patients included in this analysis were a subset of patients enrolled in the ARDS Network Fluid and Catheter Treatment Trial (FACTT). All centers enrolling in FACTT obtained local IRB approval and all patients or their surrogates provided informed consent. This data analysis was also specifically considered exempt by the Vanderbilt Institutional Review Board. FACTT was a multi-center, randomized clinical trial of two different fluid strategies (conservative vs.