PT  - JOURNAL ARTICLE
AU  - L. B. Ware
AU  - R. D. Fremont
AU  - J. A. Bastarache
AU  - C. S. Calfee
AU  - M. A. Matthay
TI  - Determining the aetiology of pulmonary oedema by the oedema fluid-to-plasma protein ratio
AID  - 10.1183/09031936.00098709
DP  - 2010 Feb 01
TA  - European Respiratory Journal
PG  - 331--337
VI  - 35
IP  - 2
4099  - http://erj.ersjournals.com/content/35/2/331.short
4100  - http://erj.ersjournals.com/content/35/2/331.full
SO  - Eur Respir J2010 Feb 01; 35
AB  - We hypothesised that the oedema fluid-to-plasma protein (EF/PL) ratio, a noninvasive measure of alveolar capillary membrane permeability, can accurately determine the aetiology of acute pulmonary oedema. 390 mechanically ventilated patients with acute pulmonary oedema were enrolled. A clinical diagnosis of acute lung injury (ALI), cardiogenic pulmonary oedema or a mixed aetiology was based on expert medical record review at the end of hospitalisation. The EF/PL ratio was measured from pulmonary oedema fluid and plasma samples collected at intubation. 209 patients had a clinical diagnosis of ALI, 147 had a diagnosis of cardiogenic pulmonary oedema and 34 had a mixed aetiology. The EF/PL ratio had an area under the receiver-operating curve of 0.84 for differentiating ALI from cardiogenic pulmonary oedema. Using a predefined cut-off of 0.65, the EF/PL ratio had a sensitivity of 81% and a specificity of 81% for the diagnosis of ALI. An EF/PL ratio ≥0.65 was also associated with significantly higher mortality and fewer ventilator-free days. Noninvasive measurement of the EF/PL ratio is a safe and reliable bedside method for rapidly determining the aetiology of acute pulmonary oedema that can be used at the bedside in both developed and developing countries.