Measurement of extravascular lung water during abdominal aortic surgery.
Cross-clamping of the abdominal aorta can be associated with significant changes in haemodynamic variables. However, intraoperative changes in extravascular lung water (EVLW) have not been studied. Nine patients undergoing elective surgery, either aortic aneurysm repair or aorto-bifemoral grafting, were monitored invasively with arterial lines, pulmonary artery catheters and Edwards lung water catheters inserted in either the brachial or axillary artery. Determinations of EVLW were made prior to and five minutes after application of the aortic cross-clamp and at 30-minute intervals during the course of the operation. Baseline EVLW was found to be 7-9 ml.kg-1. There were no significant changes in haemodynamic variables and no changes in EVLW with cross-clamping of the aorta. The EVLW did not change during the course of surgery. The EVLW did not increase in the absence of sustained elevation of pulmonary capillary wedge pressure. One patient developed an axillary artery thrombosis which required thrombectomy at the site of lung water catheter insertion. Two other patients lost their distal pulses without overt ischaemic changes. It was felt that such relatively high incidence of complications precluded further use of the lung water catheter in the axillary or brachial artery.