The standardized partial regression coefficients were 0.958 for PVPI and 0.646 for ITBV in ALI/ARDS patients, and were 0.836 and 0.814 in non-ALI/ARDS patients, respectively, suggesting the important contribution of PVPI on the EVLWI in ALI/ARDS.Relationship between extravascular lung water index selleck chemicals Ceritinib and PaO2/FiO2 ratioFor this analysis, patients with pleural effusion with atelectasis were excluded because the increased EVLW is not the pathogenetic mechanism of this condition, and EVLWI in these patients was not high as in those patients with ALI/ARDS and cardiogenic edema.The P/F ratio varied widely at all levels of EVLWI in patients with both ALI/ARDS and cardiogenic edema (Figure (Figure6).6). A negative but weak correlation was noted between EVLWI and the P/F ratio in all patients except for those with pleural effusion with atelectasis (r = -0.

213, P < 0.01) and ALI/ARDS (r = -0.215, P < 0.01). No correlation was found between EVLWI and PVPI in cardiogenic edema patients (r = -0.176, P = 0.39).Figure 6Correlation between extravascular lung water index and PaO2/FiO2 ratio. There was a negative and weak correlation between extravascular lung water index (EVLWI) and PaO2/FiO2 (P/F) ratio in all patients except for pleural effusion with atelectasis patients ...Differential diagnosis of ALI/ARDS on the basis of pulmonary vascular permeabilityReceiver operating characteristic curves were generated using PVPI and ITBV on the day of enrollment to differentiate between ALI/ARDS patients and non-ALI/ARDS patients. The area under the curve for PVPI (0.886; confidence interval, 0.

836 to 0.935) was significantly larger than that for ITBV (0.575; confidence interval, 0.471 to 0.651; P < 0.01) (Figure (Figure77).Figure 7Receiver operating characteristic curves for pulmonary vascular permeability index and intrathoracic blood volume. Receiver operating characteristic curves for pulmonary vascular permeability index (PVPI) and intrathoracic blood volume (ITBV) on the day ...The cutoff value for the definitive quantitative diagnosis of ALI/ARDS needs to be determined considering the high specificity despite the decreased level of sensitivity, as discussed in the next section. The cutoff value of the PVPI to diagnose ALI/ARDS was found to be between 2.85 (sensitivity, 0.54; specificity, 0.95) and 2.6 (sensitivity, 0.64; specificity, 0.90).

The cutoff value of the PVPI to diagnose non-ALI/ARDS was between 1.7 (sensitivity, 0.50; specificity, 0.95) and 2.0 (sensitivity, 0.70; specificity, 0.90).DiscussionIn this prospective multi-institutional observational study, EVLW and pulmonary vascular permeability were assessed by transpulmonary thermodilution in patients Drug_discovery requiring mechanical ventilation with P/F ratio �� 300 mmHg and bilateral pulmonary infiltration on chest X-ray scan.