Radiologic assessment of volemic status: vascular pedicle width

Objectives

Portable, supine chest roentgenograms (CXRs) are the most commonly used noninvasive method to identify pulmonary edema in the ICU. We conduct a study to evaluate the influence of cardiomegaly, pulmonary edema and vascular pedicle width (VPW) on diagnosing hypervolemia using digital CXRs.

Methods

A radiologist selected eight CXRs to assure equal proportions of: cardiothoracic ratio (CTR) >0.55; presence of Kerley's lines and VPW >70 mm. Assuming that VPW >70 mm is indicative of hypervolemia, two groups of 10 intensivists (≤ 10 years and >10 years of activity) were enrolled without any additional clinical information.

Results

See Table 1.

Table 1 Evaluation of the agreement, vascular pedicle width >70 mm and hypervolemia

Conclusions

The overall agreement of VPW and the diagnostic of hypervolemia is poor among young and older intensivists. Older intensivists are prone to admit hypervolemia even in the absence of cardiomegaly or pulmonary congestion.