A noninvasive technique for monitoring lung vascular permeability in man

Increased microvascular permeability resulting in increased plasma protein extravasation is the hallmark of acute inflammatory oedema and hence radiolabelled proteins can be used to monitor this process. The adult respiratory distress syndrome (ARDS) is characterized by acute inflammatory oedema and thus provides an ideal model for studying this type of oedema in the human lung. A noninvasive technique applicable to the intensive care unit has been developed for monitoring the pulmonary accumulation of the plasma protein transferrin. Transferrin was radiolabelled in vivo with indium-113m and its accumulation was monitored using a portable probe radiation detector. After correcting for changes in intrathoracic blood distribution, by simultaneously monitoring the accumulation of technetium-99m-labelled red blood cells, an index of plasma protein accumulation was calculated. In all patients with established ARDS (n = 10) the index values were greater than 1.0 X 10(-3) min-1 and these were clearly separate from the values of less than 0.5 X 10(-3) min-1 in all healthy volunteers (n = 5; P less than 0.001). The technique can clearly detect raised plasma protein accumulation indices in the lungs of patients with established inflammatory oedema of ARDS and hence may provide a pharmacological tool for the rapid evaluation in these conditions of the effects of drugs (like corticosteroids) which are known to modulate inflammatory oedema.