Increased vascular pedicle width preceding burn-related pulmonary edema

Widening of the vascular pedicle on the chest roentgenogram is a recently identified sign of increased circulating blood volume. To determine whether vascular pedicle enlargement can be detected during the initial day of burn resuscitation and whether this change correlates with the early development of pulmonary edema, we reviewed the serial chest roentgenograms of 42 patients with cutaneous burns and risk factors for inhalation injury. Although no patient had pulmonary edema at the time of vascular pedicle measurements, 18 (42.9%) developed this complication during the 3.3 ± 1.5 days after injury. These patients were significantly older (p<0.025) and had received more resuscitative fluid (P<0.005) than those without pulmonary edema. Initial vascular pedicle width was similar in both groups (5.9 ± 0.9 vs 6.0 ± 1.0 cm) and did not change in patients without pulmonary edema (5.8 ± 0.7 cm). Vascular pedicle width increased (6.9 ± 1.2 cm, p<0.01) in patients who subsequently developed pulmonary edema, and 12 of the 13 patients who had changes exceeding + 1.0 cm had this problem. Enlargement of the vascular pedicle is associated with early burn-related pulmonary edema and might provide a clinically useful predictor of this cardiopulmonary complication.