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VOLUME 21 , ISSUE 8 ( 2017 ) > List of Articles

RESEARCH ARTICLE

How useful is extravascular lung water measurement in managing lung injury in intensive care unit?

Anirban Bhattacharjee, Debasis Pradhan, Prithwis Bhattacharyya, Daniala Chhunthang, Akash Handique, Angkita Barman, Mohd Yunus

Keywords : Acute respiratory distress syndrome, extravascular lung water, septic shock, thermodilution

Citation Information : Bhattacharjee A, Pradhan D, Bhattacharyya P, Chhunthang D, Handique A, Barman A, Yunus M. How useful is extravascular lung water measurement in managing lung injury in intensive care unit?. Indian J Crit Care Med 2017; 21 (8):494-499.

DOI: 10.4103/ijccm.IJCCM_40_17

License: CC BY-ND 3.0

Published Online: 01-08-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Context: The primary goal of septic shock management is optimization of organ perfusion, often at the risk of overloading the interstitium and causing pulmonary edema. The conventionally used end points of resuscitation do not generally include volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). Aims: This study aimed to assess the prognostic value of EVLWI and PVPI by calculating their correlation with the severity of lung injury. Settings and Design: This prospective observational study included twenty mechanically ventilated critically ill patients with Acute Physiology and Chronic Health Evaluation score (APACHE II) >20. Subjects and Methods: EVLWI and PVPI were measured using transpulmonary thermodilution, and simultaneously, PaO2:FiO2 ratio, alveolar-arterial gradient of oxygen (AaDO2), and chest radiograph scores from two radiologists were obtained. Statistical Analysis: The correlation of EVLWI and PVPI with chest radiograph scores, PaO2:FiO2 ratio, and AaDO2 were calculated. The inter-observer agreement between the two radiologists was tested using kappa test. Results: EVLWI and PVPI correlated modestly with PaO2:FiO2 (r = −0.32, P = 0.0004; r = −0.39, P = 0.0001). There was a better correlation of EVLWI and PVPI with PaO2:FiO2 ratio (r = −0.71, P < 0.0001; r = −0.58, P = 0.0001) in the acute respiratory distress syndrome (ARDS) subgroup. The EVLWI values correlated significantly with corresponding chest radiograph scores (r = 0.71, P < 0.0001 for observer 1 and r = 0.68, P < 0.0001 for observer 2). Conclusions: EVLWI and PVPI may have a prognostic significance in the assessment of lung injury in septic shock patients with ARDS. Further research is required to reveal the usefulness of EVLWI as an end point of fluid resuscitation in the management of septic shock with ARDS.


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  1. Perel A, Monnet X. Extravascular lung water. In: Vincent J, Hall J, editos. Encyclopedia of Intensive Care Medicine. Berlin Heidelberg: Springer-Verlag; 2011.
  2. Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: Recent advances and clinical applications. Ann Intensive Care 2015;5:38.
  3. Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 1999;27:639-60.
  4. Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest 2002;122:2080-6.
  5. Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE, et al. Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest 1985;88:649-52.
  6. Chew MS, Ihrman L, During J, Bergenzaun L, Ersson A, Undén J, et al. Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock. Crit Care 2012;16:R1.
  7. Berkowitz DM, Danai PA, Eaton S, Moss M, Martin GS. Accurate characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med 2008;36:1803-9.
  8. Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, et al. Extravascular lung water indexed to predicted body weight is a novel predictor of Intensive Care Unit mortality in patients with acute lung injury. Crit Care Med 2010;38:114-20.
  9. Phillips CR, Chesnutt MS, Smith SM. Extravascular lung water in sepsis-associated acute respiratory distress syndrome: Indexing with predicted body weight improves correlation with severity of illness and survival. Crit Care Med 2008;36:69-73.
  10. Fernández-Mondéjar E, Rivera-Fernández R, García-Delgado M, Touma A, Machado J, Chavero J, et al. Small increases in extravascular lung water are accurately detected by transpulmonary thermodilution. J Trauma 2005;59:1420-3.
  11. Brown LM, Calfee CS, Howard JP, Craig TR, Matthay MA, McAuley DF, et al. Comparison of thermodilution measured extravascular lung water with chest radiographic assessment of pulmonary oedema in patients with acute lung injury. Ann Intensive Care 2013;3:25.
  12. Martin GS, Eaton S, Mealer M, Moss M. Extravascular lung water in patients with severe sepsis: A prospective cohort study. Crit Care 2005;9:R74-82.
  13. Szakmany T, Heigl P, Molnar Z. Correlation between extravascular lung water and oxygenation in ALI/ARDS patients in septic shock: Possible role in the development of atelectasis? Anaesth Intensive Care 2004;32:196-201.
  14. Laggner A, Kleinberger G, Sommer G, Haller J, Lenz K, Base W, et al. Determination of extravascular lung water in critical patients: Comparison with radiological, hemodynamic and functional lung findings. Schweiz Med Wochenschr 1985;115:210-3.
  15. Touho H, Karasawa J, Shishido H, Yamada K, Yamazaki Y. Hypoxemia in the acute stage of hypertensive intracerebral hemorrhage, with special reference to increased extravascular lung water. Neurol Med Chir (Tokyo) 1989;29:724-7.
  16. Knoch M, Vogell H, Höltermann W, Müller E, Lennartz H. The measurement of extravascular lung water – Significant in the follow-up of ARDS? Anasth Intensivther Notfallmed 1990;25:411-5.
  17. Tyagi A, Sethi AK, Girotra G, Mohta M. The microcirculation in sepsis. Indian J Anaesth 2009;53:281-93.
  18. Jozwiak M, Silva S, Persichini R, Anguel N, Osman D, Richard C, et al. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome. Crit Care Med 2013;41:472-80.
  19. Chung FT, Lin HC, Kuo CH, Yu CT, Chou CL, Lee KY, et al. Extravascular lung water correlates multiorgan dysfunction syndrome and mortality in sepsis. PLoS One 2010;5:e15265.
  20. Matthay MA. Clinical measurement of pulmonary edema. Chest 2002;122:1877-9.
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