Objective
Measurement of extravascular lung water (EVLW) as a clinical tool for the assessment
of pulmonary function has been found to be more appropriate than oxygenation parameters
or radiographic techniques. In this study, we analyzed the prognostic value of EVLW
in critically ill patients.
Design
Retrospective analysis.
Setting
Operative ICU of a university hospital.
Measurements and results
We retrospectively analyzed 373 critically ill patients (133 female and 240 male patients;
age range, 10 to 89 years; mean ± SD age, 53 ± 19 years) who were treated in our ICU
between 1996 and 2000. All these patients were hemodynamically monitored by the transpulmonary
double-indicator (thermo-dye) dilution technique. Each patient received a femoral
artery sheath through which a 4F flexible catheter with an integrated thermistor and
fiberoptic was advanced into the infradiaphragmatic aorta. EVLW was calculated using
a computer system. For each measurement, 15 to 17 mL of cooled 2% indocyanine green
were injected central venously. In our results, maximum EVLW was significantly higher
in nonsurvivors (n = 186) than in survivors (n = 187) [median, 14.3 mL/kg vs 10.2
mL/kg, respectively; p < 0.001]. In univariate logistic regression models, EVLW (r2 = 0.024, p = 0.003) at baseline as well as simplified acute physiology score (SAPS)
II (r2 = 0.135, p < 0.0001) and APACHE (acute physiology and chronic health evaluation)
II scores (r2 = 0.050, p < 0.0001) were significant predictors of mortality. If SAPS II and APACHE
II scores are combined, r2 increases to 0.136, but the improvement over SAPS II alone is not significant. The
addition of baseline EVLW further increases r2 to 0.149 (p = 0.021 for the improvement), indicating that EVLW contributes independently
to prognosis.
Conclusion
EVLW correlated well with survival (ie, nonsurvivors had significantly higher EVLW values than survivors) and is an independent
predictor of prognosis.
Key words
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Article Info
Publication History
Accepted:
April 12,
2002
Received:
September 12,
2001
Identification
Copyright
© 2002 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Clinical Measurement of Pulmonary EdemaChestVol. 122Issue 6
- PreviewPulmonary edema is an important cause of acute respiratory failure in critically ill patients. In patients with acute myocardial infarction or with exacerbations of chronic left heart failure, pulmonary edema is often a major complication, leading to arterial hypoxemia and the need for treatment in an ICU setting. In some patients, assisted ventilation is required either with noninvasive ventilation or with positive-pressure ventilation via an endotracheal tube. Pulmonary edema also is a cardinal feature of clinical acute lung injury (ALI) and ARDS, resulting from an increase in lung vascular permeability with exudation of protein-rich edema fluid into the interstitium and distal air spaces of the lung.
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