Extravascular Lung Water and Acute Lung Injury

Abstract

Acute lung injury carries a high burden of morbidity and mortality and is characterised by nonhydrostatic pulmonary oedema. The aim of this paper is to highlight the role of accurate quantification of extravascular lung water in diagnosis, management, and prognosis in “acute lung injury” and “acute respiratory distress syndrome”. Several studies have verified the accuracy of both the single and the double transpulmonary thermal indicator techniques. Both experimental and clinical studies were searched in PUBMED using the term “extravascular lung water” and “acute lung injury”. Extravascular lung water measurement offers information not otherwise available by other methods such as chest radiography, arterial blood gas, and chest auscultation at the bedside. Recent data have highlighted the role of extravascular lung water in response to treatment to guide fluid therapy and ventilator strategies. The quantification of extravascular lung water may predict mortality and multiorgan dysfunction. The limitations of the dilution method are also discussed.

Extravascular lung water in acute respiratory distress syndrome: potential clinical value, assumptions and limitations

“…These findings are in accordance with the available literature [2-4], which suggests that EVLW is a good predictor of mortality with an odds ratio of 8.8 [5]. However, there is still no firm consensus on its range of normal values and the best indexing parameter (for example, actual or predicted body weight or pulmonary blood volume) against which EVLW should be normalised.…”

Electrical impedance tomography (EIT) for quantification of pulmonary edema in acute lung injury

“…The widely used standard chest x-ray is unreliable for estimation of pulmonary fluid content [ 5 , 6 ]. X-ray is capable of detecting only changes in EVLW exceeding 38 % [ 7 ] and therefore is not suited to guide therapeutic interventions aimed at changing EVLW [ 8 ].…”

Extravascular Lung Water and Sepsis

“…EVLW ile arteryel oksijenizasyon arasındaki ilişki incelendiğinde ise, arteryel oksijenizasyonun bozulması için EVLW'ın normalin % 200'ü kadar artması gerektiği sonucuna varılmıştır (30) . Septik şok hastalarında, EVLWI ve akciğer hasar skoru artışı, kompliyans ve oksijenizasyonda azalma ile orantılıdır.…”