How to Perform Indexing of Extravascular Lung Water

Wolf, Stefan; Riess, A; Landscheidt, Julia F.; Lumenta, Christianto B.; Schürer, L.; Friederich, Patrick

doi:10.1097/ccm.0b013e318275cd75

Cited by 24 publications

(15 citation statements)

References 55 publications

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“…In one of the most recent studies [15], “Chew et al found that EVLW indexed to absolute body weight resulted in a stronger association with outcome” including mortality compared to EVLWI pred [24]. Despite the overall strong predictive capacity of EVLWI in this and other recent trials [12]–[19], these inconsistencies demonstrate the need to optimize indexation of EVLW. Therefore, we recently analyzed a prospectively maintained database regarding the association of EVLW to biometric data [18].…”

Section: Introductionmentioning

confidence: 75%

“…This study demonstrated that height was the only biometric parameter independently associated to EVLW. These data were recently confirmed by Wolf et al, using a similar approach in a surgical group [19]. Despite these conclusive data, both studies did not investigate, if indexation of EVLW to height (EVLWI height ) provides better association to pulmonary function and outcome.…”

Section: Introductionmentioning

confidence: 88%

“…EVLW and its indexation to body weight (EVLWI) became routinely available after the introduction of single-indicator trans-pulmonary thermodilution (TPTD) [1]–[5]. A number of animal and clinical studies demonstrated an association of EVLW(I) to mortality and to parameters of pulmonary function such as PaO 2 /FiO 2 [5]–[19]. Variability of body weight (BW) and height strongly calls for biometric adjustment and indexation.…”

Section: Introductionmentioning

confidence: 99%

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Association between Different Indexations of Extravascular Lung Water (EVLW) and PaO2/FiO2: A Two-Center Study in 231 Patients

et al. 2014

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BackgroundVariability of body weight (BW) and height calls for indexation of volumetric hemodynamic parameters. Extravascular lung water (EVLW) has formerly been indexed to actual BW (BWact) termed EVLW-index (EVLWI). In overweight patients indexation to BWact might inappropriately lower indexed EVLWIact. Several studies suggest indexation of EVLWI to predicted BW (EVLWIpred). However, data regarding association of EVLWIact and EVLWpred to mortality and PaO2/FiO2 are inconsistent. Two recent studies based on biometric database-analyses suggest indexation of EVLWI to height (EVLWIheight). Therefore, our study compared the association of un-indexed EVLW, EVLWIheight, EVLWpred and EVLWIact to PaO2/FiO2 and Oxygenation index (OI = mean airway pressure*FiO2*/PaO2).MethodsA total of 2119 triplicate transpulmonary thermodilutions (TPTDs; PiCCO; Pulsion Medical-Systems, Germany) were performed in 50 patients from the evaluation, and 181 patients from the validation groups. Correlations of EVLW and EVLWI to PaO2/FiO2, OI and ROC-AUC-analyses regarding PaO2/FiO2<200 mmHg (primary endpoint) and OI>10 were performed.ResultsIn the evaluation group, un-indexed EVLW (AUC 0.758; 95%-CI: 0.637-0.880) and EVLWIheight (AUC 0.746; 95%-CI: 0.622-0.869) provided the largest ROC-AUCs regarding PaO2/FiO2<200 mmHg. The AUC for EVLWIpred was smaller (0.713). EVLWIact provided the smallest AUC (0.685). This was confirmed in the validation group: EVLWIheight provided the largest AUC (0.735), EVLWIact (0.710) the smallest. In the merged data-pool, AUC was significantly greater for EVLWIheight (0.729; 95%-CI: 0.674–0.784) compared to all other indexations including EVLWIact (ROC-AUC 0.683, p = 0.007) and EVLWIpred (ROC-AUC 0.707, p = 0.015). The association of EVLW(I) was even stronger to OI compared to PaO2/FiO2. In the merged data-pool, EVLWIheight provided the largest AUC regarding “OI>10” (0.778; 95%-CI: 0.713–0.842) compared to 0.739 (95%-CI: 0.669–0.810) for EVLWIact and 0.756 (95%-CI: 0.688–0.824) for EVLWIpred.ConclusionsIndexation of EVLW to height (EVLWIheight) improves the association of EVLW(I) to PaO2/FiO2 and OI compared to all other indexations including EVLWIpred and EVLWIact. Also considering two recent biometric database analyses, EVLWI should be indexed to height.

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Section: Introductionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Association between Different Indexations of Extravascular Lung Water (EVLW) and PaO2/FiO2: A Two-Center Study in 231 Patients

et al. 2014

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“…This improves accuracy in obese patients and improves correlation with severity of illness and survival in acute lung injury patients [105−107]. Recent data shows that no indexation at all or indexation related to height is better [108], as suggested by others [109,110]. The problem is that there are no good ranges for normal values and such algorithms and decision trees should be used with caution [21, 111].…”

Section: Step 8 Normal Values and Indexationmentioning

confidence: 99%

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

Hofkens¹,

Verrijcken²,

Merveille³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Haemodynamic monitoring with transpulmonary thermodilution (TPTD) is less invasive than a pulmonary artery catheter, and is increasingly used in the Intensive Care Unit and the Operating Room. Optimal treatment of the critically ill patient demands adequate, precise and continuous monitoring of clinical parameters. Little is known about staff knowledge of the basic principles and practical implementation of TPTD measurements at the bedside. The aims of this review are to: 1) present the results of a survey on the knowledge of TPTD measurement among 252 nurses and doctors; and 2) to focus on specific situations and common pitfalls in order to improve patient management in daily practice. Methods: Web-based survey on knowledge of PiCCO technology (Pulsion Medical Systems, Feldkirchen, Germany), followed by PubMed and Medline search with review of the relevant literature regarding the use of TPTD in specific situations. Results: In total, 252 persons participated in the survey: 196 nurses (78%) and 56 medical doctors (22%) of whom 17 were residents in training. Knowledge on the use of TPTD appears to be suboptimal, with an average score of 58.3%. Doctors performed better than nurses (62.7% vs 57.0%, P = 0.012). About 190 out of 252 (75.4%) scored at least 50% but only 45 respondents (17.9%) obtained a score of 70% or more. Having five years of PiCCO experience was present in 15.8% of the participants and this was correlated to passing the test, defined as obtaining a test result of ≥ 50% (P = 0.07) or obtaining a test result of ≥ 70% (P = 0.05). There were no other parameters significantly predictive for obtaining a result above 50% or above 70% such as gender or doctor versus nurse or Belgian versus Dutch residency, or years of ICU experience. High quality education of nursing and medical staff is necessary to perform the technique correctly and to analyse and interpret the information that can be obtained. Visual inspection of thermodilution curves is important as this can point towards specific pathology. Interpretation of the parameters that can be obtained with TPTD in specific conditions is discussed. Finally, a practical approach is given in ten easy steps for nurses and doctors. Conclusion: TPTD has gained its place in the haemodynamic monitoring field, but, as with any technique, its virtue is only fully appreciated with correct use and interpretation.

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“…BW) and formulas (e.g. BSA) might improve indexation of volumetric parameters including GEDVI and extravascular lung water index (EVLWI) [16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

Huber

Mair

Götz

et al. 2016

J Clin Monit Comput

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Global end-diastolic volume (GEDV) has been indexed to body surface area (BSA). However, data validating this indexation of GEDV are scarce. Furthermore, it has been suggested to index GEDV to "predicted BSA" based on predicted body weight. Therefore, we aimed to identify biometric parameters independently associated with GEDV. We analyzed a database including 3812 TPTD measurements in 234 patients treated in the ICU of a German university hospital. GEDVI indexed to actual BSA was significantly lower than GEDVI indexed to predicted BSA (748 ± 179 vs. 804 ± 190 mL/m; p < 0.001). GEDV was independently associated with older age, male sex, height, and actual body weight. In a regression model for the estimation of GEDV, age and height were the most important parameters: Each year in age and each cm in height increased GEDV by 9 and 15 mL, respectively. In addition to height and weight also age and sex should be considered for indexation of GEDV.

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How to Perform Indexing of Extravascular Lung Water

Cited by 24 publications

References 55 publications

Association between Different Indexations of Extravascular Lung Water (EVLW) and PaO2/FiO2: A Two-Center Study in 231 Patients

Association between Different Indexations of Extravascular Lung Water (EVLW) and PaO2/FiO2: A Two-Center Study in 231 Patients

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

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