Influence of Extravascular Lung Water Determination in Fluid and Vasoactive Therapy

Abstract

Quantification of EVLW in patients who can be considered euvolemic induces important modifications in fluid and vasoactive therapy. These changes generally resulted in a lower volume loading and a positive outcome for the patient.

The precision of PiCCO®measurements in hypothermic post‐cardiac arrest patients

“…There is good evidence regarding the efficacy of goal-directed fluid management based on transpulmonary thermodilution-measured variables using the PiCCO Ò monitoring system (Pulsion Medical Systems, Munich, Germany) [14][15][16]. This has been shown to provide optimal volume management for critically ill patients with necrotising pancreatitis [15], and to reduce the vasopressor requirements of cardiac surgery patients [14].…”

“…In a human autopsy study, we previously validated the accuracy of extravascular lung water measurements in the postmortem lung, and defined normal values [17]. The inclusion of such criteria into the therapeutic decision making process has been shown to influence fluid therapy in hypoxaemic patients [16]. Moreover, pulmonary vascular permeability index values can be used to differentiate between cardiogenic and non-cardiogenic pulmonary oedema [18], and these have been shown to correlate with the levels of plasma elastase, which is a biological mediator that alters the pulmonary vascular permeability in patients with severe pneumonia [19].…”

Transpulmonary Thermodilution: Its Role in Assessment of Lung Water and Pulmonary Edema

“…central venous pressure), the implementation of EVLW based protocol in the therapeutic management resulted in a change in original treatment plan in 52% of the patients (Figure 4). This clinical protocol was effective in 82% of the patients 63 .…”

Effect of dobutamine on extravascular lung water index, ventilator function, and perfusion parameters in acute respiratory distress syndrome associated with septic shock

“…Early resolution of edema is critical for recovery from ARDS due to the development of pulmonary edema, which can impair gas exchange, causing refractory hypoxemia, and an early diagnosis of the pathological accumulation of EVLW ( Figure 2)during resuscitation could allow for earlier intervention times and considerable changes in the therapeutic plan (Pino-Sanchez et al 2009). In this study, we chose 8 ml/ kg (Michard et al 2012) as a cut-off for normal EVLW, not the urine output and oxygen delivery were increased ( p ϭ 0.0358, p ϭ 0.0090, respectively).…”