Prognostic Value of Extravascular Lung Water in Critically Ill Patients

Sakka, Samir G.; Klein, M.; Reinhart, Konrad; Meier‐Hellmann, Andreas

doi:10.1378/chest.122.6.2080

Cited by 370 publications

(252 citation statements)

References 25 publications

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“…Pulse contour analysis using a PiCCO-plus device (Pulsion Medical Systems) calibrated by transpulmonary thermodilution was used recently to monitor various parameters, including cardiac output, contractility, afterload, volume management, and lung water, in critically ill patients. 23,30 Accordingly, in this multicenter prospective cohort study, we investigated postoperative changes in the cardiopulmonary circulation in patients with SAH by using the PiCCO-plus pulse contour device.…”

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confidence: 99%

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

Obata

Takeda

Sato

et al. 2016

JNS

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S ubarachnoid hemorrhage (SAH) from a ruptured aneurysm is accompanied by several complications, including electrolyte abnormalities, vasospasm, hydrocephalus, cardiac dysfunction, and pulmonary edema. 15,16,18 Among these complications, delayed cerebral ischemia (DCI) remains an important cause of morbidity and death. 15 Many studies have investigated the prevention or treatment of DCI after SAH.Triple-H therapy (i.e., hypertension, hypervolemia, and hemodilution) has reportedly been an effective approach abbreviatioNs CI = cardiac index; CRP = C-reactive protein; DCI = delayed cerebral ischemia; ELWI = extravascular lung water index; GEDI = global end-diastolic volume index; PVPI = pulmonary vascular permeability index; SAH = subarachnoid hemorrhage; SVRI = systemic vascular resistance index; WFNS = World Federation of Neurosurgical Societies. obJective Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. methods A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. results Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. coNclusioNs Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.Clinical trial registration no.: UMIN000003794 (clinicaltrials.gov)http://thejns.org/doi/abs/10.3171/2015.6.JNS1519

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A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

Obata

Takeda

Sato

et al. 2016

JNS

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“…EVLW has been shown to be an independent predictor of prognosis and survival in critically ill patients [90], and in esophagectomy has been found to correlate with PaO2/FiO2 ratio, pulmonary compliance, lung injury score [91], and pulmonary complications [92]. EVLW is derived by subtracting the pulmonary blood volume (PBV) from the pulmonary thermal volume (PTV); there has, therefore, been concern regarding the use of EVLWI after lung resection, as both PBV and PTV may change [93].…”

Section: Early Detection Of Pulmonary Edemamentioning

confidence: 99%

Volume Management and Resuscitation in Thoracic Surgery

Ashes

Slinger

2014

Curr Anesthesiol Rep

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Lung injury following thoracic surgery is a major cause of morbidity and mortality. A consistent risk factor is excessive perioperative fluid administration, not only following pneumonectomy, but also after lesser lung resections and esophageal surgery. Recent insights into the pathophysiology of lung injury after thoracic surgery include the role of the endothelial glycocalyx, pulmonary endothelium, lung lymphatics, and right ventricular dysfunction. While a restrictive approach to fluid administration may reduce the risk of lung injury, there are concerns regarding the risks of acute kidney injury with this approach. Goal-directed approaches may be applied to the thoracic surgical population, and lung ultrasound appears to be a promising new technique to further guide perioperative fluid therapy. There is a paucity of data to guide the choice of crystalloid or colloid solution. Further research is required regarding prevention, diagnosis, and treatment of lung injury following thoracic surgery.

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“…Ciddi sepsiste EVLW'nin prognostik değeri olarak eşik değer 10 ml kg -1 olarak alındığında, bu değerin üzerindeki ölçüm-lerde % 88.2 duyarlılık ve % 67.2 özgüllüğe sahip olduğu gösterilmiştir (35) . EVLW'ın, sepsiste prognostik değere sahip olduğunu destekleyen çok sayıda çalış-ma söz konusudur (29,31,35,36) . EVLWI yanık zemininde gelişen sepsiste prognostik değere sahip olduğu ve klinik belirtilerden 1 gün önce yükseldiği saptanmıştır.…”

Section: Ii) Damar Dışı Akciğer Suyunun Sepsiste Prognostik Değeriunclassified