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Chapter 12 - Assessment of Extravascular Lung Water

Published online by Cambridge University Press:  28 April 2020

By
Torsten Loop
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
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Summary

The determination of extravascular lung water reflects the integrity and function of the pulmonary capillary barrier. An increase in extravascular lung water (EVLW) may be caused by an increase in the barrier’s permeability or the pressure in the pulmonary vasculature and can be derived accurately by single transpulmonary thermodilution measurement. In patients with the acute respiratory distress syndrome, extravascular lung water may be of prognostic relevance and help guide therapy utilizing a goal-directed strategy.

Keywords

Extravascular lung waterthermodilutionacute respiratory distress syndrome
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 117 - 122
Publisher: Cambridge University Press
Print publication year: 2020

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References

Ware, LB, Matthay, MA. Clinical practice: acute pulmonary edema. N Engl J Med 2005;353:2788–96.Google Scholar
Starling, EH. On the absorption of fluids from the connective tissue spaces. J Physiol 1896;19:312–26.Google Scholar
Miserocchi, G. Mechanisms controlling the volume of pleural fluid and extravascular lung water. Eur Respir Rev 2009;18:244–52.Google Scholar
Tagami, T, Kushimoto, S, Yamamoto, Y, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care 2010;14:R162.Google Scholar
Tagami, T, Sawabe, M, Kushimoto, S, et al. Quantitative diagnosis of diffuse alveolar damage using extravascular lung water. Crit Care Med 2013;41:2144–50.Google Scholar
Huber, W, Mair, S, Gotz, SQ, et al. Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients. Intensive Care Med 2013;39:146–50.Google Scholar
Phillips, CR, Chesnutt, MS, Smith, SM. Extravascular lung water in sepsis-associated acute respiratory distress syndrome: indexing with predicted body weight improves correlation with severity of illness and survival. Crit Care Med 2008;36:69–73.CrossRefGoogle ScholarPubMed
Saugel, B, Ringmaier, S, Holzapfel, K, et al. Physical examination, central venous pressure, and chest radiography for the prediction of transpulmonary thermodilution-derived hemodynamic parameters in critically ill patients: a prospective trial. J Crit Care 2011;26:402–10.CrossRefGoogle ScholarPubMed
Lange, NR, Schuster, DP. The measurement of lung water. Crit Care 1999;3:R19–R24.Google Scholar
Pearce, ML, Yamashita, J, Beazell, J. Measurement of pulmonary edema. Circ Res 1965;16:482–8.CrossRefGoogle ScholarPubMed
Volpicelli, G, Elbarbary, M, Blaivas, M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38:577–91.Google Scholar
Enghard, P, Rademacher, S, Nee, J, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care 2015;19:36.Google Scholar
Sibbald, WJ, Warshawski, FJ, Short, AK, et al. Clinical studies of measuring extravascular lung water by the thermal dye technique in critically ill patients. Chest 1983;83:725–31.Google Scholar
Mihm, FG, Feeley, TW, Jamieson, SW. Thermal dye double indicator dilution measurement of lung water in man: comparison with gravimetric measurements. Thorax 1987;42:72–6.Google Scholar
Sakka, SG, Ruhl, CC, Pfeiffer, UJ, et al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 2000;26:180–7.CrossRefGoogle ScholarPubMed
Michard, F, Schachtrupp, A, Toens, C. Factors influencing the estimation of extravascular lung water by transpulmonary thermodilution in critically ill patients. Crit Care Med 2005;33:1243–7.Google Scholar
Kushimoto, S, Taira, Y, Kitazawa, Y, et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome. Crit Care 2012;16:R232.Google Scholar
Monnet, X, Anguel, N, Osman, D, et al. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med 2007;33:448–53.Google Scholar
Jozwiak, M, Teboul, JL, Monnet, X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care 2015;5:38.CrossRefGoogle ScholarPubMed
Brown, LM, Liu, KD, Matthay, MA. Measurement of extravascular lung water using the single indicator method in patients: research and potential clinical value. Am J Physiol Lung Cell Mol Physiol 2009;297:L547–58.Google Scholar
Bendjelid, K, Giraud, R, Siegenthaler, N, Michard, F. Validation of a new transpulmonary thermodilution system to assess global end-diastolic volume and extravascular lung water. Crit Care 2010;14:R209.Google Scholar
Kiefer, N, Hofer, CK, Marx, G, et al. Clinical validation of a new thermodilution system for the assessment of cardiac output and volumetric parameters. Crit Care 2012;16:R98.Google Scholar
Monnet, X, Teboul, JL. Transpulmonary thermodilution: advantages and limits. Crit Care 2017;21:147.Google Scholar
Berkowitz, DM, Danai, PA, Eaton, S, Moss, M, Martin, GS. Accurate characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med 2008;36:1803–9.Google Scholar
LeTourneau, JL, Pinney, J, Phillips, CR. Extravascular lung water predicts progression to acute lung injury in patients with increased risk. Crit Care Med 2012;40:847–54.Google Scholar
Kushimoto, S, Endo, T, Yamanouchi, S, et al; PiCCO pulmonary edema study group. Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition. Crit Care 2013;17:R132.CrossRefGoogle Scholar
Sakka, SG. Extravascular lung water in ARDS patients. Minerva Anestesiol 2013;79:274–84.Google Scholar
Schuster, DP. Identifying patients with ARDS: time for a different approach. Intensive Care Med 1997;23:1197–203.Google Scholar
Perel, A. Extravascular lung water and the pulmonary vascular permeability index may improve the definition of ARDS. Crit Care 2013;17:108.Google Scholar
Kuzkov, VV, Kirov, MY, Sovershaev, MA, et al. Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit Care Med 2006;34:1647–53.Google Scholar
Wang, H, Cui, N, Su, L, et al. Prognostic value of extravascular lung water and its potential role in guiding fluid therapy in septic shock after initial resuscitation. J Crit Care 2016;33:106–13.Google Scholar
Sakr, Y, Vincent, JL, Reinhart, K, et al. Sepsis occurrence in acutely ill patients investigators: high tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest 2005;128:3098–108.Google Scholar
Boussat, S, Jacques, T, Levy, B, et al. Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema. Intensive Care Med 2002;28:712–8.Google Scholar
Mitchell, JP, Schuller, D, Calandrino, FS, Schuster, DP. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis 1992;145:990–8.CrossRefGoogle ScholarPubMed
Tran-Dinh, A, Augustin, P, Dufour, G, et al. Evaluation of cardiac index and extravascular lung water after single-lung transplantation using the transpulmonary thermodilution technique by the PiCCO2 device. J Cardiothorac Vasc Anesth 2018;32(4):1731–5.Google Scholar
Cordemans, C, De Laet, I, Van Regenmortel, N, et al. Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care 2012;2:S1.Google Scholar
Mutoh, T, Kazumata, K, Ishikawa, T, Terasaka, S. Performance of bedside transpulmonary thermodilution monitoring for goal-directed hemodynamic management after subarachnoid hemorrhage. Stroke 2009;40:2368–74.Google Scholar
Lenkin, AI, Kirov, MY, Kuzkov, VV, et al. Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial. Crit Care Res Pract 2012;2012:821218.Google Scholar
Kapoor, PM, Magoon, R, Rawat, RS, et al. Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass. Ann Card Anaesth 2017;20:83–9.Google Scholar
Compton, F, Hoffmann, C, Zidek, W, Schmidt, S, Schaefer, JH. Volumetric hemodynamic parameters to guide fluid removal on hemodialysis in the intensive care unit. Hemodial Int 2007;11:231–7.Google Scholar
Fernández Mondéjar, E, Vazquez Mata, G, Cárdnas, A, et al. Ventilation with positive end-expiratory pressure reduces extravascular lung water and increases lymphatic flow in hydrostatic pulmonary edema. Crit Care Med 1996;24:1562–7.Google Scholar
Colmenero-Ruiz, M, Fernández-Mondéjar, E, Fernández-Sacristán, MA, Rivera-Fernández, R, Vazquez-Mata, G. PEEP and low tidal volume ventilation reduce lung water in porcine pulmonary edema. Am J Respir Crit Care Med 1997;155:964–70.Google Scholar
Dres, M, Teboul, JL, Anguel, N, et al. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med 2014;42:1882–9.Google Scholar

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