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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2014

Open Access 01-12-2014 | Research

Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients

Authors: Takashi Tagami, Toshiaki Nakamura, Shigeki Kushimoto, Ryoichi Tosa, Akihiro Watanabe, Tadashi Kaneko, Hidetada Fukushima, Hiroshi Rinka, Daisuke Kudo, Hideaki Uzu, Akira Murai, Makoto Takatori, Hiroo Izumino, Yoichi Kase, Ryutarou Seo, Hiroyuki Takahashi, Yasuhide Kitazawa, Junko Yamaguchi, Manabu Sugita, Hiroyuki Takahashi, Yuichi Kuroki, Takashi Kanemura, Kenichiro Morisawa, Nobuyuki Saito, Takayuki Irahara, Hiroyuki Yokota

Published in: Annals of Intensive Care | Issue 1/2014

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Abstract

Background

The features of early-phase acute respiratory distress syndrome (ARDS) are leakage of fluid into the extravascular space and impairment of its reabsorption, resulting in extravascular lung water (EVLW) accumulation. The current study aimed to identify how the initial EVLW values and their change were associated with mortality.

Methods

This was a post hoc analysis of the PiCCO Pulmonary Edema Study, a multicenter prospective cohort study that included 23 institutions. Single-indicator transpulmonary thermodilution-derived EVLW index (EVLWi) and conventional prognostic factors were prospectively collected over 48 h after enrollment. Associations between 28-day mortality and each variable including initial (on day 0), mean, maximum, and Δ (subtracting day 2 from day 0) EVLWi were evaluated.

Results

We evaluated 192 ARDS patients (median age, 69 years (quartile, 24 years); Sequential Organ Failure Assessment (SOFA) score on admission, 10 (5); all-cause 28-day mortality, 31%). Although no significant differences were found in initial, mean, or maximum EVLWi, Δ-EVLWi was significantly higher (i.e., more reduction in EVLWi) in survivors than in non-survivors (3.0 vs. −0.3 mL/kg, p = 0.006). Age, maximum, and Δ-SOFA scores and Δ-EVLW were the independent predictors for survival according to the Cox proportional hazard model. Patients with Δ-EVLWi > 2.8 had a significantly higher incidence of survival than those with Δ-EVLWi ≤ 2.8 (log-rank test, χ2 = 7.08, p = 0.008).

Conclusions

Decrease in EVLWi during the first 48 h of ARDS may be associated with 28-day survival. Serial EVLWi measurements may be useful for understanding the pathophysiologic conditions in ARDS patients. A large multination confirmative trial is required.
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Metadata
Title
Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients
Authors
Takashi Tagami
Toshiaki Nakamura
Shigeki Kushimoto
Ryoichi Tosa
Akihiro Watanabe
Tadashi Kaneko
Hidetada Fukushima
Hiroshi Rinka
Daisuke Kudo
Hideaki Uzu
Akira Murai
Makoto Takatori
Hiroo Izumino
Yoichi Kase
Ryutarou Seo
Hiroyuki Takahashi
Yasuhide Kitazawa
Junko Yamaguchi
Manabu Sugita
Hiroyuki Takahashi
Yuichi Kuroki
Takashi Kanemura
Kenichiro Morisawa
Nobuyuki Saito
Takayuki Irahara
Hiroyuki Yokota
Publication date
01-12-2014
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2014
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-014-0027-7

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