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Critical Care
Published in: Critical Care 2/2005

Open Access 01-04-2005 | Research

Extravascular lung water in patients with severe sepsis: a prospective cohort study

Authors: Greg S Martin, Stephanie Eaton, Meredith Mealer, Marc Moss

Published in: Critical Care | Issue 2/2005

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Abstract

Introduction

Few investigations have prospectively examined extravascular lung water (EVLW) in patients with severe sepsis. We sought to determine whether EVLW may contribute to lung injury in these patients by quantifying the relationship of EVLW to parameters of lung injury, to determine the effects of chronic alcohol abuse on EVLW, and to determine whether EVLW may be a useful tool in the diagnosis of acute respiratory distress syndrome (ARDS).

Methods

The present prospective cohort study was conducted in consecutive patients with severe sepsis from a medical intensive care unit in an urban university teaching hospital. In each patient, transpulmonary thermodilution was used to measure cardiovascular hemodynamics and EVLW for 7 days via an arterial catheter placed within 72 hours of meeting criteria for severe sepsis.

Results

A total of 29 patients were studied. Twenty-five of the 29 patients (86%) were mechanically ventilated, 15 of the 29 patients (52%) developed ARDS, and overall 28-day mortality was 41%. Eight out of 14 patients (57%) with non-ARDS severe sepsis had high EVLW with significantly greater hypoxemia than did those patient with low EVLW (mean arterial oxygen tension/fractional inspired oxygen ratio 230.7 ± 36.1 mmHg versus 341.2 ± 92.8 mmHg; P < 0.001). Four out of 15 patients with severe sepsis with ARDS maintained a low EVLW and had better 28-day survival than did ARDS patients with high EVLW (100% versus 36%; P = 0.03). ARDS patients with a history of chronic alcohol abuse had greater EVLW than did nonalcoholic patients (19.9 ml/kg versus 8.7 ml/kg; P < 0.0001). The arterial oxygen tension/fractional inspired oxygen ratio, lung injury score, and chest radiograph scores correlated with EVLW (r2 = 0.27, r2 = 0.18, and r2 = 0.28, respectively; all P < 0.0001).

Conclusions

More than half of the patients with severe sepsis but without ARDS had increased EVLW, possibly representing subclinical lung injury. Chronic alcohol abuse was associated with increased EVLW, whereas lower EVLW was associated with survival. EVLW correlated moderately with the severity of lung injury but did not account for all respiratory derangements. EVLW may improve both risk stratification and management of patients with severe sepsis.
Appendix
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Literature
1.
Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003, 348: 1546-1554. 10.1056/NEJMoa022139CrossRefPubMed
2.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002CrossRefPubMed
3.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992, 101: 1644-1655.CrossRefPubMed
4.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003, 31: 1250-1256. 10.1097/01.CCM.0000050454.01978.3BCrossRefPubMed
5.
Wheeler AP, Bernard GR: Treating patients with severe sepsis. N Engl J Med 1999, 340: 207-214. 10.1056/NEJM199901213400307CrossRefPubMed
6.
Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, Ognibene FP: Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 1990, 113: 227-242.CrossRefPubMed
7.
Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KD: Deaths: final data for 2001. Natl Vital Stat Rep 2003, 52: 1-115.PubMed
8.
Martin GS, Bernard GR: Airway and lung dysfunction in sepsis. Intensive Care Med 2001, S63-S79.
9.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R: The American–European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994, 149: 818-824.CrossRefPubMed
10.
Moss M, Goodman PL, Heinig M, Barkin S, Ackerson L, Parsons PE: Establishing the relative accuracy of three new definitions of the adult respiratory distress syndrome. Crit Care Med 1995, 23: 1629-1637. 10.1097/00003246-199510000-00006CrossRefPubMed
11.
Moss M, Bucher B, Moore FA, Moore EE, Parsons PE: The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA 1996, 275: 50-54. 10.1001/jama.275.1.50CrossRefPubMed
12.
Moss M, Steinberg KP, Guidot DM, Duhon GF, Treece P, Wolken R, Hudson LD, Parsons PE: The effect of chronic alcohol abuse on the incidence of ARDS and the severity of the multiple organ dysfunction syndrome in adults with septic shock. Chest 1999, 116: 97S-98S. 10.1378/chest.116.suppl_1.97SCrossRefPubMed
13.
Guidot DM, Modelska K, Lois M, Jain L, Moss IM, Pittet JF, Brown LA: Ethanol ingestion via glutathione depletion impairs alveolar epithelial barrier function in rats. Am J Physiol Lung Cell Mol Physiol 2000, 279: L127-L135.PubMed
14.
Burnham EL, Brown LA, Halls L, Moss M: Effects of chronic alcohol abuse on alveolar epithelial barrier function and glutathione homeostasis. Alcohol Clin Exp Res 2003, 27: 1167-1172. 10.1097/01.ALC.0000075821.34270.98CrossRefPubMed
15.
Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, et al.: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001, 344: 699-709. 10.1056/NEJM200103083441001CrossRefPubMed
16.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13: 818-829.CrossRefPubMed
17.
Goedje O, Hoeke K, Lichtwarck-Aschoff M, Faltchauser A, Lamm P, Reichart B: Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med 1999, 27: 2407-2412. 10.1097/00003246-199911000-00014CrossRefPubMed
18.
Sakka SG, Reinhart K, Meier-Hellmann A: Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intensive Care Med 1999, 25: 843-846. 10.1007/s001340050962CrossRefPubMed
19.
Lichtwarck-Aschoff M, Zeravik J, Pfeiffer UJ: Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation. Intensive Care Med 1992, 18: 142-147.CrossRefPubMed
20.
Godje O, Peyerl M, Seebauer T, Dewald O, Reichart B: Reproducibility of double indicator dilution measurements of intrathoracic blood volume compartments, extravascular lung water, and liver function. Chest 1998, 113: 1070-1077.CrossRefPubMed
21.
Sakka SG, Reinhart K, Wegscheider K, Meier-Hellmann A: Is the placement of a pulmonary artery catheter still justified solely for the measurement of cardiac output? J Cardiothorac Vasc Anesth 2000, 14: 119-124. 10.1016/S1053-0770(00)90002-8CrossRefPubMed
22.
Sakka SG, Ruhl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A: Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 2000, 26: 180-187. 10.1007/s001340050043CrossRefPubMed
23.
Holm C, Tegeler J, Mayr M, Pfeiffer U, Henckel vD, Muhlbauer W: Effect of crystalloid resuscitation and inhalation injury on extravascular lung water: clinical implications. Chest 2002, 121: 1956-1962. 10.1378/chest.121.6.1956CrossRefPubMed
24.
Newman EV, Merrell M, Genecin A, Monge C, Milnor WR, McKeever WP: The dye dilution method for describing the central circulation. Circulation 1951, 4: 735-746.CrossRefPubMed
25.
Neumann P: Extravascular lung water and intrathoracic blood volume: double versus single indicator dilution technique. Intensive Care Med 1999, 25: 216-219. 10.1007/s001340050819CrossRefPubMed
26.
Elings VB, Lewis FR: A single indicator technique to estimate extravascular lung water. J Surg Res 1982, 33: 375-385. 10.1016/0022-4804(82)90052-XCrossRefPubMed
27.
Risberg B, Osburn K, Pilgreen K, Wax SD, Webb WR: Lung thermal volume as an indicator of pulmonary extravascular water. Eur Surg Res 1982, 14: 245-251.CrossRefPubMed
28.
Sturm JA: Development and significance of lung water measurement in clinical and experimental practice. In Practical Applications of Fiberoptics in Critical Care Monitoring. Edited by: Lewis FR, Pfeiffer UJ. Berlin, Germany: Springer-Verlag; 1990:129-139.CrossRef
29.
Pfeiffer UJ, Backus G, Blumel G, Eckart J, Muller P, Winkler P, Zeravik J, Zimmermann GJ: A fiberoptics-based system for integrated monitoring of cardiac output, intrathoracic blood volume, extravascular lung water, O 2 saturation, and a-v differences. In Practical Applications of Fiberoptics in Critical Care Monitoring. Edited by: Lewis FR, Pfeiffer UJ. Berlin, Germany: Springer-Verlag; 1990:114-125.CrossRef
30.
Elings VB, Lewis FR: A single indicator technique to estimate extravascular lung water. J Surg Res 1982, 33: 375-385. 10.1016/0022-4804(82)90052-XCrossRefPubMed
31.
Mihm FG, Feeley TW, Rosenthal MH, Lewis F: Measurement of extravascular lung water in dogs using the thermal-green dye indicator dilution method. Anesthesiology 1982, 57: 116-122.CrossRefPubMed
32.
Murray JF, Matthay MA, Luce JM, Flick MR: An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988, 138: 720-723.CrossRefPubMed
33.
Honore PM, Jacquet LM, Beale RJ, Renauld JC, Valadi D, Noirhomme P, Goenen M: Effects of normothermia versus hypothermia on extravascular lung water and serum cytokines during cardiopulmonary bypass: a randomized, controlled trial. Crit Care Med 2001, 29: 1903-1909. 10.1097/00003246-200110000-00009CrossRefPubMed
34.
Selzer ML, Vinokur A, van Rooijen L: A self-administered Short Michigan Alcoholism Screening Test (SMAST). J Stud Alcohol 1975, 36: 117-126.CrossRefPubMed
35.
Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA: Interobserver variability in applying a radiographic definition for ARDS. Chest 1999, 116: 1347-1353. 10.1378/chest.116.5.1347CrossRefPubMed
36.
Baudendistel L, Shields JB, Kaminski DL: Comparison of double indicator thermodilution measurements of extravascular lung water (EVLW) with radiographic estimation of lung water in trauma patients. J Trauma 1982, 22: 983-988.CrossRefPubMed
37.
Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE: Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest 1985, 88: 649-652.CrossRefPubMed
38.
Sakka SG, Klein M, Reinhart K, Meier-Hellmann A: Prognostic value of extravascular lung water in critically ill patients. Chest 2002, 122: 2080-2086. 10.1378/chest.122.6.2080CrossRefPubMed
39.
Davey-Quinn A, Gedney JA, Whiteley SM, Bellamy MC: Extravascular lung water and acute respiratory distress syndrome: oxygenation and outcome. Anaesth Intensive Care 1999, 27: 357-362.PubMed
40.
Eisenberg PR, Hansbrough JR, Anderson D, Schuster DP: A prospective study of lung water measurements during patient management in an intensive care unit. Am Rev Respir Dis 1987, 136: 662-668.CrossRefPubMed
41.
Brigham KL, Kariman K, Harris TR, Snapper JR, Bernard GR, Young SL: Correlation of oxygenation with vascular permeability-surface area but not with lung water in humans with acute respiratory failure and pulmonary edema. J Clin Invest 1983, 72: 339-349.PubMedCentralCrossRefPubMed
42.
Sivak ED, Richmond BJ, O'Donavan PB, Borkowski GP: Value of extravascular lung water measurement vs portable chest x-ray in the management of pulmonary edema. Crit Care Med 1983, 11: 498-501.CrossRefPubMed
43.
Lewis FR, Elings VB, Sturm JA: Bedside measurement of lung water. J Surg Res 1979, 27: 250-261. 10.1016/0022-4804(79)90138-0CrossRefPubMed
44.
Lewis FR, Elings VB, Hill SL, Christensen JM: The measurement of extravascular lung water by thermal-green dye indicator dilution. Ann N Y Acad Sci 1982, 384: 394-410.CrossRefPubMed
45.
Mihm FG, Feeley TW, Jamieson SW: Thermal dye double indicator dilution measurement of lung water in man: comparison with gravimetric measurements. Thorax 1987, 42: 72-76.PubMedCentralCrossRefPubMed
46.
Velazquez M, Haller J, Amundsen T, Schuster DP: Regional lung water measurements with PET: accuracy, reproducibility, and linearity. J Nucl Med 1991, 32: 719-725.PubMed
47.
48.
Nuckton TJ, Alonso JA, Kallet RH, Daniel BM, Pittet JF, Eisner MD, Matthay MA: Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med 2002, 346: 1281-1286. 10.1056/NEJMoa012835CrossRefPubMed
49.
Moss M, Guidot DM, Wong-Lambertina M, Ten Hoor T, Perez RL, Brown LA: The effects of chronic alcohol abuse on pulmonary glutathione homeostasis. Am J Respir Crit Care Med 2000, 161: 414-419.CrossRefPubMed
50.
Elings VB, Lewis FR: A single indicator technique to estimate extravascular lung water. J Surg Res 1982, 33: 375-385. 10.1016/0022-4804(82)90052-XCrossRefPubMed
51.
Matthay MA: Clinical measurement of pulmonary edema. Chest 2002, 122: 1877-1879. 10.1378/chest.122.6.1877CrossRefPubMed
Metadata
Title
Extravascular lung water in patients with severe sepsis: a prospective cohort study
Authors
Greg S Martin
Stephanie Eaton
Meredith Mealer
Marc Moss
Publication date
01-04-2005
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3025

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