Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 1/2011

01-01-2011 | Pediatric Original

Prognostic value of extravascular lung water index in critically ill children with acute respiratory failure

Authors: Riccardo Lubrano, Corrado Cecchetti, Marco Elli, Caterina Tomasello, Giuliana Guido, Matteo Di Nardo, Raffaele Masciangelo, Elisabetta Pasotti, Maria Antonietta Barbieri, Elena Bellelli, Nicola Pirozzi

Published in: Intensive Care Medicine | Issue 1/2011

Login to get access

Abstract

Purpose

In critically ill adults, a reduction in the extravascular lung water index (EVLWi) decreases time on mechanical ventilation and improves survival. The purpose of this study is to assess the prognostic value of EVLWi in critically ill children with acute respiratory failure and investigate its relationships with PaO2, PaO2/FiO2 ratio, A-aDO2, oxygenation index (OI), mean airway pressure, cardiac index, pulmonary permeability, and percent fluid overload.

Methods

Twenty-seven children admitted to PICU with acute respiratory failure received volumetric hemodynamic and blood gas monitoring following initial stabilization and every 4 h thereafter, until discharge from PICU or death. All patients are grouped in two categories: nonsurvivors and survivors.

Results

Children with a fatal outcome had higher values of EVLWi on admission to PICU, as well as higher A-aDO2 and OI, and lower PaO2 and PaO2/FIO2 ratio. After 24 h EVLWi decreased significantly only in survivors. As a survival indicator, EVLWi has good sensitivity and good specificity. Changes in EVLWi, OI, and mean airway pressure had a time-dependent influence on survival that proved significant according to the Cox test. Survivors spent fewer hours on mechanical ventilation. We detected a correlation of EVLWi with percent fluid overload and pulmonary permeability.

Conclusions

Like OI and mean airway pressure, EVLWi on admission to PICU is predictive of survival and of time needed on mechanical ventilation.
Appendix
Available only for authorised users
Literature
1.
Monnet X, Anguel N, Osman D, Hamzaoui O, Richard C, Teboul JL (2007) Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med 33:1125–1132CrossRefPubMed
2.
Martin GS, Eaton S, Mealer M, Moss M (2005) Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care 9:R74–R82CrossRefPubMed
3.
Groenneveld AB, Verheij J (2006) Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS. Intensive Care Med 32:1315–1321CrossRef
4.
Sibbald WJ, Short AK, Warshawski FJ, Cunningham DG, Cheung H (1985) Thermal dye measurements of extravascular lung water in critically ill patients: intravascular Starling forces and extravascular lung water in the adult respiratory distress syndrome. Chest 87:585–592CrossRefPubMed
5.
Eisenberg PR, Hansbrough JR, Anderson D, Schuster DP (1987) A prospective study of lung water measurements during patient management in an intensive care unit. Am Rev Respir Dis 136:662–668PubMed
6.
Mitchell JP, Schuller D, Calandrino FS, Schuster DP (1992) Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis 145:990–998PubMed
7.
Sakka SG, Klein M, Reinhart K, Meier-Hellmann A (2002) Prognostic value of extravascular lung water in critically ill patients. Chest 122:2080–2086CrossRefPubMed
8.
The National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trial Network (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354:2564–2575CrossRef
9.
Rosenberg AL, Dechert RE, Park PK, Bartlett RH, NHI NHLBI ARDS Network (2009) Association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet Tidal Volume Study cohort. J Intensive Care Med 24:35–46CrossRefPubMed
10.
Rivers EP (2006) Fluid management strategies in acute lung injury—liberal, conservative, or both? N Engl J Med 354:2598–2600CrossRefPubMed
11.
Sakka SG, Rühl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A (2000) Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 26:180–187CrossRefPubMed
12.
Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE (1985) Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest 88:649–652CrossRefPubMed
13.
Takayama Y, Iwasaka T, Sugiura T, Sumimoto T, Takeuchi M, Tsuji H, Takashima H, Taniguchi H, Inada M (1991) Increased extravascular lung water in patients with low pulmonary artery occlusion pressure after acute myocardial infarction. Crit Care Med 19:21–25CrossRefPubMed
14.
Robin ED (1985) The cult of Swan-Ganz catheter: overuse and abuse of pulmonary flow catheter. Ann Intern Med 103:445–449PubMed
15.
Katzenelson R, Perel A, Berkenstadt H, Preisman S, Kogan S, Sternik L, Segal E (2004) Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit Care Med 32:1550–1554CrossRefPubMed
16.
Pauli C, Falker U, Genz T, Hennig M, Lorenz HP, Hess J (2002) Cardiac output determination in children: equivalence of the transpulmonary thermodilution method to the direct Fick principle. Intensive Care Med 28:947–952CrossRefPubMed
17.
Brivet FG, Jacobs F, Colin P (2004) Calculated global end-diastolic volume does not correspond to the largest heart blood volume: a bias for cardiac function index? Inensive Care Med 30:2133–2134CrossRef
18.
Kubitz JC, Annecke T, Kemming GI, Forkl S, Kronas N, Goetz AE, Reuter DA (2006) The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur J Cardiothorac Surg 30:90–95CrossRefPubMed
19.
Fernandez-Mondejar E, Guerrero-Lopez F, Colmenero M (2007) How important is the measurement of extravascular lung water? Curr Opin Crit Care 13:79–83CrossRefPubMed
20.
Cecchetti C, Lubrano R, Cristaldi S, Stoppa F, Barbieri MA, Elli M, Masciangelo R, Perrotta D, Travasso E, Raggi C, Marano M, Pirozzi N (2008) Relationship between global end-diastolic volume and cardiac output in critically ill infants and children. Crit Care Med 36:928–932PubMed
21.
Michard F (2007) Bedside assessment of extravascular lung water by dilution methods: temptations and pitfalls. Crit Care Med 35:1186–1192CrossRefPubMed
22.
Phillips CR, Chesnutt MS, Smith SM (2008) 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 36:69–73CrossRefPubMed
23.
El-Khatib MF, Jamaleggine GW (2004) A new oxygenation index for reflecting intrapulmonary shunting in patients undergoing open-heart surgery. Chest 125:592–596CrossRefPubMed
24.
Rodriguez Martinez CE, Guzman MC, Castillo JM, Sossa MP, Ojeda P (2006) Evaluation of clinical criteria for the acute respiratory distress syndrome in pediatric patients. Pediatr Crit Care Med 7:335–339CrossRefPubMed
25.
Ralston M, Hazinski MF, Zaritsky AL, Schexnayder SM, Kleiman ME (2006) PALS provider manual. American Heart Association, Dallas
26.
World Medical Association (2000) Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 284:3043–3045CrossRef
27.
Pollak MM, Ruttiman UE, Geston PR (1998) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116CrossRef
28.
Francis DB, Hu KC (1977) An algorithm for the automated determination of cardiac output by the Stewart-Hamilton method. IEEE Trans Biomed Eng 24:482–484CrossRefPubMed
29.
Meier P, Zierler KL (1954) On the theory of the indicator-dilution method for measurement of blood flow and volume. J Appl Physiol 6:731–734PubMed
30.
Kuzkov VV, Kirov MY, Sovershaev MA, Kuklin VN, Suburov EV, Waerhaug K, Bjertnaes LJ (2006) Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit Care Med 34:1647–1653CrossRefPubMed
31.
Trachsel D, McCrindle BW, Nakagawa S, Bohn D (2005) Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med 172:206–211CrossRefPubMed
32.
Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, Rogers K, Reid C, Tanner AJ, Easley KA (2004) Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med 32:1771–1776CrossRefPubMed
33.
Kneyber MC, Brouwers GA, Caris JA, Chedamni S, Plötz FB (2008) Acute respiratory distress syndrome: is it under recognized in the pediatric intensive care unit? Intensive Care Med 34:751–754CrossRefPubMed
34.
Dahlem P, van Aalderen WM, Hamaker ME, Dijkgraaf MG, Bos AP (2003) Incidence and short-term outcome of acute lung injury in mechanically ventilated children. Eur Respir J 22:980–985CrossRefPubMed
35.
Berkowitz DM, Pajman AD, Eaton S, Moss M, Martin GS (2008) Acute characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med 36:1803–1809CrossRefPubMed
36.
Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, Hackbarth R, Somers MJ, Baum M, Symons JM, Flores FX, Benfield M, Askenazi D, Chand D, Fortenberry JD, Mahan JD, McBryde K, Blowey D, Goldstein SL (2010) Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kid Dis 55:316–325CrossRefPubMed
37.
Hoover NG, Heard M, Reid C, Wagoner S, Rogers K, Foland J, Paden ML, Fortenberry JD (2008) Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support. Intensive Care Med 34:2241–2247CrossRefPubMed
38.
Groeneveld ABJ, Polderman KH (2005) Acute lung injury, overhydration or both? Critical Care 9:136–137CrossRefPubMed
39.
Matthay MA, Robriquet L, Fang X (2005) Alveolar epithelium. Role in lung fluid balance and acute lung injury. Proc Am Thorac Soc 2:206–213CrossRefPubMed
40.
Ware LB, Matthay MA (2001) Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1376–1383PubMed
41.
Goldstein SL, Somers MJ, Baum MA, Symons JM, Brophy PD, Blowey D, Bunchman TE, Baker C, Mottes T, McAfee N, Barnett J, Morrison G, Rogers K, Fortenberry JD (2005) Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 67:653–658CrossRefPubMed
42.
Metha RI, Pascual MT, Soroko S, Chertow GM (2002) Diuretics mortality and nonrecovery of renal function in acute renal failure. JAMA 288:2547–2553CrossRef
Metadata
Title
Prognostic value of extravascular lung water index in critically ill children with acute respiratory failure
Authors
Riccardo Lubrano
Corrado Cecchetti
Marco Elli
Caterina Tomasello
Giuliana Guido
Matteo Di Nardo
Raffaele Masciangelo
Elisabetta Pasotti
Maria Antonietta Barbieri
Elena Bellelli
Nicola Pirozzi
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-2047-6

Other articles of this Issue 1/2011

Intensive Care Medicine 1/2011 Go to the issue

Physiological and Technical Notes

Left ventricular rotation: a neglected aspect of the cardiac cycle

Original

Clinicians’ response to hyperoxia in ventilated patients in a Dutch ICU depends on the level of FiO2

Original

Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis

Clinical Perspective

Cardiogenic shock and nutrition: safe?

Original

Effects of norepinephrine on renal perfusion, filtration and oxygenation in vasodilatory shock and acute kidney injury

Original

Circulating high sensitivity troponin T in severe sepsis and septic shock: distribution, associated factors, and relation to outcome