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Published in: Intensive Care Medicine 1/2013

Open Access 01-01-2013 | Physiological and Technical Notes

Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients

Authors: Wolfgang Huber, Sebastian Mair, Simon Q. Götz, Julia Tschirdewahn, Johanna Siegel, Roland M. Schmid, Bernd Saugel

Published in: Intensive Care Medicine | Issue 1/2013

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Abstract

Purpose

With regard to large inter-individual variability of height, body weight (BW), and age, several hemodynamic parameters are adjusted for biometric data. This also applies to extravascular lung water (EVLW), which traditionally was indexed to actual BW (BW-act) resulting in EVLW-index (EVLWI; i.e., EVLWI-act). Since indexation to BW-act might inappropriately diminish EVLWI-act in obese patients, the indexation has been changed to predicted BW (BW-pred) resulting in EVLWI-pred. BW-pred is a weight estimation formula calculated from height and gender that has not been derived from population-based data. The aim of the study was to investigate the independent association of biometric data with EVLW.

Methods

We analyzed a hemodynamic monitoring database including 3,691 transpulmonary thermodilution-derived EVLW measurements (234 consecutive patients; intensive care unit of a university hospital). We performed univariate and multivariate analyses regarding the association of biometric data with the first EVLW measurement and the mean EVLW value of each patient.

Results

In univariate analysis, the first EVLW significantly correlated with height (r = 0.254; p < 0.001), but neither with age nor BW-act. Similar findings were made in the analysis of the patients’ EVLW means of all measurements (“one point per patient”). In multivariate analysis (primary endpoint), including BW-act, height, age, and gender, only height was independently associated with EVLW, with each centimeter of height increasing the first measurement of EVLW by 6.882 mL (p < 0.001) and mean EVLW by 6.727 mL (p < 0.001).

Conclusions

Height is the only biometric parameter independently associated with the first and mean EVLW. In adult patients, EVLW should be indexed to height.
Literature
1.
go back to reference 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 136:662–668PubMedCrossRef 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 136:662–668PubMedCrossRef
2.
go back to reference Sakka SG, Klein M, Reinhart K, Meier-Hellmann A (2002) Prognostic value of extravascular lung water in critically ill patients. Chest 122:2080–2086PubMedCrossRef Sakka SG, Klein M, Reinhart K, Meier-Hellmann A (2002) Prognostic value of extravascular lung water in critically ill patients. Chest 122:2080–2086PubMedCrossRef
3.
go back to reference Fernandez-Mondejar E, Castano-Perez J, Rivera-Fernandez R, Colmenero-Ruiz M, Manzano F, Perez-Villares J, de la Chica R (2003) Quantification of lung water by transpulmonary thermodilution in normal and edematous lung. J Crit Care 18:253–258PubMedCrossRef Fernandez-Mondejar E, Castano-Perez J, Rivera-Fernandez R, Colmenero-Ruiz M, Manzano F, Perez-Villares J, de la Chica R (2003) Quantification of lung water by transpulmonary thermodilution in normal and edematous lung. J Crit Care 18:253–258PubMedCrossRef
4.
go back to reference 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–R82 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–R82
5.
go back to reference Berkowitz DM, Danai PA, Eaton S, Moss M, Martin GS (2008) Accurate characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med 36:1803–1809PubMedCrossRef Berkowitz DM, Danai PA, Eaton S, Moss M, Martin GS (2008) Accurate characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med 36:1803–1809PubMedCrossRef
6.
go back to reference 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 36:69–73PubMedCrossRef 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 36:69–73PubMedCrossRef
7.
go back to reference Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, McAuley DF (2010) Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med 38:114–120PubMedCrossRef Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, McAuley DF (2010) Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med 38:114–120PubMedCrossRef
8.
go back to reference Chew MS, Ihrman L, During J, Bergenzaun L, Ersson A, Unden J, Ryden J, Akerman E, Larsson M (2012) Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock. Crit Care 16:R1PubMedCrossRef Chew MS, Ihrman L, During J, Bergenzaun L, Ersson A, Unden J, Ryden J, Akerman E, Larsson M (2012) Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock. Crit Care 16:R1PubMedCrossRef
9.
go back to reference Tagami T, Kushimoto S, Yamamoto Y, Atsumi T, Tosa R, Matsuda K, Oyama R, Kawaguchi T, Masuno T, Hirama H, Yokota H (2010) Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care 14:R162PubMedCrossRef Tagami T, Kushimoto S, Yamamoto Y, Atsumi T, Tosa R, Matsuda K, Oyama R, Kawaguchi T, Masuno T, Hirama H, Yokota H (2010) Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care 14:R162PubMedCrossRef
10.
go back to reference Letourneau JL, Pinney J, Phillips CR (2012) Extravascular lung water predicts progression to acute lung injury in patients with increased risk. Crit Care Med 40:847–854PubMedCrossRef Letourneau JL, Pinney J, Phillips CR (2012) Extravascular lung water predicts progression to acute lung injury in patients with increased risk. Crit Care Med 40:847–854PubMedCrossRef
11.
go back to reference Michard F, Fernandez-Mondejar E, Kirov MY, Malbrain M, Tagami T (2012) A new and simple definition for acute lung injury. Crit Care Med 40:1004–1006PubMedCrossRef Michard F, Fernandez-Mondejar E, Kirov MY, Malbrain M, Tagami T (2012) A new and simple definition for acute lung injury. Crit Care Med 40:1004–1006PubMedCrossRef
12.
go back to reference Mallat J, Pepy F, Lemyze M, Barrailler S, Gasan G, Tronchon L, Thevenin D (2012) Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients. J Crit Care 27:376–383PubMedCrossRef Mallat J, Pepy F, Lemyze M, Barrailler S, Gasan G, Tronchon L, Thevenin D (2012) Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients. J Crit Care 27:376–383PubMedCrossRef
13.
go back to reference Akinnusi ME, Pineda LA, El Solh AA (2008) Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med 36:151–158PubMedCrossRef Akinnusi ME, Pineda LA, El Solh AA (2008) Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med 36:151–158PubMedCrossRef
14.
go back to reference O’Brien JM Jr, Phillips GS, Ali NA, Lucarelli M, Marsh CB, Lemeshow S (2006) Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med 34:738–744PubMedCrossRef O’Brien JM Jr, Phillips GS, Ali NA, Lucarelli M, Marsh CB, Lemeshow S (2006) Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med 34:738–744PubMedCrossRef
15.
go back to reference Saugel B, Umgelter A, Schuster T, Phillip V, Schmid RM, Huber W (2010) Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheter. Crit Care 14:R95PubMedCrossRef Saugel B, Umgelter A, Schuster T, Phillip V, Schmid RM, Huber W (2010) Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheter. Crit Care 14:R95PubMedCrossRef
16.
go back to reference Huber W, Umgelter A, Reindl W, Franzen M, Schmidt C, von Delius S, Geisler F, Eckel F, Fritsch R, Siveke J, Henschel B, Schmid RM (2008) Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index. Crit Care Med 36:2348–2354PubMedCrossRef Huber W, Umgelter A, Reindl W, Franzen M, Schmidt C, von Delius S, Geisler F, Eckel F, Fritsch R, Siveke J, Henschel B, Schmid RM (2008) Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index. Crit Care Med 36:2348–2354PubMedCrossRef
17.
go back to reference Sakka SG, Ruhl 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 26:180–187PubMedCrossRef Sakka SG, Ruhl 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 26:180–187PubMedCrossRef
18.
go back to reference Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F, Casaburi R, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson D, Macintyre N, McKay R, Miller MR, Navajas D, Pellegrino R, Viegi G (2005) Standardisation of the measurement of lung volumes. Eur Respir J 26:511–522PubMedCrossRef Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F, Casaburi R, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson D, Macintyre N, McKay R, Miller MR, Navajas D, Pellegrino R, Viegi G (2005) Standardisation of the measurement of lung volumes. Eur Respir J 26:511–522PubMedCrossRef
19.
go back to reference Pai MP, Paloucek FP (2000) The origin of the “ideal” body weight equations. Ann Pharmacother 34:1066–1069PubMedCrossRef Pai MP, Paloucek FP (2000) The origin of the “ideal” body weight equations. Ann Pharmacother 34:1066–1069PubMedCrossRef
20.
go back to reference Stocks J, Quanjer PH (1995) Reference values for residual volume, functional residual capacity and total lung capacity. ATS workshop on lung volume measurements. Official statement of the European Respiratory Society. Eur Respir J 8:492–506PubMedCrossRef Stocks J, Quanjer PH (1995) Reference values for residual volume, functional residual capacity and total lung capacity. ATS workshop on lung volume measurements. Official statement of the European Respiratory Society. Eur Respir J 8:492–506PubMedCrossRef
Metadata
Title
Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients
Authors
Wolfgang Huber
Sebastian Mair
Simon Q. Götz
Julia Tschirdewahn
Johanna Siegel
Roland M. Schmid
Bernd Saugel
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2745-3

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