| Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock. | |
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MedLine Citation:
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PMID: 22214612 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ABSTRACT: INTRODUCTION: The diagnosis of acute lung injury may be more robust if more accurate physiological markers can be identified. Extravascular lung water (EVLW) is one possible marker, and has been shown to correlate with respiratory function and mortality in patients with sepsis. Whether EVLW confers diagnostic value in a general population with shock, and which index performs best is unclear. We investigated the diagnostic accuracy of various EVLW indices in patients with shock. METHODS: Prospective, observational cohort study of 51 patients admitted to a tertiary ICU with shock. EVLW was measured within 6 hours of ICU admission and indexed to actual weight (EVLW/ABW), predicted body weight (EVLW/PBW) and pulmonary blood volume (EVLW/PBV). Their relation to the diagnosis and severity of lung injury and intensive care unit (ICU)-mortality were studied. Positive and negative likelihood ratios, pre- and post-test odds for a diagnosis of lung injury and mortality were calculated. RESULTS: All EVLW indices were higher among patients with lung injury and significantly correlated with respiratory parameters. Further, all EVLW indices were significantly higher in nonsurvivors. Using EVLW improves the post-test odds ratio for the diagnosis of acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and severe lung injury (sLI) by up to 8-fold. Combining increased EVLW and a diagnosis of ALI, ARDS or sLI increases the post-test odds of ICU-mortality. EVLW/ABW and PBV gave the best diagnostic performance in this population. CONCLUSIONS: EVLW was associated with degree of lung injury and mortality, regardless of the index used, confirming that it may be used as a bedside indicator for disease severity. Using EVLW as a bedside test conferred added diagnostic value for the identification of patients with lung injury. |
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Authors:
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Michelle S Chew; Lilian Ihrman; Joachim During; Lill Bergenzaun; Anders Ersson; Johan Unden; Jorgen Ryden; Eva Akerman; Marina Larsson |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-3 |
Journal Detail:
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Title: Critical care (London, England) Volume: 16 ISSN: 1466-609X ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-4 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9801902 Medline TA: Crit Care Country: - |
Other Details:
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Languages: ENG Pagination: R1 Citation Subset: - |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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