Document Detail


Predictors of pulmonary edema formation during fluid loading in the critically ill with presumed hypovolemia*.
MedLine Citation:
PMID:  22080639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: It is largely unknown why extravascular lung water may increase during fluid loading in the critically ill with presumed hypovolemia. In this study we evaluated the hemodynamic predictors of such an increase.
DESIGN: A prospective observational study.
PATIENTS: Sixty-three presumed hypovolemic mechanically ventilated patients (22 septic and 41 nonseptic patients).
INTERVENTION: Fluid loading with saline or colloid fluids guided by (changes in) cardiac filling pressures.
MEASUREMENTS AND MAIN RESULTS: Before and after fluid-loading, hemodynamic and respiratory variables were recorded, including variables obtained by transpulmonary dilution such as cardiac index, pulmonary blood volume index, and extravascular lung water. Baseline parameters and change in parameters were compared between patients with a change in extravascular lung water <10% and patients with a change in extravascular lung water ≥ 10%. Predictive values for change in extravascular lung water ≥ 10% were evaluated. Baseline cardiac index and pulmonary blood volume index were higher, whereas change in cardiac index, change in pulmonary blood volume index, and change in PaO2/FIO2 ratio were lower in patients with a change in extravascular lung water ≥ 10% than in patients with a change in extravascular lung water <10%. The change in extravascular lung water correlated to baseline cardiac index (r = 0.17; p = .001), baseline pulmonary blood volume index (r = 0.15; p = .001), change in pulmonary blood volume index (r = 0.16; p < .001), and change in PaO2/FIO2 ratio (r = 0.13; p = .004). In multiple logistic regression analysis baseline cardiac index, baseline pulmonary blood volume index, the change in cardiac index, change in pulmonary blood volume index, and change in PaO2/FIO2 ratio individually contributed to prediction of a change in extravascular lung water ≥ 10%, independent of the presence of sepsis, pulmonary vascular permeability, and cardiac filling pressures. A change in extravascular lung water ≥ 10% was predicted by baseline cardiac index (77% sensitivity, 98% specificity) and pulmonary blood volume index (92% sensitivity, 68% specificity), and by change in cardiac index (69% sensitivity, 59% specificity), change in pulmonary blood volume index (77% sensitivity, 82% specificity), and change in PaO2/FIO2 ratio (77% sensitivity, 66% specificity).
CONCLUSION: Extravascular lung water increase during fluid loading in the critically ill is predicted by a plateau of cardiac function and pulmonary vascular filling at baseline, rather than by pulmonary vascular permeability and filling pressures. Increasing extravascular lung water is further reflected by a decrease of PaO2/FIO2 ratio. These observations may help preventing pulmonary fluid overloading.
Authors:
Jurjan Aman; A B Johan Groeneveld; Geerten P van Nieuw Amerongen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-20     Completed Date:  2012-04-23     Revised Date:  2012-12-14    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  793-9     Citation Subset:  AIM; IM    
Affiliation:
Departments of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Critical Illness
Female
Fluid Therapy / adverse effects*
Forecasting
Humans
Hypovolemia / therapy*
Male
Middle Aged
Prospective Studies
Pulmonary Edema / etiology*
Comments/Corrections
Comment In:
Crit Care Med. 2012 Mar;40(3):994-5   [PMID:  22343849 ]
Crit Care Med. 2012 Nov;40(11):3107; author reply 3107   [PMID:  23080456 ]
Crit Care Med. 2012 Sep;40(9):2741-2; author reply 2742   [PMID:  22903119 ]
Crit Care Med. 2012 Apr;40(4):1392; author reply 1392-3   [PMID:  22425864 ]

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