title: Extravascular lung water and acute respiratory distress syndrome--oxygenation and outcome.
abstract: We studied eleven consecutive patients to assess the influence of extravascular lung water on clinical outcome. All patients were mechanically ventilated using a standardized protocol. Inspired oxygen concentration was adjusted to an initial target PaO2 of greater than 8.0 kPa (60.8 mmHg). All patients received inhaled nitric oxide (NO) at a concentration of 20 ppm. Extravascular lung water index (EVLWI) was measured by a dual indicator technique (COLD Z-021 monitoring system, Pulsion, Munich, Germany). Patients were managed with fluids and inotropes according to a standard protocol. Median age was 45 (range 27-60) years, mean APACHE II score on admission 31 (range 17-36), duration of mechanical ventilation 15 (range 6-28) days, mean admission Murray lung injury score 2.5 (range 2-3) and admission EVLWI 20.8 (range 8.7 to 54.7) ml.kg-1. The only variables independently predictive of PaO2/FiO2 ratio were serum albumin (B = 1.7 +/- 1.61) and EVLWI (B = -2.1 +/- 0.47), r2 = 0.33, P < 0.0001. In severe ARDS, (PaO2/FiO2 < 150 mmHg), mean EVLWI was 24.4 (22.4 to 26.4, 95% confidence intervals) ml.kg-1 compared with 15.1 (12.2 to 18.0) ml.kg-1 during moderate ARDS (P < 0.001). Serum albumin likewise differed, 29.4 (27.6 to 31.2) vs 35.1 (31.8 to 38.4) g.l-1, P < 0.005. PAOP was higher during periods of poor oxygenation, 12.7 (11.9 to 13.5) vs 9.3 (7.9 to 10.7) mmHg, P < 0.001. The four survivors had greater initial EVLWI than non-survivors, 31 (24.1 to 37.9) vs 20.7 (16.0 to 25.4) ml.kg-1, P = 0.034 and showed a greater reduction in lung water, 15.2 (9.3 to 21.1) vs 5.4 (2.1 to 8.7) ml.kg-1, P = 0.013.
authors.affiliation: Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Davey-Quinn
authors.forename: J A
authors.initials: JA
authors.lastname: Gedney
authors.forename: S M
authors.initials: SM
authors.lastname: Whiteley
authors.forename: M C
authors.initials: MC
authors.lastname: Bellamy
mesh_terms: D018806:APACHE; D000280:Administration, Inhalation; D000328:Adult; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin; D009569:Nitric Oxide; D010100:Oxygen