Extravascular lung water in patients with septic shock during a fluid regimen guided by cardiac index.
BACKGROUND
To elucidate whether patients with a septic shock develop pulmonary edema in a treatment protocol in which volume loading is guided by its effect on the cardiac output, rather than by preset values of pulmonary artery wedge pressure (PAWP).


METHODS
15 consecutive patients with the diagnosis of septic shock were studied in a prospective observational study. Cardiac output, PAWP and extravascular lung water index (EVLWI) were determined at regular intervals during the first 24 h of treatment. Fluid challenges were given if MAP was <80 mm Hg and/or CI was <4.5 l/min/m(2), and PAWP was <16 mm Hg. Further fluid challenges were only given if the preceding fluid challenge resulted in an increase in CI of more than 10% and PAWP was still <16 mm Hg.


RESULTS
EVLWI was slightly above normal (10.4+/-1.2 ml/kg) and did not change during the treatment protocol. One third of the patients had an initial PAWP>16 mmHg. In these patients, EVLWI was significantly higher than in patients with an initial PAWP <16 mm Hg (14.1+/-1.1 ml/kg versus 10.0+/-0.9 ml/kg, P=0.026). No significant correlation was found between PAWP and EVLWI.


CONCLUSIONS
In this study, patients with septic shock did not develop pulmonary edema during the first 24 h of treatment, when their fluid regimen was guided by the effects on cardiac output.
Bindels
A J
AJ
Leiden University Medical Center, Department of General Internal Medicine, Medical Intensive Care Unit, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. abindels@worldonline.nl
van der Hoeven
J G
JG
Meinders
A E
AE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D002404:Catheterization / Q000379:methods; D004395:Dye Dilution Technique; D015633:Extravascular Lung Water; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control*; D011669:Pulmonary Wedge Pressure; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy