title: Effect of crystalloid resuscitation and inhalation injury on extravascular lung water: clinical implications.
abstract: OBJECTIVE
  Arterial thermal dilution with an integrated fiberoptic monitoring system (COLD Z-021; Pulsion Medical Systems; Munich, Germany) allows measurement of extravascular lung water (EVLW) and pulmonary permeability index (PPI). The aim of this study was to evaluate the widespread clinical assumption that early respiratory failure following burn and inhalation injury is due to interstitial fluid accumulation in the lung.
  
  
  METHODS
  Clinical, prospective study.
  
  
  METHODS
  ICU of a university referral center of burn care.
  
  
  METHODS
  Thirty-five severely burned adults (> 20% of body surface area).
  
  
  METHODS
  Resuscitation therapy was guided by the results of hemodynamic monitoring using the intrathoracic blood volume (ITBV) as a cardiac preload indicator. The resuscitation goals included a normalization of preload (ITBV > 850 mL/m(2)) and cardiac index (> 3.5 L/min/m(2)) within 24 h after ICU admission. Fluid loading was implemented to reach these goals.
  
  
  RESULTS
  One hundred forty lung water measurements were performed at 0 h, 12 h, 24 h, and 48 h after admission to the ICU. Significant elevation of EVLW and PPI was found in three measurements (2%) at 48 h after ICU admission, and was in one patient associated with inhalation injury. EVLW and PPI were not significantly different between patients with and without inhalation injury. No correlation was found between resuscitation volume and EVLW (r(2) = 0.02) or between the alveolar-arterial oxygen pressure difference and EVLW (r(2) = 0.017). Chest radiograph abnormalities were found in 2 of 22 patients with inhalation injury; these were not associated with increased values of EVLW.
  
  
  CONCLUSIONS
  Early fluid accumulation in the lung in burned patients is very uncommon, even in the presence of inhalation injury. There is no evidence that thermal injury causes an increase in pulmonary capillary membrane permeability.
authors.affiliation: Department of Plastic and Handsurgery, Burn Unit, Klinikum Bogenhausen, Technical University Munich, Munich, Germany. wmuehlbauer@t-online.de
authors.forename: Charlotte
authors.initials: C
authors.lastname: Holm
authors.forename: Julia
authors.initials: J
authors.lastname: Tegeler
authors.forename: Martina
authors.initials: M
authors.lastname: Mayr
authors.forename: Ullrich
authors.initials: U
authors.lastname: Pfeiffer
authors.forename: Guido
authors.initials: G
authors.lastname: Henckel von Donnersmarck
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mühlbauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002059:Burns, Inhalation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003102:Colloids; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology; D012151:Resuscitation
chemical_list: D003102:Colloids