Influence of extravascular lung water determination in fluid and vasoactive therapy.
BACKGROUND
Preload parameters in postresuscitation phase are not sufficiently sensitive to guide fluid therapy in critically ill patients. We analyzed modifications in the fluid therapy and vasoactive drugs of critically ill patients that were produced by inclusion of extravascular lung water (EVLW) data in the treatment protocol and evaluated the short-term response.


METHODS
This observational and prospective study included consecutive patients with hypotension or hypoxemia, comparing the therapeutic plan for fluid and vasoactive drug treatment between before and after knowing the EVLW value.


RESULTS
We studied 42 patients. After knowing the EVLW, 52.4% (n = 22) of initial therapeutic plans were changed, modifying fluid therapy in all of these cases and vasoactive therapy in 22% of them. EVLW value was 13.91 +/- 5.62 in patients with change of therapeutic plan versus 10 +/- 4.52 in those with no change (p < 0.05). No differences were found in preload parameters as a function of change/no change. The most frequent decision change (n = 13) was to fluid reduction plus diuretic administration, and patients with this modification had significantly (p < 0.05) higher EVLW values compared with the remaining patients with a change in fluid therapy. Out of the 22 patients with a modified therapeutic decision, the therapy proved effective in 18 patients


CONCLUSIONS
Quantification of EVLW in patients who can be considered euvolemic induces important modifications in fluid and vasoactive therapy. These changes generally resulted in a lower volume loading and a positive outcome for the patient.
Pino-Sánchez
Francisca
F
Intensive Care Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain. paquipin@gmail.com
Lara-Rosales
Ramón
R
Guerrero-López
Francisco
F
Chamorro-Marín
Virginia
V
Navarrete-Navarro
Pedro
P
Carazo-de la Fuente
Eugenio
E
Fernández-Mondéjar
Enrique
E
D000704:Analysis of Variance; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D016638:Critical Illness / Q000628:therapy*; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000860:Hypoxia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007201:Indicator Dilution Techniques; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D018805:Sepsis / Q000503:physiopathology / Q000628:therapy*
D002317:Cardiovascular Agents