Extravascular lung water index measurement in critically ill children does not correlate with a chest x-ray score of pulmonary edema.
BACKGROUND
Extravascular lung water index (EVLWI) can be measured at the bedside using the transpulmonary thermodilution technique (TPTD). The goal of this study was to compare EVLWI values with a chest x-ray score of pulmonary edema and markers of oxygenation in critically ill children.


METHODS
This was a prospective observational study in a pediatric intensive care unit of a university hospital. We included 27 critically ill children with an indication for advanced invasive hemodynamic monitoring. No specific interventions for the purpose of the study were carried out. Measurements included EVLWI and other relevant hemodynamic variables. Blood gas analysis, ventilator parameters, chest x-ray and TPTD measurements were obtained within a three-hour time frame. Two radiologists assessed the chest x-ray and determined a score for pulmonary edema.


RESULTS
A total of 103 measurements from 24 patients were eligible for final analysis. Mean age was two years (range: two months to eight years). Median cardiac index was 4.00 (range: 1.65 to 10.85) l/min/m2. Median EVLWI was 16 (range: 6 to 31) ml/kg. The weighted kappa between the chest x-ray scores of the two radiologists was 0.53. There was no significant correlation between EVLWI or chest x-ray score and the number of ventilator days, severity of illness or markers of oxygenation. There was no correlation between EVLWI and the chest x-ray score. EVLWI was significantly correlated with age and length (r2 of 0.47 and 0.67 respectively).


CONCLUSIONS
The extravascular lung water index in critically ill children does not correlate with a chest x-ray score of pulmonary edema, nor with markers of oxygenation.
Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. j.lemson@ic.umcn.nl
Joris
J
Lemson
Lya E
LE
van Die
Anique E A
AE
Hemelaar
Johannes G
JG
van der Hoeven
D001784:Blood Gas Analysis / Q000379:methods; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D015633:Extravascular Lung Water / Q000378:metabolism* / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013902:Radiography, Thoracic; D012720:Severity of Illness Index; D013815:Thermodilution