Global end-diastolic volume, serum osmolarity, and albumin are risk factors for increased extravascular lung water.
BACKGROUND
The transpulmonary thermodilution technique allows the determination of cardiac preload (global end-diastolic volume index) and quantification of pulmonary edema (extravascular lung water index [EVLWI]). Pulmonary edema commonly develops in critically ill patients; however, the underlying pathophysiology, that is, hydrostatic (cardiac) or permeability-induced (noncardiac), often remains unclear. In this study, hemodynamic and serum parameters of osmolarity and oncotic pressure were analyzed to identify risk factors for increased EVLWI.


METHODS
A retrospective, single-center analysis in an intensive care unit of a university hospital was performed. No interventions were made for the study. Forty-two critically ill patients were included, and 126 simultaneous hemodynamic measurements and serum determinations were analyzed by logistic regression and Spearman rank correlation coefficient analysis.


RESULTS
Global end-diastolic volume index (P = .001), serum albumin (P = .006), and serum osmolarity (P = .029) were significant factors for increased EVLWI (defined as >10 mL/kg).


CONCLUSIONS
Hypervolemia, hypoalbuminemia, and high plasma osmolarity are associated with increased EVLWI.
Yagi
Takeshi
T
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 755-8505, Japan.
Kaneko
Tadashi
T
Tsuruta
Ryosuke
R
Kasaoka
Shunji
S
Miyauchi
Takashi
T
Fujita
Motoki
M
Kawamura
Yoshikatsu
Y
Sakka
Samir G
SG
Maekawa
Tsuyoshi
T
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002496:Central Venous Pressure; D016638:Critical Illness; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011654:Pulmonary Edema / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013318:Stroke Volume; D013815:Thermodilution
D015415:Biomarkers; D012709:Serum Albumin