Abstract
BackgroundExtravascular lung water (EVLW), as measured by the thermodilution method, reflects the extent of pulmonary edema. Currently, there are no clinically effective treatments for preventing increases in pulmonary vascular permeability, a hallmark of lung pathophysiology, in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). In this study, we examined the contributions of hemodynamic and osmolarity factors, for which appropriate interventions are expected in critical care, to EVLW in patients with ALI/ARDS.MethodsWe performed a subgroup analysis of a multicenter observational study of patients with acute pulmonary edema. Overall, 207 patients with ALI/ARDS were enrolled in the study. Multivariate regression analysis was used to evaluate the associations of hemodynamic and serum osmolarity parameters with the EVLW index (EVLWI; calculated as EVLW/Ideal body weight). We analyzed factors measured on the day of enrollment (day 0), and on days 1 and 2 after enrollment.ResultsMultivariate regression analysis showed that global end-diastolic volume index (GEDVI) was significantly associated with EVLWI measured on days 0, 1, and 2 (P = 0.002, P < 0.001, and P = 0.003, respectively), whereas other factors were not significantly associated with EVLWI measured on all 3 days.ConclusionsAmong several hemodynamic and serum osmolarity factors that could be targets for appropriate intervention, GEDVI appears to be a key contributor to EVLWI in patients with ALI/ARDS.Trial registrationUniversity Hospital Medical Information Network (UMIN) Clinical Trials Registry UMIN000003627.
Highlights
Extravascular lung water (EVLW), as measured by the thermodilution method, reflects the extent of pulmonary edema
Cardiogenic pulmonary edema is caused by hydrostatic factors, whereas non-cardiogenic pulmonary edema is caused by vascular permeability, which is known as permeability pulmonary edema [1]
extravascular lung water index (EVLWI) was used to quantify pulmonary edema and was strongly associated with global end-diastolic volume index (GEDVI) measured on all 3 days, suggesting that appropriate control of the circulating blood volume is an important factor in the management of cardiogenic edema and permeability pulmonary edema
Summary
Extravascular lung water (EVLW), as measured by the thermodilution method, reflects the extent of pulmonary edema. Cardiogenic pulmonary edema is caused by hydrostatic factors (e.g., volume overload and/or pulmonary hypertension caused by inadequate cardiac function), whereas non-cardiogenic pulmonary edema is caused by vascular permeability, which is known as permeability pulmonary edema [1] Both forms of pulmonary edema are associated with increased extravascular lung water. Our preliminary study showed that hemodynamic and osmolarity parameters were risk factors for hydrostatic and permeability pulmonary edema [6] This is important because hemodynamic and osmolarity factors could be controlled by the physician. In this context, the aim of this study was to identify hemodynamic and/or osmolarity risk factors for an increase of extravascular lung water index (EVLWI) that could be controlled in clinical settings as possible treatment targets for ALI/ARDS
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