Significance of extravascular lung water in fluid management for patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract

Objective To explore the correlations of extravascular lung water index (ELWI), oxygenation index and intrathoracic blood volume index (ITBI) in patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and examine the significance of ELWI in fluid management. Methods A total of 63 hospitalized AECOPD patients with respiratory failure were recruited from our hospital from October 2010 to April 2013. Pulse indicator continuous cardiac output (PiCCO) technology was employed to monitor ITBI and ELWI. We compared the relationship of ELWI, ITBI and oxygenation index. And simple correlation analysis was used for statistical processing. Results Significant negative correlation existed in ELWI and oxygenation index (r=-0.741, P<0.01). ELWI 14 ml/kg was defined as a cutoff value for subgroup analysis. A negative correlation existed between ELWI and oxygenation index in the subgroup with ELWI<14 ml/kg, but there was no significant difference (r=-0.524, P=0.080); in the subgroup with ELWI≥14 ml/kg, there was significant negative correlation (r=-0.952, P<0.01). No significant correlation existed between ELWI and ITBI (r=0.477, P=0.072). ITBI 1 000 ml/m2 was defined as a cutoff value for subgroup analysis. No significant difference existed in the subgroup with ITBI<1 000 ml/m2(r=0.332, P=0.117). However, significant positive correlation existed in the subgroup with ITBI≥1 000 ml/m2 (r=0.677, P<0.01). Conclusion Excessive extravascular lung water is an important factor for acute exacerbation of COPD leading to respiratory failure. Key words: Extravascular lung water; Pulmonary disease, chronic obstructive; Fluid management