Extravascular Lung Water Index Levels Research Articles

Evaluation of the prognostic value of lncRNA UCA1 combined with extravascular lung water index and lung ultrasound score in patients with acute lung injury

AbstractIntroductionAcute lung injury (ALI) is a common and rapidly developing critical inflammatory lung disease in clinic. This study investigated the predictive value of lncRNA UCA1, extravascular lung water index (EVLWI), and lung ultrasound score (LUS) in predicting the overall outcome of patients with ALI.MethodsPatients with ALI were recruited for detecting the content of UCA1, EVLWI, and LUS. All patients were cataloged into the survival group and death group according to the prognosis. The discrepancy of UCA1, EVLWI, and LUS was compared in the two groups. The prognostic significance of UCA1, EVLWI, LUS, and their combination was estimated by logistic regression and the receiver operating characteristic (ROC) curve.ResultsThe levels of UCA1, LUS, and EVLWI were elevated in the death group compared with the survival group. The content of UCA1 was positively correlated with LUS scores and EVLWI scores. UCA1, LUS, and EVLWI were independent indicators of predicting the prognosis of patients with ALI. The ROC curve reflected that UCA1, LUS, and EVLWI could forecast the endpoint events of patients with ALI whereas their combined approach had the highest accuracy.ConclusionHighly expressed UCA1 is a biomarker in forecasting the outcome of patients with ALI. It had high accuracy in predicting the endpoint of patients with ALI when combined with LUS and EVLWI.

A prospectively randomized controlled study of the effects of intensive insulin therapy combined with glutamine on nutritional metabolism, inflammatory response, and hemodynamics in severe burn patients

Objective: To observe the effects of intensive insulin therapy combined with glutamine on nutritional metabolism, inflammatory response, and hemodynamics in severe burn patients. Methods: Thirty-two severe burn patients who met the inclusion criteria and hospitalized in the Affiliated Huaihai Hospital of Xuzhou Medical University from June 2017 to January 2019 were recruited into a prospectively randomized controlled study. According to the random number table, the patients were divided into conventional insulin therapy alone group, conventional insulin therapy+glutamine group, intensive insulin therapy alone group, and intensive insulin therapy+glutamine group, with 8 patients in each group, with genders of 5 males and 3 females, 4 males and 4 females, 3 males and 5 females, 4 males and 4 females, and ages of (35±7), (36±9), (33±11), and (38±7) years, respectively. Patients in conventional insulin therapy alone group were treated with conventional insulin therapy on the basis of routine treatment to control the blood glucose. Patients in conventional insulin therapy+glutamine group were supplemented with alanyl-glutamine for more than 14 days in addition to the treatment in conventional insulin therapy alone group. Patients in intensive insulin therapy alone group were treated with intensive insulin therapy on the basis of routine treatment to control the blood glucose. Patients in intensive insulin therapy+glutamine group were supplemented with alanyl-glutamine in addition to the treatment in intensive insulin therapy alone group. On treatment day (TD) 1, 3, 7, and 14, the blood glucose, albumin, prealbumin, white blood cell count, procalcitonin (PCT), and C-reactive protein (CRP) of patients in the 4 groups were detected. The cardiac index (CI), stroke volume index (SVI), global end-diastolic volume index (GEDVI), systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI), and pulmonary vascular permeability index (PVPI) of patients in the 4 groups on TD 1, 3, and 7 were measured. Data were statistically analyzed with Fisher's exact probability test, one-way analysis of variance, analysis of variance for repeated measurement, and Bonferroni method. Results: All patients in the 4 groups successfully completed the study, and there were no withdrawal cases. On TD 3, 7, and 14, the blood glucose of patients in intensive insulin therapy alone group ((5.9±1.3), (5.8±0.6), (5.5±0.5) mmol/L) and intensive insulin therapy+glutamine group ((5.9±1.1), (5.6±1.1), (5.2±0.8) mmol/L) were significantly lower than those in conventional insulin therapy alone group ((9.1±0.5), (8.4±0.9), (7.4±1.1) mmol/L, P<0.05). Compared with those in conventional insulin therapy alone group, the levels of albumin of patients in conventional insulin therapy+glutamine group, intensive insulin therapy alone group, and intensive insulin therapy+glutamine group were significantly increased on TD 7 and 14 (P<0.05). Compared with the level of albumin of patients in intensive insulin therapy+glutamine group, the levels of albumin of patients in conventional insulin therapy+glutamine group and intensive insulin therapy alone group were significantly decreased on TD 14 (P<0.05). Compared with those in conventional insulin therapy alone group, the levels of prealbumin of patients in conventional insulin therapy+glutamine group and intensive insulin therapy alone group were significantly increased on TD 7 and 14 (P<0.05). Compared with those in intensive insulin therapy+glutamine group, the levels of prealbumin of patients in intensive insulin therapy alone group and conventional insulin therapy+glutamine group were significantly decreased on TD 1, 7, and 14 (P<0.05). There were no statistically significant differences in the white blood cell count, PCT, and CRP of patients in the 4 groups in pairwise comparison between groups on TD 1, 3, 7, and 14 (P>0.05). On TD 3 and 7, the levels of cardiac index, SVI, GEDVI, and SVRI of patients in intensive insulin therapy+glutamine group were significantly higher than those in conventional insulin therapy alone group (P<0.05), while the levels of EVLWI and PVPI were significantly lower than those in conventional insulin therapy alone group (P<0.05). Conclusions: Glutamine combined with intensive insulin therapy can improve the hypermetabolism in patients after severe burns, reduce the decomposition and consumption of endogenous nutrient substrates, and at the same time help the recovery of cardiac function and maintenance of hemodynamic stability.

The prognosis evaluation of sICAM-1, KL-6 combined with EVLWI in severe pneumonia patients with acute respiratory distress syndrome

Objective To evaluate the prognostic value of extravascular lung water index (EVLWI), soluble intercellular adhesion molecule-1(sICAM-1) and Krebs yon den lungen-6 (KL-6) in severe pneumonia patients with Severe Acute Respiratory Syndrome (ARDS). Methods A prospective study was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from October 2017 to February 2020. The study included 65 severe pneumonia patients with ARDS, who was performed by measurement of pulse index continuous cardiac output and survived more than 3days after admission. The Extravascular Lung Water Index（EVLWI）, sICAM-1, KL-6 and Oxygenation Index(OI) on 1st, 3rd and 5th day were detected. APACHE Ⅱ score, patient survival events (days) and survival outcome were recorded. Correlation analysis between EVLWI, sICAM-1, KL-6 and OI was performed on the 1st，3rd and 5th day after admission. Independent risk factors of mortality in severe pneumonia patients with ARDS were analyzed by multiple logistic regression. Receiver operating characteristic curve was drawn，and the prognostic value of each parameter was assessed finally. Results The PCT, EVLWI, sICAM-1, KL-6 and APACHE Ⅱ score in the death group were significantly higher than those in the survival group (P 0.05）. These parameters including levels of EVLWI, sICAM-1, KL-6, Procalcitonin and APACHE Ⅱ score in the death group were significantly higher than those in the survival group on the 1st，3rd and 5th day (P<0.05), whereas the OI was significantly lower than that of the survival group on the 3rd and 5th day (P<0.05). Logistic regression analysis showed that EVLWI, sICAM-1, KL-6 level were significantly related with the mortality of these patients. The levels of sICAM-1, kl-6 and EVLWI on 1st，3rd and 5th day after RICU admission showed a significant negative correlation with OI (P<0.001). Whereas, The levels of sICAM-1, kL-6 on 1st，3rd and 5th day showed a significant positive correlation with EVLWI (P<0.001). The sensitivity and specificity of sICAM-1, KL-6 combined with EVLWI in prognosis evaluation on 1st，3rd and 5th day were 75.0%，84.4%, 85.0%，66.7%，80.0%，86.7%, respectively. The AUC was 0.864，0.881，0.892 on 1st，3rd and 5th day, respectively (P<0.001), which had a better prognostic value than each of them. Conclusions EVLWI, sICAM-1 and KL-6 were independent risk factors for the prognosis of severe pneumonia patients with ARDS. The combination of EVLWI, sICAM-1 and KL-6 might be important in early predicting the prognosis of the 28d mortality. © 2021 Chinese Medical Association. All rights reserved.

B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients.

Introduction:Visualization of B-lines via lung ultrasound provides a non-invasive estimation of pulmonary hydration. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) assessed by transpulmonary thermodilution (TPTD) represent the most validated parameters of lung water and alveolocapillary permeability, but measurement is invasive and expensive. This study aimed to compare the correlations of B-lines scores from extensive 28-sector and simplified 4-sector chest scan with EVLWI and PVPI derived from TPTD in the setting of intensive care unit (primary endpoint).Methods:We performed scoring of 28-sector and 4-sector B-Lines in 50 critically ill patients. TPTD was carried out with the PiCCO-2-device (Pulsion Medical Systems SE, Maquet Getinge Group). Median time exposure for ultrasound procedure was 12 minutes for 28-sector and 4 minutes for 4-sector scan.Results:Primarily, we found close correlations of 28-sector as well as 4-sector B-Lines scores with EVLWI (R2 = 0.895 vs. R2 = 0.880) and PVPI (R2 = 0.760 vs. R2 = 0.742). Both B-lines scores showed high accuracy to identify patients with specific levels of EVLWI and PVPI. The extensive 28-sector B-lines score revealed a moderate advantage compared to simplified 4-sector scan in detecting a normal EVLWI ≤ 7 (28-sector scan: sensitivity = 81.8%, specificity = 94.9%, AUC = 0.939 versus 4-sector scan: sensitivity = 81.8%, specificity = 82.1%, AUC = 0.902). Both protocols were approximately equivalent in prediction of lung edema with EVLWI ≥ 10 (28-sector scan: sensitivity = 88.9%, specificity = 95.7%, AUC = 0.977 versus 4-sector scan: sensitivity = 81.5%, specificity = 91.3%, AUC = 0.958) or severe pulmonary edema with EVLWI ≥ 15 (28-sector scan: sensitivity = 91.7%, specificity = 97.4%, AUC = 0.995 versus 4-sector scan: sensitivity = 91.7%, specificity = 92.1%, AUC = 0.978). As secondary endpoints, our evaluations resulted in significant associations of 28-sector as well as simplified 4-sector B-Lines score with parameters of respiratory function.Conclusion:Both B-line protocols provide accurate non-invasive evaluation of lung water in critically ill patients. The 28-sector scan offers a marginal advantage in prediction of pulmonary edema, but needs substantially more time than 4-sector scan.

The value of growth differentiation factor-15 and extravascular lung water index in severity grading of acute respiratory distress syndrome patients and their prognosis prediction

To investigate the value of growth differentiation factor-15 (GDF-15) and extravascular lung water index (EVLWI) in severity grading and prognosis prediction of patients with acute respiratory distress syndrome (ARDS). Patients with ARDS aged 18-75 years admitted to the department of respiratory intensive care unit (RICU) of Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to February 2020 were enrolled. All patients were treated with conventional therapies such as mechanical ventilation, anti-infection, stabilization of water, electrolytes and acid-base environment, blood purification and nutritional support according to their conditions. Besides, the pulse-indicated continuous cardiac output (PiCCO) was performed after admission to the department, and EVLWI before treatment and at 24, 48 and 72 hours of treatment were recorded. Serum GDF-15 level was measured by enzyme linked immunosorbent assay (ELISA) during the same period. Patients were classified as mild, moderate, and severe degree according to the 2012 Berlin Definition of ARDS, and EVLWI and GDF-15 levels in patients with different disease levels before and after treatment were compared. In addition, the length of intensive care unit (ICU) stay, ICU mortality, and 28-day mortality of patients with different GDF-15 or EVLWI levels were analyzed comparatively, with the GDF-15 3 458 ng/L and EVLWI 15 mL/kg as the cut point. A total of 82 patients with ARDS were enrolled, including 22 patients with mild ARDS, 28 patients with moderate ARDS, and 32 patients with severe ARDS. The GDF-15 and EVLWI levels in patients with moderate and severe ARDS at each time point before and after treatment were higher than those in patients with mild ARDS. Both GDF-15 and EVLWI levels in patients with severe ARDS were higher than those in the patients with moderate ARDS. The differences were statistically significant at all the time points except for the difference of GDF-15 levels at 24 hours after treatment (ng/L: 3 900.41±546.43 vs. 3 695.66±604.73, P > 0.05). [GDF-15 (ng/L): 3 786.11±441.45 vs. 3 106.83±605.09 before treatment, 3 895.48±558.96 vs. 3 333.29±559.66 at 48 hours, 3 397.33±539.56 vs. 3 047.53±499.57 at 72 hours; EVLWI (mL/kg): 19.06±1.91 vs. 14.31±1.50 before treatment, 18.56±2.23 vs. 13.26±1.69 at 24 hours, 17.23±1.76 vs. 12.45±1.36 at 48 hours, 15.47±1.81 vs. 11.13±2.19 at 72 hours, all P < 0.05]. According to the cut-off value, there were 23 patients with GDF-15 ≥ 3 458 ng/L and GDF-15 < 3 458 ng/L respectively and there were 23 patients with EVLWI ≥ 15 mL/kg and EVLWI < 15 mL/kg respectively. The length of ICU stay and 28-day mortality in patients with high GDF-15 were significantly higher than those in patients with low GDF-15 [length of ICU stay (days): 21.22±2.69 vs. 15.37±3.14, 28-day mortality: 56.5% vs. 21.7%, both P < 0.05]. The length of ICU stay and 28-day mortality in patients with high EVLWI were also significantly higher than those in patients with low EVLWI [length of ICU stay (days): 18.45±2.61 vs. 14.98±2.75, 28-day mortality: 47.8% vs. 17.4%, both P < 0.05]. To some extent, GDF-15 and EVLWI levels reflect the severity of patients with ARDS, and high GDF-15 and EVLWI levels are significantly associated with poor prognosis in patients with ARDS.

Prognostic value of the dynamic changes in extra vascular lung water index and angiopoietin-2 in severe multiple trauma patients with acute respiratory distress syndrome

To observe the dynamic changes in extra vascular lung water index (EVLWI) and angiopoietin-2 (Ang-2) in severe multiple trauma patients with acute respiratory distress syndrome (ARDS), analyze the risk factor for short-term mortality, and to evaluate their prognostic values for prognosis. A total of 54 severe multiple trauma patients with ARDS admitted to emergency intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from June 2014 to December 2018 were enrolled. The acute physiology and chronic health evaluation II (APACHE II), injury severity score (ISS) and oxygenation index (PaO2/FiO2), EVLWI [pulse-induced contour cardiac output (PiCCO) monitor] and plasma Ang-2 level [enzyme-linked immunosorbent assay (ELISA)] at 0 (immediately), 24, 48 and 72 hours after ICU admission, and the differences in PaO2/FiO2, EVLWI and Ang-2 between 0 hour and 72 hours (ΔPaO2/FiO2, ΔEVLWI, ΔAng-2) were calculated. The 28-day survival of patients was recorded, and the patients were divided into survival group and non-survival group. The differences in above mentioned parameters between the two groups were compared. Multivariate Logistic regression was used to analyze the independent risk factors associated with the prognosis. Receiver operating characteristic (ROC) curve was drawn to evaluate the prognostic values of ΔEVLWI and ΔAng-2 on the prognosis, and the Kaplan-Meier survival curve was plotted. 115 patients were enrolled in the final analysis, 72 survived in 28 days, 43 died, and the mortality rate was 37.4%. The APACHE II and ISS scores of the non-survival group were significantly higher than those of the survival group [APACHE II score: 25.7±2.7 vs. 20.6±2.2, ISS score: 22.1±3.1 vs. 18.1±2.1, both P < 0.05]. EVLWI and Ang-2 showed a gradual downwards tendency with the prolongation of the length of ICU stay in the survival group, but no significant change was found in the non-survival group. Parallel contour test showed that both P < 0.05, indicating that the curves between the two groups had different tendencies and were not parallel. The levels of EVLWI, Ang-2 and PaO2/FiO2 showed no statistical differences from 0 hour to 24 hours between the two groups, but EVLWI and Ang-2 in the non-survival group were significantly higher than those in the survival group from 48 hours on [EVLWI (mL/kg): 15.5±4.2 vs. 10.8±3.2, Ang-2 (ng/L): 352.7±51.2 vs. 237.9±42.8, both P < 0.05], and PaO2/FiO2 was significantly decreased [mmHg (1 mmHg = 0.133 kPa): 126.1±43.7 vs. 211.2±33.8, P < 0.05]. The ΔEVLWI and ΔAng-2 in the non-survival group were significantly lower than those in the survival group [ΔEVLWI (mL/kg): -0.9±6.1 vs. 3.1±6.4, ΔAng-2 (ng/L): -45.3±32.1 vs. 79.8±58.2, both P < 0.05], but ΔPaO2/FiO2 showed no significant difference as compared with the survival group (mmHg: 23.2±24.2 vs. -22.1±22.8, P > 0.05). Multivariate Logistic regression analysis demonstrated that ΔEVLWI [odds ratio (OR) = 2.811, 95% confidence interval (95%CI) = 1.232-3.161, P = 0.001], ΔAng-2 (OR = 2.204, 95%CI = 1.012-3.179, P = 0.001) and APACHE II (OR = 1.206, 95%CI = 1.102-1.683, P = 0.002) were independent risk factors for 28-day mortality of severe multiple trauma patients with ARDS. ROC curve analysis showed that the area under ROC curve (AUC) of ΔEVLWI for predicting 28-day prognosis of severe multiple trauma patients with ARDS was 0.832, which was higher than ΔAng-2 (AUC = 0.790) and APACHE II (AUC = 0.735). When the cut-off value of ΔEVLWI was 2.3 mL/kg, the sensitivity was 79.1%, and the specificity was 81.9%. Kaplan-Meier survival curve showed that the patients with ΔEVLWI > 2.3 mL/kg had a significantly higher 28-day cumulative survival rate as compared with the patients with ΔEVLWI ≤ 2.3 mL/kg (log-rank test: χ2 = 23.385, P = 0.000). ΔEVLWI and ΔAng-2 can be used as independent risk factors for 28-day mortality of severe multiple trauma patients with ARDS, and the predictive value of ΔEVLWI was better than Ang-2 and APACHE II. Dynamic observation of EVLWI could improve the accuracy of death forecasting for severe multiple trauma patients with ARDS.

The correlation between the human neutrophil gelatinase-associated lipocalin and the extravascular lung water index being analysised in patients with acute lung injury

Objective To study whether there is a correlation between the content of neutrophil gelatinase-asociated lipocalin(NGAL) and extravascular lung water index(EVLWI) in patients with acute lung injury(ALI) induced by septic shock . Methods We prospectively collected 110 patients with septic shock from December 2013 to June 2015, who had already completed the initial fluid resuscitation within 6 hours according to the guide. In accordance with whether combined with ALI, patients were divided into two groups: non ALI group was A group (n=61), and ALI group was B group (n=49). Baseline information, EVLWI and other indexes of hemodynamic monitored by PICCO of each group was collected prior to admission in intensive care unit. EVWI and the content of NGAL in alveolar lavage fluid, which detected by ELISA, were gathered after the initial fluid resuscitation. Results There were no significant differences at the baseline level between the two groups (P>0.05). The risk factors of EVLWI in patients with septic shock were analyzed by multivariate linear regression analysis.The risk factors contained fluid balance, NGAL, cardiac index(CI), Global end diastolic volume index(GEDI), human albumin(ALB), globulin(GLO). The results showed that EVLWI had linear regression with NGAL and GEDI. The equation of linear regression were Y(NGAL)=2.017+ 0.035X, and Y(GEDI)=-0.671+ 0.004X, respectively.Correlation analysis indicated that there was significantly positive correlation between EVLWI and GEDI(r=0.835, P=0.000) and between NGAL and GEDI(r=0.489, P=0.000). In contrast, after immobilization of GEDI, we did not find any significant correlation between EVLWI and NGAL(r=0.381, P=0.060). Conclusions In case of fluid infusion volume is relatively too much , there is a strong correlation between NGAL in alveolar lavage fluid and EVLWI levels for early fluid resuscitation in patients with sepetic shock. Key words: Intensive care unit; Sepsis; Septic shock; Acute lung injury; Bronchoalveolar lavage fluid; Extravascular lung water index; Neutrophil gelatinase-associated lipocalin; PICCO

Effect of rhubarb on extravascular lung water in patients with acute respiratory distress syndrome.

The aim of this study was to evaluate the effect of rhubarb on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). A total of 80 patients with ARDS were randomly divided into a treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rhubarb (30.0 g/d) and patients in the control group received conventional therapy for seven consecutive days. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were determined using pulse contour cardiac output (PiCCO) technology, and the oxygenation index was measured by blood gas analysis at baseline and on days 3, 5 and 7 after treatment. The oxygenation index was higher and the levels of EVLWI and PVPI were lower after treatment in the two groups; however, these indexes showed significant differences on the 5th and 7th days after rhubarb treatment compared with the results in the control group (p<0.05). Rhubarb can decrease EVLWI and PVPI, and improve oxygenation in patients with ARDS.

Assessment of fluid volume in critically ill patients with extravascular lung water index

To examine the effect of rapid infusion test guided by extravascular lung water index ( EVLWI ) on hemodynamics in critically ill patients at different states in order to guide volume resuscitation. A prospective observation was conducted. Forty critically ill patients admitted to Department of Critical Care Medicine of Tianjin Third Central Hospital from June 2012 to April 2014 were enrolled. Based on the levels of EVLWI and pulmonary vascular permeability index ( PVPI ) and the cardiac function, the patients were divided into four groups: septic patients with normal EVLWI and PVPI ( n = 17 ), septic patients with increased EVLWI and PVPI ( n = 3 ), septic patients with increased EVLWI and normal PVPI ( n = 4 ), and coronary heart disease and heart failure patients with normal EVLWI and PVPI ( n = 16 ). The rapid infusion test was conducted in all patients using lactated Ringer solution 250 mL, followed by infusion of crystalloid with rate of 150 mL/h. The conditions of mechanical ventilation and vasoactive drugs were not changed during study. The changes in EVLWI, intrathoracic blood volume index ( ITBVI ), and cardiac index ( CI ) before capacity load, at immediate capacity load, and 15, 45, 105 minutes after load were determined by pulse indicator continuous cardiac output ( PiCCO ). On the base of volume status before and after the liquid infusion, the standard for the changes were: stroke volume ( SV ) increased by 12%-15%, central venous pressure ( CVP ) greater ≥ 2 mmHg ( 1 mmHg = 0.133 kPa ), CI>15%, and ITBVI change greater than 10%. There were no statistically significant differences in the observed indicators at the each time point before and after rapid infusion test among the four groups ( all P>0.05 ). In septic patients with normal EVLWI and PVPI group, ITBVI was slightly increased by 5.4%-9.7% from 15 minutes to 45 minutes after rapid infusion test. In coronary heart disease and heart failure patients with normal EVLWI and PVPI group, the EVLWI was increased by 11.9%, 5.9%, and 14.7% respectirely at 15, 45, and 105 minutes, ITBVI was slightly increased by 6.4% at 45 minutes, CI was increased by 29.5% immediately after rapid infusion. In septic patients with increased EVLWI and PVPI group, CVP was increased by 8 mmHg immediately, EVLWI was increased significantly by 15.8% at 45 minutes, ITBVI was slightly decreased by 10.0% at 45 minutes, CI was increased by 24.7% immediately, and increased by 17.0% at 105 minutes, and PVPI was increased by 15.6%-28.1% at 15-105 minutes after rapid infusion. In septic patients with increased EVLWI and normal PVPI group, CVP was increased by 1.5 mmHg at 15 minutes, EVLWI was increased immediately, which was increased by 17.4%, 24.0%, and 31.4% respectively at 15, 45, and 105 minutes, ITBVI was increased by 13.9% at 15 minutes, CI was increased by 16.1% at 15 minutes after rapid fluid infusion. Rapid fluid replacement in critically ill patients with crystalloid, regardless of whether the EVLWI was normal or increased, the short-term response was affected by the volume and cardiac function of patients. Different status of patients showed different volume effect curve: no significant changes in hemodynamic parameters were found in patients with normal EVLWI and volume parameters. In patients with potential cardiac dysfunction, CI and EVLWI increased significantly; regardless of PVPI increased or normal, EVLWI and CI were increased in patients with elevated EVLWI; two different changes could be found in the two types of pulmonary edema while ITBVI was increased.

Influence of fluid loading in patients at different stages of septic shock: a prospective study

To explore the influence of fluid loading at different stages in patients with septic shock. A prospective study was conducted. Forty-two mechanically ventilated patients in septic shock were enrolled in the Department of Critical Care Medicine of the Fourth People's Hospital of Shenyang from March 2010 to March 2014. Fluid loading was performed at 0, 24, 48 and 72 hours after the diagnosis of septic shock. The hemodynamic parameters including cardiac output ( CO ), stroke volume ( SV ), and extravascular lung water index ( EVLWI ) were measured by pulse indicator continuous cardiac output ( PiCCO ), and arterial partial pressure ( PaO2 ) was determined. Positive responders were defined as SV increased by more than 15% after fluid loading. Increase of lung water was defined as EVLWI increased after fluid loading and its value was more than 7 mL/kg. Oxygenation descend was defined when oxygenation index ( PaO2/FiO2 ) lowered. Fluid responsiveness, extravascular lung water, and oxygenation were analyzed and recorded at different stages in patients with septic shock. Fluid loading test was conducted for a total of 168 times in 42 patients. Compared with those before fluid loading test, the heart rate ( HR ) was lowered, and mean arterial pressure ( MAP ), CO, and SV were increased after fluid loading at 0, 24, 48 hours ( all P<0.01),unchanged at 72 hours. EVLWI levels at all time points were increased including an increase of EVLWI less than 7 mL/kg at 0 hour and 24 hours, and higher than 7 mL/kg at 48 hours and 72 hours [ EVLWI ( mL/kg ) at 0 hour: 6.0±1.5 vs. 4.7±1.5, t = -4.183, P = 0.000; 24 hours: 6.5±1.5 vs. 5.6±1.3, t = -6.000, P = 0.000; 48 hours: 8.1±2.2 vs. 6.1±1.7, t = -7.246, P = 0.000; 72 hours: 9.0±2.4 vs. 6.2±1.5, t = -7.524, P = 0.000 ]. After fluid loading, PaO2/FiO2 was increased remarkably at 0 hour and 24 hours, unchanged at 48 hours, and decreased significantly at 72 hours [ PaO2/FiO2 ( mmHg, 1 mmHg = 0.133 kPa ) at 0 hour: 189.6±34.5 vs. 183.2±36.6, t = -3.644, P = 0.002; 24 hours: 194.6±35.7 vs. 190.7±37.5, t = -4.594, P = 0.000; 48 hours: 201.8±30.2 vs. 200.8±33.0, t = -0.793, P=0.437; 72 hours: 201.7±24.8 vs. 206.2±26.9, t = 2.243, P = 0.036 ]. The rate of positive response gradually decreased: 85.7%, 80.9%, 42.8%, 28.6% at 0, 24, 48, and 72 hours, the rate of lung water increased was gradually elevated: 9.8%, 14.3%, 42.8%, 61.9% at 0, 24, 48, and 72 hours, and there was an increase of rate of lowering oxygenation with elapse of time ( 9.5%, 11.9%, 19.0%, 33.3% at 0, 24, 48 and 72 hours ). Compared with 0 hour, the rate of positive response decreased and rate of lung water increased were increased from 48 hours on ( P<0.05 or P<0.01 ), and rate of lowering oxygenation was increased at 72 hours ( P<0.01 ). 48 to 72 hours might be the crucial period of occurrence of volume overload in patients with septic shock. Curtailing fluid infusion during this period might reduce the occurrence of pulmonary edema.

Value of detection of pentraxins 3 value combined with measurement of vascular lung water index in prognosis of patients with sepsis

To evaluate prognostic value of pentraxin3 ( PTX3 ) content combining with extravascular lung water index ( EVLWI ) in patients with sepsis. A retrospective analysis of complete clinical data of septic patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2014 was conducted. These patients were divided into two groups, survival group and death group, according to the outcome on the 28th day. Pulse index continuous cardiac output ( PiCCO ) was used to record the levels of EVLWI on the 1st, 2nd and 3rd day of intensive care unit ( ICU ) admission. The plasma level of PTX3 was measured simultaneously by enzyme-linked immunosorbent assay ( ELISA ). At the same time, acute physiology and chronic health evaluation II ( APACHEII) score and sequential organ failure assessment ( SOFA ) were calculated. Correlation analysis between plasma PTX3 and EVLWI values was performed, receiver operating characteristic curve ( ROC ) was drawn, and the prognostic value of each parameter was assessed finally. A total of 74 septic patients were enrolled, with 41 cases in the survival group and 33 cases in the non-survival group. Blood lactate, APACHEII, SOFA scores in the non-survival group were significantly higher than those of the survival group at ICU admission, and the length of ICU stay was significantly shorter than that of the survival group, while differences of the other clinical characteristics between two groups were not statistically significant. The plasma PTX3 level gradually declined with time in both groups, and plasma PTX3 at 1, 2, 3 days after ICU admission in non-survival group were significantly higher than those in survival group [ PTX3 ( μg/L ) at 1 day: 46.3±10.5 vs. 19.4±6.5, t = -13.486, P = 0.000; 2 days: 34.8±10.7 vs. 17.7±8.4, t = -8.284, P = 0.000; 3 days: 23.9±11.2 vs. 15.6±7.9, t = -5.036, P = 0.000 ]. EVLWI gradually declined in survival group, but increased in death group. EVLWI at 1, 2, 3 days after ICU admission in non-survival group were significantly higher than those in survival group [ EVLWI ( mL/kg ) at 1 day: 12.12±4.31 vs. 10.02±2.87, t = -2.502, P = 0.023; 2 days: 13.67±4.95 vs. 9.08±2.89, t = -5.188, P = 0.000; 3 days: 14.51±5.06 vs. 8.09±2.50, t = -7.126, P = 0.000 ]. PTX3 at 1, 2, 3 days after ICU admission showed a significant positive correlation with EVLWI ( r1 = 0.747, r2 = 0.719, r3 = 0.705, all P = 0.000 ). ROC curve analysis showed that the area under the ROC ( AUC ) of PTX3 at 1 day was 0.845±0.045, at the cut-off point of 23.0 μg/L, PTX3 showed a sensitivity of 84.8%, a specificity of 74.1%, a negative predictive value of 85.81%, and a positive predictive value of 72.42%. AUC of EVLWI at 3 days was 0.838±0.048, at the cut-off point of 10.5 mL/kg, EVLWI showed a sensitivity of 83.9%, a specificity of 82.9%, a negative predictive value of 86.45%, and a positive predictive value of 79.79%. Their sensitivities and specificities were found to be better than APACHEII, SOFA score. AUC of PTX3 combined with EVLWI at 1 day was 0.886±0.038. On the 1st day after ICU admission, with combination of the two indicators, cut-off point was found to be 0.312, a sensitivity of 86.8%, a specificity of 85.4%, a negative predictive value of 88.93%, and a positive predictive value of 82.72%. On the 3rd day after ICU admission, AUC of PTX3 combined with EVLWI was 0.856±0.046, and showed a cut-off of 0.471 for the prognosis of sepsis, a sensitivity of 85.8%, a specificity of 85.4%, a negative predictive value of 87.97%, and a positive predictive value of 82.50%. Compared with other single index, a combination of above mentioned two indexes showed a better sensitivity and specificity. PTX3 can serve as a novel prognostic indicator at early stage in septic patients. Combined with EVLWI, it shows important value in predicting prognosis of septic patients, and it also provides guidance in treatment of high-risk patients.

Extravascular Lung Water Correlates Multiorgan Dysfunction Syndrome and Mortality in Sepsis

BackgroundThis study was designated to investigate whether increased extravascular lung water index (EVLWI) may correlate multiple organ dysfunction syndrome (MODS) and mortality in sepsis.MethodsWe designed a prospective cohort study in an intensive care unit of a tertiary care hospital. Sixty-seven patients with severe sepsis were included. Data were used to determine an association between EVLWI and the development of MODS and mortality. These connections were determined by the multiple logistic regression, plotting the receiver operating characteristic (ROC) curve and by Spearman test.ResultsEVLWI levels were higher in MODS patients on day 1 (median (IQR), 18(12.8–23.9) ml/kg, n = 38, p<0.0001) than in those without (median (IQR), 12.4 (7.9–16.3) ml/kg, n = 29) and day 3 (median (IQR), 17.8 (11.2–22.8) ml/kg, n = 29, p = 0.004) than in those without (median (IQR), 12.4 (8.0–16.3) ml/kg, n = 29). EVLWI was used as an independent predictor of the development of MODS (odds ratio, 1.6; p = 0.005; 95% confidence interval, 1.2∼2.2) during ICU stay. The area under the ROC curve showed that EVLWI levels could predict MODS (0.866) and mortality (0.881) during ICU stay. Meanwhile, the higher of SOFA score, the more EVLWI was found on day 1 (r = 0.7041, p<0.0001) and day 3 (r = 0.7732, p<0.0001).ConclusionsIncreased EVLWI levels correlates development of MODS and mortality during the patients' ICU stay. Further more, the potential of novel treatment in severe sepsis with lung injury may develop.

Effects of Extravascular Lung Water on the Measurement of Transpulmonary Thermodilution Cardiac Output in Acute Respiratory Distress Syndrome Patients

Transpulmonary thermodilution cardiac output is used in calculating aortic impedance for calibrating the pulse-contour analysis and is applied to calculate extravascular lung water (EVLW). Whether pulmonary edema affects the accuracy of transpulmonary thermodilution is controversial. This study aimed to investigate the effects of extravascular lung water index (EVLWI) on the transpulmonary thermodilution measurement in acute respiratory distress syndrome (ARDS). A prospective study. The medical intensive care unit of one medical center. Twenty-four ARDS patients. The continuous pulmonary artery thermodilution cardiac index (CCIpa) and the bolus transpulmonary thermodilution cardiac index (BCItp) data were recorded at baseline and repeated immediately and at 2, 4, and 6 hours after volume expansion with a 500-mL infusion of 10% pentastarch (hydroxyethyl starch 200/0.5) at a rate of 10 mL/kg/h. A total of 120 paired CI measurements were analyzed. Linear regression analysis showed a close correlation between BCItp and CCIpa (R = 0.87). The mean BCItp was higher than CCIpa, and the Bland-Altman analysis revealed a bias of 0.51 ± 0.78 L/min/m(2). The limits of agreement (2 standard deviations) was 1.66 L/min/m(2) (+2.07 and -1.05 L/min/m(2)), and the percentage error was 31.5%. Levels of EVLWI negatively correlated with the difference between BCItp and CCIpa (R = -0.19). In ARDS patients, the agreement between transpulmonary thermodilution and pulmonary artery thermodilution for cardiac output measurement is marginally acceptable. The severity of pulmonary edema expressed as EVLWI weakly and negatively correlates with the difference between BCItp and CCIpa derived from the two techniques.