Extravascular Lung Water and Its Association with Weight, Height, Age, and Gender: a Study in Intensive Care Unit Patients

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2012 Nov 20

PMID 23160768

Citations 15

Authors

Wolfgang Huber

Sebastian Mair

Simon Q Gotz

Julia Tschirdewahn

Johanna Siegel

Roland M Schmid

Bernd Saugel

Affiliations

Soon will be listed here.

Abstract

Purpose: With regard to large inter-individual variability of height, body weight (BW), and age, several hemodynamic parameters are adjusted for biometric data. This also applies to extravascular lung water (EVLW), which traditionally was indexed to actual BW (BW-act) resulting in EVLW-index (EVLWI; i.e., EVLWI-act). Since indexation to BW-act might inappropriately diminish EVLWI-act in obese patients, the indexation has been changed to predicted BW (BW-pred) resulting in EVLWI-pred. BW-pred is a weight estimation formula calculated from height and gender that has not been derived from population-based data. The aim of the study was to investigate the independent association of biometric data with EVLW.

Methods: We analyzed a hemodynamic monitoring database including 3,691 transpulmonary thermodilution-derived EVLW measurements (234 consecutive patients; intensive care unit of a university hospital). We performed univariate and multivariate analyses regarding the association of biometric data with the first EVLW measurement and the mean EVLW value of each patient.

Results: In univariate analysis, the first EVLW significantly correlated with height (r = 0.254; p < 0.001), but neither with age nor BW-act. Similar findings were made in the analysis of the patients' EVLW means of all measurements ("one point per patient"). In multivariate analysis (primary endpoint), including BW-act, height, age, and gender, only height was independently associated with EVLW, with each centimeter of height increasing the first measurement of EVLW by 6.882 mL (p < 0.001) and mean EVLW by 6.727 mL (p < 0.001).

Conclusions: Height is the only biometric parameter independently associated with the first and mean EVLW. In adult patients, EVLW should be indexed to height.

Citing Articles

Alert-Grouping: Smart Personalization of Monitoring System Thresholds to Help Healthcare Teams Struggle with Alarm Fatigue in Intensive Care.

Rozenes S, Fux A, Kagan I, Hellerman M, Tadmor B, Benis A J Med Syst. 2023; 47(1):113.

PMID: 37934335 DOI: 10.1007/s10916-023-02010-6.

A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays.

Schulz D, Rasch S, Heilmaier M, Abbassi R, Poszler A, Ulrich J Crit Care. 2023; 27(1):201.

PMID: 37237287 PMC: 10214619. DOI: 10.1186/s13054-023-04426-5.

Increased extravascular lung water index (EVLWI) reflects rapid non-cardiogenic oedema and mortality in COVID-19 associated ARDS.

Rasch S, Schmidle P, Sancak S, Herner A, Huberle C, Schulz D Sci Rep. 2021; 11(1):11524.

PMID: 34075155 PMC: 8169693. DOI: 10.1038/s41598-021-91043-3.

Lung ultrasound score assessing the pulmonary edema in pediatric acute respiratory distress syndrome received continuous hemofiltration therapy: a prospective observational study.

Wang F, Wang C, Shi J, Shan Y, Miao H, Sun T BMC Pulm Med. 2021; 21(1):40.

PMID: 33494739 PMC: 7830818. DOI: 10.1186/s12890-021-01394-w.

Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients.

Saugel B, Wildgruber M, Staudt A, Dieckmeyer M, Holzapfel K, Kaissis G J Clin Monit Comput. 2018; 33(1):5-12.

PMID: 29680878 DOI: 10.1007/s10877-018-0144-1.

References

Pai M, PALOUCEK F . The origin of the "ideal" body weight equations. Ann Pharmacother. 2000; 34(9):1066-9. DOI: 10.1345/aph.19381. View

Wanger J, Clausen J, Coates A, Pedersen O, Brusasco V, Burgos F . Standardisation of the measurement of lung volumes. Eur Respir J. 2005; 26(3):511-22. DOI: 10.1183/09031936.05.00035005. View

Tagami T, Kushimoto S, Yamamoto Y, Atsumi T, Tosa R, Matsuda K . Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010; 14(5):R162. PMC: 3219254. DOI: 10.1186/cc9250. View

Saugel B, Umgelter A, Schuster T, Phillip V, Schmid R, Huber W . Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheter. Crit Care. 2010; 14(3):R95. PMC: 2911732. DOI: 10.1186/cc9030. View

Phillips C, Chesnutt M, Smith S . Extravascular lung water in sepsis-associated acute respiratory distress syndrome: indexing with predicted body weight improves correlation with severity of illness and survival. Crit Care Med. 2007; 36(1):69-73. DOI: 10.1097/01.CCM.0000295314.01232.BE. View

Sakka S, Klein M, Reinhart K, Meier-Hellmann A . Prognostic value of extravascular lung water in critically ill patients. Chest. 2002; 122(6):2080-6. DOI: 10.1378/chest.122.6.2080. View

Michard F, Fernandez-Mondejar E, Kirov M, Malbrain M, Tagami T . A new and simple definition for acute lung injury*. Crit Care Med. 2012; 40(3):1004-6. DOI: 10.1097/CCM.0b013e31823b97fd. View

LeTourneau J, Pinney J, Phillips C . Extravascular lung water predicts progression to acute lung injury in patients with increased risk*. Crit Care Med. 2011; 40(3):847-54. PMC: 3272541. DOI: 10.1097/CCM.0b013e318236f60e. View

Martin G, Eaton S, Mealer M, Moss M . Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care. 2005; 9(2):R74-82. PMC: 1175916. DOI: 10.1186/cc3025. View

10.

Eisenberg P, Hansbrough J, Anderson D, Schuster D . A prospective study of lung water measurements during patient management in an intensive care unit. Am Rev Respir Dis. 1987; 136(3):662-8. DOI: 10.1164/ajrccm/136.3.662. View

11.

Fernandez-Mondejar E, Castano-Perez J, Rivera-Fernandez R, Colmenero-Ruiz M, Manzano F, Perez-Villares J . Quantification of lung water by transpulmonary thermodilution in normal and edematous lung. J Crit Care. 2003; 18(4):253-8. DOI: 10.1016/j.jcrc.2003.10.009. View

12.

Stocks J, Quanjer P . Reference values for residual volume, functional residual capacity and total lung capacity. ATS Workshop on Lung Volume Measurements. Official Statement of The European Respiratory Society. Eur Respir J. 1995; 8(3):492-506. DOI: 10.1183/09031936.95.08030492. View

13.

Akinnusi M, Pineda L, El Solh A . Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2007; 36(1):151-8. DOI: 10.1097/01.CCM.0000297885.60037.6E. View

14.

Huber W, Umgelter A, Reindl W, Franzen M, Schmidt C, von Delius S . Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index. Crit Care Med. 2008; 36(8):2348-54. DOI: 10.1097/CCM.0b013e3181809928. View

15.

Berkowitz D, Danai P, Eaton S, Moss M, Martin G . Accurate characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med. 2008; 36(6):1803-9. PMC: 2713576. DOI: 10.1097/CCM.0b013e3181743eeb. View

16.

Mallat J, Pepy F, Lemyze M, Barrailler S, Gasan G, Tronchon L . Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients. J Crit Care. 2012; 27(4):376-83. DOI: 10.1016/j.jcrc.2012.03.009. View

17.

OBrien Jr J, Phillips G, Ali N, Lucarelli M, Marsh C, Lemeshow S . Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med. 2006; 34(3):738-44. PMC: 1868702. DOI: 10.1097/01.ccm.0000202207.87891.fc. View

18.

Sakka S, Ruhl C, Pfeiffer U, Beale R, McLuckie A, Reinhart K . Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000; 26(2):180-7. DOI: 10.1007/s001340050043. View

19.

Craig T, Duffy M, Shyamsundar M, McDowell C, McLaughlin B, Elborn J . Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med. 2009; 38(1):114-20. DOI: 10.1097/CCM.0b013e3181b43050. View

20.

Chew M, Ihrman L, During J, Bergenzaun L, Ersson A, Unden J . Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock. Crit Care. 2012; 16(1):R1. PMC: 3396226. DOI: 10.1186/cc10599. View