Articles: extravascular-lung-water.
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Int J Clin Pharm Th · Nov 2012
Prediction of distribution volume of vancomycin in critically ill patients using extravascular lung water and pulmonary vascular permeability indices.
Alterations in distribution volume affect the concentrations of hydrophilic drugs in plasma and tissues at the time of initial therapy. When the distribution volume of hydrophilic antimicrobials is increased in critically ill patients with a serious infection, antimicrobial concentrations are reduced, which may adversely affect the efficacy of antimicrobial therapy. A transpulmonary thermodilution technique system (PiCCO) enables measurements of pulmonary vascular permeability index (PVPI) and extravascular lung water index (EVLWI), which are related to pulmonary edema and pulmonary vascular permeability, respectively. In addition, those indices may also be related to the distribution volume of hydrophilic antimicrobials. The aim of this study was to investigate the relationships of PVPI and EVLWI with the distribution volume of vancomycin (Vss), as well as to establish a method for estimating Vss for planning an appropriate initial dose for individual patients. ⋯ EVLWI determined by the PiCCO system is useful to predict Vss and should lead to more effective vancomycin therapy for critically ill patients at the initial stage.
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Meta Analysis Comparative Study
Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: a meta-analysis of the literature.
Hemodynamic parameters such as the global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI), derived by transpulmonary thermodilution, have gained increasing interest for guiding fluid therapy in critically ill patients. The proposed normal values (680-800ml/m(2) for GEDVI and 3-7ml/kg for EVLWI) are based on measurements in healthy individuals and on expert opinion, and are assumed to be suitable for all patients. We analyzed the published data for GEDVI and EVLWI, and investigated the differences between a cohort of septic patients (SEP) and patients undergoing major surgery (SURG), respectively. ⋯ The published data for GEDVI and EVLWI are heterogeneous, particularly in critically ill patients, and often exceed the proposed normal values derived from healthy individuals. In the group of septic patients, GEDVI and EVLWI were significantly higher than in the group of patients undergoing major surgery. This points to the need for defining different therapeutic targets for different patient populations.
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Journal of critical care · Aug 2012
Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients.
The purpose was to investigate whether extravascular lung water (EVLW) indexed to actual body weight (EVLWa) is an independent predictor of mortality in patients with septic shock, to determine the relationship between EVLWa and other markers of lung injury, and to test if indexing EVLW with predicted body weight (EVLWp) strengthens its predictive power. ⋯ Extravascular lung water indexed or not to predicted body weight is an independent predictor of mortality in patients with septic shock. Repeated measurements of EVLW indexes over time, rather than a too-early measurement, seem to be more appropriate for predicting outcome.
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Journal of critical care · Aug 2012
Review Meta AnalysisPrognostic value of extravascular lung water index in critically ill patients: a systematic review of the literature.
The prognostic value of extravascular lung water (EVLW) has been widely investigated; however, a wide range of its predictive accuracy has been reported. ⋯ The EVLWI appears to be a good predictor of mortality in critically ill patients.