Articles: extravascular-lung-water.
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Early optimization of fluid status is of central importance in the treatment of critically ill patients. This study aims to investigate whether inferior vena cava (IVC) diameters correlate with invasively assessed hemodynamic parameters and whether this approach may thus contribute to an early, non-invasive evaluation of fluid status. Thirty mechanically ventilated patients with severe sepsis or septic shock (age 60 +/- 15 years; APACHE-II score 31 +/- 8; 18 male) were included. ⋯ In this study, IVC diameters were found to correlate with central venous pressure, extravascular lung water index, intrathoracic blood volume index, the intrathoracic thermal volume, and the PaO(2)/FiO(2) oxygenation index. Therefore, sonographic determination of IVC diameter seems useful in the early assessment of fluid status in mechanically ventilated septic patients. At this point in time, however, IVC sonography should be used only in addition to other measures for the assessment of volume status in mechanically ventilated septic patients.
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Intensive care medicine · Jun 2010
Case ReportsTranspulmonary thermodilution curves for detection of shunt.
Monitoring using transpulmonary thermodilution (TPTD) via a single thermal indicator technique allows measurement of cardiac output, extravascular lung water (EVLW) and volumetric variables. ⋯ In the case of recirculation of thermal indicator, the observed overestimated EVLW in absence of gas exchanges abnormality could be an indicator suggesting the search for a circulatory shunt.
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Heart failure patients are often equipped with implanted devices and are frequently hospitalized due to volume overload. Reliable prediction of imminent fluid congestion has the potential to provide early detection of cardiac decompensation and therefore might be capable of enhancing therapy management. We investigated whether implant-based impedance (Z) measurement is closely correlated with directly assessed extravascular lung water and might thus be useful for patient monitoring. ⋯ Changes of Z show a strong inverse correlation with changes of directly measured EVLWI. This allows the application of Z as a measure of intrathoracic fluid status and has the potential to optimize patient care, especially in the context of evolving telemedicine concepts.
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Journal of critical care · Mar 2010
Extravascular lung water to blood volume ratios as measures of pulmonary capillary permeability in nonseptic critically ill patients.
The aim of this study is to evaluate the value of extravascular lung water (EVLW) to intrathoracic blood volume, global end-diastolic volume, or pulmonary blood volume ratios as a reflection of pulmonary permeability in nonseptic critically ill patients with or at risk for acute lung injury/acute respiratory distress syndrome (ALI/ARDS). ⋯ The EVLW/blood volume ratios are determined, at least in part, by moderately increased pulmonary permeability in nonseptic critically ill patients with or at risk for ALI/ARDS, independent of fluid status and pressure forces. Normal ratios may help to exclude high permeability.