Articles: extravascular-lung-water.
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Clinical Trial
Effect of crystalloid resuscitation and inhalation injury on extravascular lung water: clinical implications.
Arterial thermal dilution with an integrated fiberoptic monitoring system (COLD Z-021; Pulsion Medical Systems; Munich, Germany) allows measurement of extravascular lung water (EVLW) and pulmonary permeability index (PPI). The aim of this study was to evaluate the widespread clinical assumption that early respiratory failure following burn and inhalation injury is due to interstitial fluid accumulation in the lung. ⋯ Early fluid accumulation in the lung in burned patients is very uncommon, even in the presence of inhalation injury. There is no evidence that thermal injury causes an increase in pulmonary capillary membrane permeability.
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Intensive care medicine · Jun 2002
Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema.
To evaluate whether different indicators using for guiding volume expansion are valuable tools to assess edematous lung injury in patients with septic shock. ⋯ Volume variables (TEDVI, ITBVI) are more useful indicators than pressure variables (CVP, PAOP) for assessment of EVLWI in septic patients with pulmonary edema.
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Randomized Controlled Trial Clinical Trial
Effects of dexamethasone on intravascular and extravascular fluid balance in patients undergoing coronary bypass surgery with cardiopulmonary bypass.
Cardiac surgery with cardiopulmonary bypass is often associated with postoperative hemodynamic instability. In this regard beneficial effects of corticosteroids are known. The purpose of this study was to investigate whether these effects are due mainly to a modification of the intravascular and extravascular volume status or whether a more direct improvement of cardiovascular performance by corticosteroids is the underlying mechanism. ⋯ Extravascular fluid but not extravascular lung water is increased in patients after surgery with cardiopulmonary bypass. Pretreatment of adult patients with 1 mg/kg-1 dexamethasone before coronary bypass grafting decreases extravascular fluid gain and seems to improve postoperative cardiovascular performance. This effect is not caused by a better intravascular volume status.
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Intensive care medicine · Apr 2002
What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome?
To evaluate the effects of prone ventilation on respiratory parameters and extravascular lung water (EVLW) in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in order to characterise the optimal duration of ventilation in the prone position. ⋯ Over the 18 h period studied there was progressive improvement in gas exchange, pulmonary shunt and EVLW. Although it is not possible to exclude that improvement over this period was unrelated to prone positioning, these findings suggests that ventilation in the prone position for more prolonged periods may be required for optimal improvement and warrants further study.
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Due to concerns about the efficacy and safety of using pulmonary artery catheterization to evaluate hemodynamic status, noninvasive diagnostic testing has gained increased importance. This article focuses on both the supportive evidence and the limitations of applying the vascular pedicle width (VPW), which is the mediastinal silhouette of the great vessels, as an aid in the assessment of patients' intravascular volume status. The objective measurement of the VPW obtained from either upright or supine chest radiographs (CXRs which are often already available though not fully utilized) can increase the accuracy of the clinical and radiographic assessment of intravascular volume status by 15 to 30%, and this value may be even higher when VPW is used serially within the same patient. ⋯ Reappraisal of the VPW and other roentgenographic signs should be incorporated into newly implemented studies of the Swan-Ganz catheter, ICU echocardiography, portable CT scans, and other costlier technologies. While such investigations may refine the optimum application of the portable CXR, conventional and digital supine radiographs should retain an important role in the diagnosis and management of critically ill patients. Lastly, the measurement of the VPW should be incorporated into the training of chest clinicians and radiologists.