Articles: extravascular-lung-water.
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Intensive care medicine · May 2019
Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema.
Detecting weaning-induced pulmonary oedema (WIPO) is important because its treatment might prompt extubation. For this purpose, lung ultrasound might be an attractive tool, since it demonstrates pulmonary oedema through the appearance of B-lines. ⋯ This study suggests that a Delta-B-lines ≥ 6 on four anterior points allows the diagnosis of WIPO with the best accuracy. This should be confirmed in larger populations.
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Zhonghua Wei Zhong Bing Ji Jiu Yi Xue · May 2019
[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. ⋯ 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.
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J Clin Monit Comput · Feb 2019
Observational StudyQuantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients.
Extravascular lung water (index) (EVLW(I)) can be estimated using transpulmonary thermodilution (TPTD). Computed tomography (CT) with quantitative analysis of lung tissue density has been proposed to quantify pulmonary edema. We compared variables of pulmonary fluid status assessed using quantitative CT and TPTD in critically ill patients. ⋯ There was no significant correlation between TVI and EVLWI before CT, EVLWI after CT, or mean EVLWI. CT-derived variables did not predict elevated TPTD-derived EVLWI values. In unselected critically ill patients, variables of pulmonary fluid status assessed using quantitative CT cannot be used to predict EVLWI.
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Several techniques are now available to detect and quantify pulmonary edema, from the laboratory postmortem method (gravimetry) to non-invasive wearable sensors. In critically ill patients with adult respiratory distress syndrome (ARDS), computed tomography scans are often performed to visualize lung lesions and quantify lung aeration, but their value seems somewhat limited to quantify pulmonary edema on a routine basis and of course to track changes with therapy. In this context, transpulmonary thermodilution is a convenient technique. ⋯ Echo probes are about to replace the stethoscope in our pocket and, if B lines (aka comet tails) do not allow a real quantification of pulmonary edema, they are useful to detect an increase in lung water. Finally, wireless and wearable sensors are now available to monitor patients on hospital wards and beyond (home monitoring). They should enable the detection of pulmonary congestion at a very early stage, and if combined with a proactive therapeutic strategy, have potential to improve outcome.
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Curr Opin Anaesthesiol · Feb 2019
ReviewExtravascular lung water monitoring for thoracic and lung transplant surgeries.
Excessive accumulation of extravascular lung water (EVLW) resulting in pulmonary edema is the most feared complication following thoracic surgery and lung transplant. ICUs have long relied on chest radiography to monitor pulmonary status postoperatively but the increasing recognition of the limitations of bedside plain films has fueled development of newer technologies, which offer earlier detection, quantitative assessments, and can aide in preoperative screening of surgical candidates. In this review, we focus on the emergence of transpulmonary thermodilution (TPTD) and lung ultrasound with a focus on the clinical integration of these modalities into current intraoperative and critical care practices. ⋯ Monitoring EVLW in the perioperative period offers clinicians a powerful tool to guide fluid therapy and manage pulmonary edema. Both TPTD and lung ultrasound have unique attributes in the care of thoracic surgery and lung transplant patients.