Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock

Critical Care

Marina Larsson¹  Eva Åkerman¹  Jörgen Ryden¹  Johan Undén¹  Anders Ersson¹  Lill Bergenzaun¹  Joachim During¹  Lilian Ihrman¹  Michelle S Chew¹ 

[1] Department of Intensive Care Medicine, Skåne University Hospital Malmö, Södra Förstadsgatan, Lund University, S-20502 Malmö, Sweden

关键词: likelihood ratio;    pulmonary oedema;    shock;    sepsis;    extravascular lung water;    acute lung injury;    acute respiratory distress syndrome;   

Others  :  1093264
DOI  :  10.1186/cc10599

 received in 2011-08-17, accepted in 2012-01-03,  发布年份 2012

【 摘 要 】

Introduction

The diagnosis of acute lung injury (ALI) may be more robust if more accurate physiological markers can be identified. Extravascular lung water (EVLW) is one possible marker, and it has been shown to correlate with respiratory function and mortality in patients with sepsis. Whether EVLW confers diagnostic value in a general population with shock, as well as which index performs best, is unclear. We investigated the diagnostic accuracy of various EVLW indices in patients with shock.

Methods

We studied a prospective, observational cohort of 51 patients with shock admitted to a tertiary ICU. EVLW was measured within 6 hours of ICU admission and indexed to actual body weight (EVLW/ABW), predicted body weight (EVLW/PBW) and pulmonary blood volume (EVLW/PBV). The relationship of these indices to the diagnosis and severity of lung injury and ICU mortality were studied. Positive and negative likelihood ratios, pre- and posttest odds for diagnosis of lung injury and mortality were calculated.

Results

All EVLW indices were higher among patients with lung injury and significantly correlated with respiratory parameters. Furthermore, all EVLW indices were significantly higher in nonsurvivors. The use of EVLW improves the posttest OR for the diagnosis of ALI, acute respiratory distress syndrome (ARDS) and severe lung injury (sLI) by up to eightfold. Combining increased EVLW and a diagnosis of ALI, ARDS or sLI increases the posttest odds of ICU mortality. EVLW/ABW and EVLW/PBV demonstrated the best diagnostic performance in this population.

Conclusions

EVLW was associated with degree of lung injury and mortality, regardless of the index used, confirming that it may be used as a bedside indicator of disease severity. The use of EVLW as a bedside test conferred added diagnostic value for the identification of patients with lung injury.

【 授权许可】

   
2012 Chew et al.; licensee BioMed Central Ltd.

【 图 表 】

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