Sakka S et al Chest 2002 - PULSION Medical Systems SE

pulsion

Sakka S et al Chest 2002 - PULSION Medical Systems SE

Extravascular lung

water: validation and

prognostic value

Mikhail Kirov

Departments of Anesthesiology and Intensive Care Medicine

Northern State Medical University, Arkhangelsk, Russia,

and University of Tromsø, Tromsø, Norway

*Member of the Medical Advisory Board, Pulsion Medical

Systems


Monitoring of EVLW

Pfeiffer UJ et al. Practical applications of fiberoptics in critical care monitoring. 1990, pp. 114-125

Boldt J. Crit Care Med 2002:6:52-59

Sakka SG et al. Intensive Care Med 2000;26:180-187

• Clinical examination, X-ray,

CT, blood gases

• Gravimetry

• Thermodilution techniques:

thermo-dye dilution, single

transpulmonary thermodilution

LPS OA


Validation of EVLWTDD vs. gravimetry

Slutsky RA et al. Crit Care Med 1987;13:432-435

Sturm JA. Practical applications of fiberoptics in critical care monitoring. 1990, pp. 129-139

Kirov MY et al. Intensive Care Med 2003;29:S167

2000

1600

1200

800

400

0

In brain-dead humans

EVLW in vivo (ml)

r = 0.95

y = 149 + 0.89x

n = 14

800 1600 2400

EVLW-Grav. (Ery-Cr 51 )

ml

20

16

12

8

4

0

After LPS in sheep

EVLWTDD (ml/kg)

r² = 0.80

y = 1.14x + 2.45

n = 18

0 4 8 12 16 20

EVLWI G (g/kg)


14 Mechanical ventilated patients with ARDS


Validation of EVLWST vs. EVLWTDD

Neumann P. Intensive Care Med 1999;25:216-219

Sakka SG et al. Intensive Care Med 2000;26:180-187

EVLWI ST = (0.83 × EVLWI TDD ) + 1.6 Bias = – 0.2 ml/kg, SD = 1.4 ml/kg

n = 209 patients, r = 0.96, p < 0.0001


Validation of EVLWST vs. EVLWTDD

Michard F. Crit Care Med 2005;33:1243-1247

n = 48 patients Bias = – 0.5 ml/kg, SD = 1.9 ml/kg


Validation of EVLW ST vs. gravimetry

Katzenelson R et al. Crit Care Med 2004 ;32:1550-1554

Kirov MY et al. Crit Care 2004;8:R451-R458

EVLWI by PiCCO

40

30

20

10

EVLWI by gravimetrics and by the

PiCCO technique

0

Y = 1.03X + 2.49

Spearman correlation

r = 0.967; p < 0.001

Control

Oleic acid

Left atrial balloon

0 10 20 30 40

EVLWI by gravimetrics

EVLWI ST = 1.30 × EVLW G + 2.32

(n = 18, r = 0.85, p < 0.0001)


EVLWI, CVP, and lung injury score

Kirov MY et al. Yearbook of Intensive Care and Emergency Medicine 2005; p. 449-461

Martin GS et al. Crit Care 2005;9:R74-R82

EVLWI and LIS: r 2 =0.18,

EVLWI and radiograph score:

r 2 =0.28, p


Q#2 The normal EVLW value is 3-7 3 7 ml/kg.

A value of 20 ml/kg is associated with

the following mortality rates:

1. 20%

2. 40%

3. 60%

4. 80%

Please vote now!


High EVLW is associated with

increased mortality

(65-80% (65 80% when EVLW>20 ml/kg)

Sakka S et al

Chest 2002; 1232:2080-6

N=373

Mortality (%)

90

80

70

60

50

40

30

20

Sturm JA 1990

EVLWI and Mortality

(Highest measurement)

Beale R 2001

2_6 6_8 8_10 10_12 12_16 16_20 >20

EVLWI (ml/kg)

N=241


EVLW and prognosis

Sakka SG et al. Chest 2002;122:2080-2086

Kuzkov VV et al. Crit Care Med 2006;34(6), in press.

EVLW is increased in 95% patients with pulmonary

sepsis-induced ALI and in 50% with non-pulmonary

sepsis-induced ALI


EVLW and prognosis in severe sepsis

Kirov MY et al. Yearbook of Intensive Care and Emergency Medicine 2005; p. 449-461

Martin GS et al. Crit Care 2005;9:R74-R82

Kuzkov VV et al. Crit Care Med 2006;34(6), in press.

Septic shock/ALI

Severe sepsis

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