Extravascular lung water as a prognostic tool in surgical critically ill patients

Objective

To analyse the value of extravascular lung water (EVLW) as a prognostic clinical tool in surgical critically ill patients.

Method

A retrospective study on a surgical intensive care unit. Forty-six patients were analysed. All patients were mechanically ventilated. In all patients a PiCCO (Pulse Contour Cardiac Output) catheter was inserted. Variables suxh as length of ICU admission, length of pressure controlled ventilation and ventilation settings, APACHE II score (acute physiology and chronic health evaluation) and EVLW were collected. The correlation between variables was evaluated with a linear regression model.

Results

The median APACHE II score of the included patients was 13, ranging from 7 to 33. All patients were mechanically ventilated in a pressure control mode with positive end expiratory pressure ranging from 5 to 15 and an inspiration pressure ranging from 15 to 40 cmH₂O. We divided patients into two groups: one included patients with EVLW < 10 and one included patients with EVLW of 10 or more. In the group with EVLW ≥ 10, we saw a higher mortality rate compared with the group with EVLW < 10 (35.5% vs 23.8%). In both groups we found no correlation in length of ICU admission, length of mechanical ventilation or the APACHE II score with EVLW.

Conclusion

Although we found an association between EVLW and mortality in surgical critically ill patients, we could not confirm a relation between EVLW and length of ICU admission and length of mechanical ventilation in the patient population we studied.