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Prognostic value of the extravascular lung water index in critically ill septic shock patients

Introduction

The study investigated the prognostic value of the extravascular lung water index (EVLWI) determined by the single transpulmonary thermodilution technique and its relationship with physiologic indexes of lung injury in critically ill patients with septic shock in the ICU.

Methods

The EVLWI was determined using a PiCCO monitor, and the daily fluid balance, oxygenation ratio (PaO2/FiO2), pulmonary vascular index (PVI), lung compliance and lung injury score (LIS) were recorded. The final outcome was assessed at day 28. Data (mean ± SD) were compared using Student's t test for continuous variables and by the chi-squared test for discrete variables. The correlations were estimated using Pearson's coefficient. P < 0.05 was regarded as statistically significant.

Results

Thirty patients with septic shock were admitted prospectively. Fourteen (47%) patients died before day 28. At day 1 and day 3 the EVLWI was correlated to PaO2/FiO2 (r = -0.4 and r = -0.47, respectively; P < 0.05) and to LIS (r = 0.47 and r = 0.43, respectively; P < 0.05). No correlation was found, however, between the EVLWI and lung compliance and fluid balance. The average EVLWI at baseline was 12 ± 5 ml/kg, and the difference was not different between survivors and nonsurvivors; P = 0.14. The EVLWI and PVI for day 3 in nonsurvivors were significantly higher than in the survivors (13.7 ± 4.5 vs 8.6 ± 2.6 ml/kg; P = 0.001 and 2.69 ± 0.98 vs 1.93 ± 0.65; P = 0.01, respectively). ROC statistics using the highest EVLWI value at day 3 in each individual revealed an area under the curve of 0.868 ± 0.128; P = 0.001 with a cutoff point >11.5 ml/kg. At day 3, the hospital mortality of patients with EVLWI >11.5 ml/kg was significantly higher than those with EVLWI <11.5 ml/kg (77% vs 19%; P = 0.02) with sensitivity of 77% and specificity of 80%. During the course of illness, the EWLI, PVI and fluid balance decreased from days 1 to 3 only in the survivors (P < 0.05).

Conclusion

In human septic shock, the EVLWI demonstrated moderate correlation with markers of the severity of pulmonary aggression. Dynamic observation of the EVLWI can be one of the factors for predicting the prognosis of patients with septic shock. A reduction of the EVLWI at early treatment was associated with a better prognosis.

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Mallat, J., Salaun, P., Thevenin, D. et al. Prognostic value of the extravascular lung water index in critically ill septic shock patients. Crit Care 12, P105 (2008). https://doi.org/10.1186/cc6326

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Keywords

  • Septic Shock
  • Fluid Balance
  • Septic Shock Patient
  • Lung Compliance
  • Transpulmonary Thermodilution