Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients

Abstract

PurposeWith regard to large inter-individual variability of height, body weight (BW), and age, several hemodynamic parameters are adjusted for biometric data. This also applies to extravascular lung water (EVLW), which traditionally was indexed to actual BW (BW-act) resulting in EVLW-index (EVLWI; i.e., EVLWI-act). Since indexation to BW-act might inappropriately diminish EVLWI-act in obese patients, the indexation has been changed to predicted BW (BW-pred) resulting in EVLWI-pred. BW-pred is a weight estimation formula calculated from height and gender that has not been derived from population-based data. The aim of the study was to investigate the independent association of biometric data with EVLW.MethodsWe analyzed a hemodynamic monitoring database including 3,691 transpulmonary thermodilution-derived EVLW measurements (234 consecutive patients; intensive care unit of a university hospital). We performed univariate and multivariate analyses regarding the association of biometric data with the first EVLW measurement and the mean EVLW value of each patient.ResultsIn univariate analysis, the first EVLW significantly correlated with height (r = 0.254; p < 0.001), but neither with age nor BW-act. Similar findings were made in the analysis of the patients’ EVLW means of all measurements (“one point per patient”). In multivariate analysis (primary endpoint), including BW-act, height, age, and gender, only height was independently associated with EVLW, with each centimeter of height increasing the first measurement of EVLW by 6.882 mL (p < 0.001) and mean EVLW by 6.727 mL (p < 0.001).ConclusionsHeight is the only biometric parameter independently associated with the first and mean EVLW. In adult patients, EVLW should be indexed to height.

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

“…This improves accuracy in obese patients and improves correlation with severity of illness and survival in acute lung injury patients [105−107]. Recent data shows that no indexation at all or indexation related to height is better [108], as suggested by others [109,110]. The problem is that there are no good ranges for normal values and such algorithms and decision trees should be used with caution [21, 111].…”

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

“…We previously published data on indexation of EVLW and cardiac output from the same database [17,25].…”

“…BW) and formulas (e.g. BSA) might improve indexation of volumetric parameters including GEDVI and extravascular lung water index (EVLWI) [16][17][18][19][20][21][22][23].…”

Extravascular Lung Water and Sepsis

“…Bir çok çalışmada gerçek vücut ağırlığı ("ABWI:actual body weight index") kullanılırken son yıllarda yapılan çalışmalarda tahmini vücut ağırlığı ("PBW: predicted body weight") indeksinin kullanımının daha faydalı olduğu belirtilmiştir (20)(21)(22)(23) . Teorik olarak ABW indeksine oranla PBWI kullanımı, daha doğrudur.…”

“…Söz konusu değerin yaş ve boy bağımlı olduğu vurgulanmış; erişkinlerdeki değerlerin ço-cuklara uygulanamayacağı sonucuna varılmıştır (11) . Bunun tam aksine EVLW'nin özellikle boy ile korelasyon gösterdiği; yaş ve vücut ağırlığı ile bağlantılı olmadığı da ileri sürülmüştür (22) .…”