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Tagami T, Nakamura T, Kushimoto S, et al. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care. 2014;4:27doi: 10.1186/s13613-014-0027-7.
Tagami, T., Nakamura, T., Kushimoto, S., Tosa, R., Watanabe, A., Kaneko, T., Fukushima, H., Rinka, H., Kudo, D., Uzu, H., Murai, A., Takatori, M., Izumino, H., Kase, Y., Seo, R., Takahashi, H., Kitazawa, Y., Yamaguchi, J., Sugita, M., Takahashi, H., Kuroki, Y., Kanemura, T., Morisawa, K., Saito, N., Irahara, T., & Yokota, H. (2014). Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Annals of intensive care, 427. https://doi.org/10.1186/s13613-014-0027-7
Tagami, Takashi, et al. "Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients." Annals of intensive care vol. 4 (2014): 27. doi: https://doi.org/10.1186/s13613-014-0027-7
Tagami T, Nakamura T, Kushimoto S, Tosa R, Watanabe A, Kaneko T, Fukushima H, Rinka H, Kudo D, Uzu H, Murai A, Takatori M, Izumino H, Kase Y, Seo R, Takahashi H, Kitazawa Y, Yamaguchi J, Sugita M, Takahashi H, Kuroki Y, Kanemura T, Morisawa K, Saito N, Irahara T, Yokota H. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care. 2014 Aug 13;4:27. doi: 10.1186/s13613-014-0027-7. eCollection 2014. PMID: 25593743; PMCID: PMC4273855.
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Ann Intensive Care. 2014 Aug 13;4:27. doi: 10.1186/s13613-014-0027-7. eCollection 2014.

Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients.

Annals of intensive care

Takashi Tagami, Toshiaki Nakamura, Shigeki Kushimoto, Ryoichi Tosa, Akihiro Watanabe, Tadashi Kaneko, Hidetada Fukushima, Hiroshi Rinka, Daisuke Kudo, Hideaki Uzu, Akira Murai, Makoto Takatori, Hiroo Izumino, Yoichi Kase, Ryutarou Seo, Hiroyuki Takahashi, Yasuhide Kitazawa, Junko Yamaguchi, Manabu Sugita, Hiroyuki Takahashi, Yuichi Kuroki, Takashi Kanemura, Kenichiro Morisawa, Nobuyuki Saito, Takayuki Irahara, Hiroyuki Yokota

Affiliations

  1. Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan ; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan.
  2. Intensive Care Unit, Nagasaki University Hospital, Nagasaki 852-8501, Japan.
  3. Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Miyagi 986-2242, Japan.
  4. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima 965-8611, Japan.
  5. Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
  6. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan.
  7. Department of Emergency and Critical Care Medicine, Nara Medical University, Nara 634-8522, Japan.
  8. Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka 534-0021, Japan.
  9. Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
  10. Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka 814-0180, Japan.
  11. Department of Anesthesia and Intensive Care, Hiroshima City Hospital, Hiroshima 730-8518, Japan.
  12. Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, Osaka 570-8507, Japan.
  13. Department of Critical Care Medicine, Jikei University School of Medicine, Tokyo 105-8461, Japan.
  14. Intensive Care Unit, Kobe City Medical Center General Hospital, Hyogo 650-0046, Japan.
  15. Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo 113-8519, Japan.
  16. Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka 570-8506, Japan.
  17. Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
  18. Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan.
  19. Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa 230-8765, Japan.
  20. Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, Aichi 457-8510, Japan.
  21. Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan.
  22. Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan.
  23. Department of Emergency and Critical Care Medicine, Nippon Medical School, Chiba Hokusou Hospital, Chiba 270-1694, Japan.
  24. Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama Nagayama Hospital, Tokyo 206-8512, Japan.

PMID: 25593743 PMCID: PMC4273855 DOI: 10.1186/s13613-014-0027-7

Abstract

BACKGROUND: The features of early-phase acute respiratory distress syndrome (ARDS) are leakage of fluid into the extravascular space and impairment of its reabsorption, resulting in extravascular lung water (EVLW) accumulation. The current study aimed to identify how the initial EVLW values and their change were associated with mortality.

METHODS: This was a post hoc analysis of the PiCCO Pulmonary Edema Study, a multicenter prospective cohort study that included 23 institutions. Single-indicator transpulmonary thermodilution-derived EVLW index (EVLWi) and conventional prognostic factors were prospectively collected over 48 h after enrollment. Associations between 28-day mortality and each variable including initial (on day 0), mean, maximum, and Δ (subtracting day 2 from day 0) EVLWi were evaluated.

RESULTS: We evaluated 192 ARDS patients (median age, 69 years (quartile, 24 years); Sequential Organ Failure Assessment (SOFA) score on admission, 10 (5); all-cause 28-day mortality, 31%). Although no significant differences were found in initial, mean, or maximum EVLWi, Δ-EVLWi was significantly higher (i.e., more reduction in EVLWi) in survivors than in non-survivors (3.0 vs. -0.3 mL/kg, p = 0.006). Age, maximum, and Δ-SOFA scores and Δ-EVLW were the independent predictors for survival according to the Cox proportional hazard model. Patients with Δ-EVLWi > 2.8 had a significantly higher incidence of survival than those with Δ-EVLWi ≤ 2.8 (log-rank test, χ (2) = 7.08, p = 0.008).

CONCLUSIONS: Decrease in EVLWi during the first 48 h of ARDS may be associated with 28-day survival. Serial EVLWi measurements may be useful for understanding the pathophysiologic conditions in ARDS patients. A large multination confirmative trial is required.

Keywords: Acute lung injury; Hemodynamics; Pulmonary edema; Transpulmonary thermodilution; Vascular permeability

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