Mar 6, 2007

Bedside assessment of extravascular lung water by dilution methods: temptations and pitfalls

Critical Care Medicine
Frédéric Michard

Abstract

To review the advantages and limitations of dilution methods to assess extravascular lung water (EVLW) at the bedside and to discuss the clinical value of EVLW measurements. Experimental and clinical studies were searched in PUBMED by using "extravascular lung water" and "dilution method" as keywords and further selected as studies investigating either the reliability or the clinical usefulness of dilution methods to assess EVLW. Related articles and the reference lists of selected studies were scanned for additional relevant references. Both the double-indicator (thermo-dye) dilution and the single-indicator (cold saline) dilution methods showed close agreement with gravimetric measurement of EVLW (the reference ex vivo method) and have the advantage of being available at the bedside. Most limitations of dilution methods have been described in experimental conditions and lead to an underestimation of EVLW. These limitations include large pulmonary vascular obstruction, focal lung injury, and lung resection. Dilution methods provide an easy and clinically acceptable estimation of EVLW in most critically ill patients, including those with acute respiratory distress syndrome (ARDS). Assessing EVLW may be useful to predict outcome...Continue Reading

Mentioned in this Paper

Care of Intensive Care Unit Patient
Pulmonary Edema
Lung
Point-of-Care Systems
Extravascular Lung Water
Lung Diseases, Obstructive
Lung Diseases
Vascular Occlusion
Dilution Technique
Critical Illness

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