BACKGROUND: Extravascular lung water is a quantitative marker of the amount of fluid in the thoracic cavity besides the vasculature. Indexing to both predicted and actual body weight have been proposed to compare different individuals and provide a uniform range of normal. OBJECTIVE: We explored extravascular lung water measured by single-indicator transpulmonary thermodilution in a large cohort of patients without cardiopulmonary instability, in order to evaluate current and alternative indexing methods. DESIGN: Prospective, observational. SETTING: Neurosurgical ICU in a tertiary referral academic teaching hospital. PATIENTS: One hundred and one consecutive patients requiring elective brain tumor surgery and postoperative ICU surveillance. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Indexed to predicted body weight, females had a mean extravascular lung water of 9.1 (SD=3.1, range: 5-23) mL/kg and males of 8.0 (SD=2.0, range: 4-19) mL/kg (p<0.001). Values indexed to predicted body weight were inversely correlated with the patient's height (p<0.001). Indexed to the traditionally used actual body weight, data showed a significant relationship to weight (p<0.001) and gender (p<0.05). In contrast, indexing to body height presented a method without dependencies on height, weight, or gender, yielding a uniform 95% confidence interval of 218-430 mL/m. Extravascular lung water increased with positive perioperative fluid balance (p=0.04). CONCLUSIONS: Using either predicted or actual body weight for indexing extravascular lung water does not lead to independence of height, weight, and gender of the patient. Specifying a fixed range of normal or a uniform upper threshold for all patients is misleading for either method, despite widespread use. Our data suggest that indexing extravascular lung water to height is superior to weight-based methods. As we are not aware of any abnormal hemodynamic profile for brain tumor patients, we propose our findings to be a close approximation to normal values.
BACKGROUND: Extravascular lung water is a quantitative marker of the amount of fluid in the thoracic cavity besides the vasculature. Indexing to both predicted and actual body weight have been proposed to compare different individuals and provide a uniform range of normal. OBJECTIVE: We explored extravascular lung water measured by single-indicator transpulmonary thermodilution in a large cohort of patients without cardiopulmonary instability, in order to evaluate current and alternative indexing methods. DESIGN: Prospective, observational. SETTING: Neurosurgical ICU in a tertiary referral academic teaching hospital. PATIENTS: One hundred and one consecutive patients requiring elective brain tumor surgery and postoperative ICU surveillance. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Indexed to predicted body weight, females had a mean extravascular lung water of 9.1 (SD=3.1, range: 5-23) mL/kg and males of 8.0 (SD=2.0, range: 4-19) mL/kg (p<0.001). Values indexed to predicted body weight were inversely correlated with the patient's height (p<0.001). Indexed to the traditionally used actual body weight, data showed a significant relationship to weight (p<0.001) and gender (p<0.05). In contrast, indexing to body height presented a method without dependencies on height, weight, or gender, yielding a uniform 95% confidence interval of 218-430 mL/m. Extravascular lung water increased with positive perioperative fluid balance (p=0.04). CONCLUSIONS: Using either predicted or actual body weight for indexing extravascular lung water does not lead to independence of height, weight, and gender of the patient. Specifying a fixed range of normal or a uniform upper threshold for all patients is misleading for either method, despite widespread use. Our data suggest that indexing extravascular lung water to height is superior to weight-based methods. As we are not aware of any abnormal hemodynamic profile for brain tumorpatients, we propose our findings to be a close approximation to normal values.
Authors: Wolfgang Huber; Sebastian Mair; Simon Q Götz; Julia Tschirdewahn; Johanna Frank; Josef Höllthaler; Veit Phillip; Roland M Schmid; Bernd Saugel Journal: J Clin Monit Comput Date: 2016-02-01 Impact factor: 2.502
Authors: Helena Berbara; Sebastian Mair; Analena Beitz; Benedikt Henschel; Roland M Schmid; Wolfgang Huber Journal: BMC Anesthesiol Date: 2014-09-24 Impact factor: 2.217
Authors: Bernd Saugel; Wolfgang Huber; Axel Nierhaus; Stefan Kluge; Daniel A Reuter; Julia Y Wagner Journal: Biomed Res Int Date: 2016-09-14 Impact factor: 3.411
Authors: Lisa M Brown; Carolyn S Calfee; James P Howard; Thelma R Craig; Michael A Matthay; Daniel F McAuley Journal: Ann Intensive Care Date: 2013-08-11 Impact factor: 6.925
Authors: Wolfgang Huber; Josef Höllthaler; Tibor Schuster; Andreas Umgelter; Michael Franzen; Bernd Saugel; Colin Cordemans; Roland M Schmid; Manu L N G Malbrain Journal: PLoS One Date: 2014-08-05 Impact factor: 3.240