Extravascular lung water and acute lung injury

Abstract

Acute lung injury carries a high burden of morbidity and mortality and is characterised by nonhydrostatic pulmonary oedema. The aim of this paper is to highlight the role of accurate quantification of extravascular lung water in diagnosis, management, and prognosis in "acute lung injury" and "acute respiratory distress syndrome". Several studies have verified the accuracy of both the single and the double transpulmonary thermal indicator techniques. Both experimental and clinical studies were searched in PUBMED using the term "extravascular lung water" and "acute lung injury". Extravascular lung water measurement offers information not otherwise available by other methods such as chest radiography, arterial blood gas, and chest auscultation at the bedside. Recent data have highlighted the role of extravascular lung water in response to treatment to guide fluid therapy and ventilator strategies. The quantification of extravascular lung water may predict mortality and multiorgan dysfunction. The limitations of the dilution method are also discussed.

Figure 1

Thermodilution curves showing mean transit time (MTt) and downslope decay time (DSt) of the slope. The time point (A) represents the time of injection. The product of cardiac output and MTt equals the intrathoracic thermal volume. Multiplication of the cardiac output and the DSt equals the pulmonary thermal volume (PTV). The global end diastolic volume (GEDV) is equal to the ITTV − PTV. The intrathoracic blood volume = 1.25 × GEDV. The extravascular lung water (EVLW) is equal to the ITTV less the ITBV.