Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis

doi:10.1186/s13054-022-04061-6

Meta-Analysis

. 2022 Jul 6;26(1):202.

doi: 10.1186/s13054-022-04061-6.

Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis

Francesco Gavelli^#^{1

2}, Rui Shi^#^{3

4}, Jean-Louis Teboul^{1

5}, Danila Azzolina⁶, Pablo Mercado⁷, Mathieu Jozwiak^{8

9}, Michelle S Chew¹⁰, Wolfgang Huber¹¹, Mikhail Y Kirov¹², Vsevolod V Kuzkov¹², Tobias Lahmer¹¹, Manu L N G Malbrain^{13

14}, Jihad Mallat^{15

16}, Samir G Sakka¹⁷, Takashi Tagami¹⁸, Tài Pham^{1

19}, Xavier Monnet^{1

5}

Affiliations

¹ Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France.
² Emergency Medicine Unit, Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.
³ Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France. rui.shi@universite-paris-saclay.fr.
⁴ Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France. rui.shi@universite-paris-saclay.fr.
⁵ Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France.
⁶ Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy.
⁷ Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
⁸ Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire l'Archet 1, 151 route Saint Antoine de Ginestière, 06200, Nice, France.
⁹ Equipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
¹⁰ Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹¹ II. Medizinische Klinik Und Poliklinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany.
¹² Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia.
¹³ First Department Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland.
¹⁴ International Fluid Academy, Lovenjoel, Belgium.
¹⁵ Department of Anesthesiology and Critical Care Medicine, Schaffner Hospital, Lens, France.
¹⁶ Department of Critical Care Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹⁷ Department of Intensive Care Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, Academic Teaching Hospital of the Johannes Gutenberg University Mainz, Koblenz, Germany.
¹⁸ Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan.
¹⁹ Université Paris-Saclay, UVSQ Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France.

^# Contributed equally.

PMID: 35794612
PMCID: PMC9258010
DOI: 10.1186/s13054-022-04061-6

Meta-Analysis

Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis

Francesco Gavelli et al. Crit Care. 2022.

. 2022 Jul 6;26(1):202.

doi: 10.1186/s13054-022-04061-6.

Authors

Affiliations

¹ Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France.
² Emergency Medicine Unit, Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.
³ Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France. rui.shi@universite-paris-saclay.fr.
⁴ Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France. rui.shi@universite-paris-saclay.fr.
⁵ Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France.
⁶ Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy.
⁷ Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
⁸ Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire l'Archet 1, 151 route Saint Antoine de Ginestière, 06200, Nice, France.
⁹ Equipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
¹⁰ Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹¹ II. Medizinische Klinik Und Poliklinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany.
¹² Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia.
¹³ First Department Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland.
¹⁴ International Fluid Academy, Lovenjoel, Belgium.
¹⁵ Department of Anesthesiology and Critical Care Medicine, Schaffner Hospital, Lens, France.
¹⁶ Department of Critical Care Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹⁷ Department of Intensive Care Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, Academic Teaching Hospital of the Johannes Gutenberg University Mainz, Koblenz, Germany.
¹⁸ Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan.
¹⁹ Université Paris-Saclay, UVSQ Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France.

^# Contributed equally.

PMID: 35794612
PMCID: PMC9258010
DOI: 10.1186/s13054-022-04061-6

Abstract

Background: The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients.

Methods: Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity.

Results: Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], p < 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of -4.97 mL/kg (95% CI [-6.54; -3.41], p < 0.001). The results regarding OR and mean differences were consistent in subgroup analyses.

Conclusions: The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence. Trial registration the study protocol was prospectively registered on PROSPERO: CRD42019126985.

Keywords: Critically ill patients; Hemodynamic monitoring; Lung edema; Transpulmonary thermodilution.

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Conflict of interest statement

Dr. Monnet is member of the Medical Advisory Board of Pulsion Medical Systems, Getinge. He received fees for scientific lectures from Baxter and Philips, and restricted research grants from Baxter. Dr. Teboul is member of the Medical Advisory Board of Pulsion Medical Systems, Getinge. Dr. Chew has received travel reimbursements and honoraria from Pulsion Medical Systems and Edwards Lifesciences. Dr. Huber was member of the Medical Advisory Board of Pulsion Medical Systems. Dr. Kirov is member of the Medical Advisory Boards of Pulsion Medical Systems and Philips. Dr. Lahmer received travel grants from Gilead, Pfizer and MSD. Dr. Malbrain is founding President of WSACS (The Abdominal Compartment Society, http://www.wsacs.org) and current Treasurer, he is also member of the medical advisory Board of Pulsion Medical Systems (Getinge) and Serenno Medical, and consults for ConvaTec, Acelity, Spiegelberg, and Holtech Medical. He is co-founder of the International Fluid Academy (IFA). The IFA is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law (http://www.fluidacademy.org). Dr. Sakka is member of the Medical Advisory Board of Pulsion Medical Systems. Dr. Tagami is member of the Medical Advisory Board of Pulsion Medical Systems. The other authors declare that they have no conflict of interest regarding this study.

Figures

**Fig. 2**
The pooled odds ratio of EVLW for mortality

**Fig. 3**
Mean difference in extravascular lung water levels between survivors and non-survivors

See this image and copyright information in PMC

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References

1. Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015;5:38. doi: 10.1186/s13613-015-0081-9. - DOI - PMC - PubMed
1. Monnet X, Teboul JL. Transpulmonary thermodilution: advantages and limits. Crit Care. 2017;21:147. doi: 10.1186/s13054-017-1739-5. - DOI - PMC - PubMed
1. Tagami T, Ong MEH. Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when? Curr Opin Crit Care. 2018;24:209–215. doi: 10.1097/MCC.0000000000000503. - DOI - PMC - PubMed
1. Tagami T, Sawabe M, Kushimoto S, Marik PE, Mieno MN, Kawaguchi T, et al. Quantitative diagnosis of diffuse alveolar damage using extravascular lung water. Crit Care Med. 2013;41:2144–2150. doi: 10.1097/CCM.0b013e31828a4643. - DOI - PubMed
1. Tagami T, Kushimoto S, Yamamoto Y, Atsumi T, Tosa R, Matsuda K, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010;14:R162. doi: 10.1186/cc9250. - DOI - PMC - PubMed

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[1] Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015;5:38. doi: 10.1186/s13613-015-0081-9. - DOI - PMC - PubMed

[2] Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015;5:38. doi: 10.1186/s13613-015-0081-9. - DOI - PMC - PubMed

[3] Monnet X, Teboul JL. Transpulmonary thermodilution: advantages and limits. Crit Care. 2017;21:147. doi: 10.1186/s13054-017-1739-5. - DOI - PMC - PubMed

[4] Monnet X, Teboul JL. Transpulmonary thermodilution: advantages and limits. Crit Care. 2017;21:147. doi: 10.1186/s13054-017-1739-5. - DOI - PMC - PubMed

[5] Tagami T, Ong MEH. Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when? Curr Opin Crit Care. 2018;24:209–215. doi: 10.1097/MCC.0000000000000503. - DOI - PMC - PubMed

[6] Tagami T, Ong MEH. Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when? Curr Opin Crit Care. 2018;24:209–215. doi: 10.1097/MCC.0000000000000503. - DOI - PMC - PubMed

[7] Tagami T, Sawabe M, Kushimoto S, Marik PE, Mieno MN, Kawaguchi T, et al. Quantitative diagnosis of diffuse alveolar damage using extravascular lung water. Crit Care Med. 2013;41:2144–2150. doi: 10.1097/CCM.0b013e31828a4643. - DOI - PubMed

[8] Tagami T, Sawabe M, Kushimoto S, Marik PE, Mieno MN, Kawaguchi T, et al. Quantitative diagnosis of diffuse alveolar damage using extravascular lung water. Crit Care Med. 2013;41:2144–2150. doi: 10.1097/CCM.0b013e31828a4643. - DOI - PubMed

[9] Tagami T, Kushimoto S, Yamamoto Y, Atsumi T, Tosa R, Matsuda K, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010;14:R162. doi: 10.1186/cc9250. - DOI - PMC - PubMed

[10] Tagami T, Kushimoto S, Yamamoto Y, Atsumi T, Tosa R, Matsuda K, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010;14:R162. doi: 10.1186/cc9250. - DOI - PMC - PubMed

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Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis

Affiliations

Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis

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Affiliations

Abstract

Conflict of interest statement

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