EVLWExtravascular Lung Water
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The calculation of EVLW by trans-cardiopulmonary thermodilution was initially based on a double indicator method whereby the volume of distribution of an indicator contained within the ITBV (e.g.
An eloquent sequence of calculations allows the use of thermal injectate as a single indicator to estimate EVLW with reasonably good correlation to both the double indicator technique (Figure 2) (58) and the gold standard gravimetry technique, albeit with a slight bias of overestimation due to thermal redistribution in extra-pulmonary tissue (59).
Trans-cardiopulmonary thermodilution calculation of EVLW has been proposed as a diagnostic tool both to measure sub-clinical pulmonary oedema not apparent on clinical examination or plain radiography and to differentiate hydrostatic and inflammatory aetiologies of pulmonary oedema on the basis of the pulmonary vascular permeability index, the ratio of EVLW to PBV (62,63).
As well as its diagnostic utility, EVLW measurement may have utility both prognostically in predicting survival in those admitted to ICU (64), and therapeutically by providing a measurement against which to titrate fluid balance.
APPENDIX 1 Glossary of terms CFI cardiac function index EDT exponential decay time EVLW extravascular lung water GEDV global end-diastolic volume GEF global ejection fraction ITBV intrathoracic blood volume MTT mean transit time PiCCO pulse index continuous cardiac output PVPI pulmonary vascular permeability index [S.sub.cv][O.sub.2] central venous oxygen saturation [S.sub.v][O.sub.2] mixed venous oxygen saturation
Although increased extravascular lung water (EVLW) has been reported to play a crucial role in the development of alveolar atelectasis (5), the effect of PEEP on EVLW remains controversial.
We hypothesized that mechanical ventilation with PEEP impairs lung [Q.sub.L], which in turn may contribute to an increase in EVLW. This study was, therefore, conducted as a prospective laboratory experiment to determine the effects of PEEP on EVLW and pulmonary [Q.sub.L] in awake healthy sheep.
EVLW was measured using the thermal-green double indicator technique and displayed on a lung water computer (Edwards Critical Care Division, Irvine, CA) (9,17).
EVLW was determined at the end of each study period.
The increase in PEEP resulted in a marked increase in EVLW, which returned close to baseline when PEEP was removed (Figure 2).
In the present study, the effects of PEEP on QL and EVLW were investigated.
Most likely, the increase in EVLW was triggered by augmented intra-alveolar pressure, subsequently resulting in obstruction of pulmonary lymph vessels.