Clinical studies of lung water in the critically ill

Although there are a variety of techniques by which lung water can be measured in the critically ill, the important question remains as to whether such measurements lead to improvements in treatment and survival of critically ill patients. Several investigators have tried to establish the role of extravascular lung water measurements in clinical practice. Clinical management based on protocols incorporating extravascular lung water measurement has been associated with reduced mortality in acute respiratory distress syndrome and sepsis patients. Similarly, if patients were managed according to a protocol that emphasized fluid restriction when extravascular lung water was greater than 7 ml/kg, time in the ICU and ventilator days were significantly shorter than for a comparable group of patients whose fluid management was guided by wedge pressure measurements.

More clinical trials are needed if the value of extravascular lung water measurement is to be fully exploited. Chapter References

Herman, P.G., et al. (1990). Limited correlation of left ventricular end diastolic pressure with radiographic assessment of pulmonary hemodynamics. Radiology, 174, 721-4. Lewis, F.R., Elings, V.B., and Storm, J.A. (1979). Bedside measurement of lung water. Journal of Surgical Research, 27, 250-61.

Lewis, F.R., Elings, V.B., Hill, S.L., and Christensen, J.M. (1982). The measurement of extravascular lung water by thermal-green dye indicator dilution. Annals of the New York Academy of Sciences, 384, 394-410.

McLuckie, A. (1996). The COLD system of haemodynamic monitoring. Intensive Care World, 13, 24-48.

Newman, E.V., Merrell, M., Genecin, A., Monge, C., Milnor, W.R., and McKeever, W.P. (1951). The dye dilution method for describing the central circulation. Circulation, 4, 735-45. Staub, N.C. (1986). Clinical use of lung water measurements: report of a workshop. Chest, 90, 588-94.

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