Limitations of EVLW measurement

Since it is known that albumin can exchange across capillary membranes, pulmonary blood volume is overestimated by this technique and extravascular lung water is therefore underestimated. However, the corresponding error is small and not particularly significant clinically. A more serious drawback is in the limitation of treatment options. Treatment of pulmonary oedema by diuresis and ultrafiltration has been shown to be less effective at reducing EVLW in capillary leak, compared to congestive heart failure. Similarly, the strategy of preventing oedema formation by diuresis while maintaining the circulation with catecholamine infusions appears to be futile; vasoconstriction so produced increases EVLW.


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