Hemodynamic monitoring with the help of extravascular lung water
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Hemodynamic monitoring with the help of Extravascular lung water. Richard Siebert. EVLW. Extravasular lung water measures fluid in the pulmonary interstitium , alveoli and intracellular space but not pleural effusions EVLWI corrects for total body surface.

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Hemodynamic monitoring with the help of Extravascular lung water

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Hemodynamic monitoring with the help of Extravascular lung water

Richard Siebert


EVLW

  • Extravasular lung water measures fluid in the pulmonary interstitium , alveoli and intracellular space but not pleural effusions

  • EVLWI corrects for total body surface.

  • LVEDI asses fluid status and possibly fluid responsiveness


How is EVLW determined ?

  • ( ITTV)Intrathoracic thermal volume =volume of blood in RA,RV,Pulmonary blood vessels , EVLW, LA and LV (Measured by thermodilation)

  • (ITBV) intrathoracic blood volume= Volume of blood in the RA,RV,Lung blood vessels , LA and LV. ( GEDV X 1.25)

  • EVLW=ITTV-ITBV


EVLWI and PF ratio


GEDVI and EVLWI

  • GEDVI has been used to predict fluid responsiveness but thi has been challenged ( Mavik . P Journal of ICM

  • EVLWI has been used to predict fluid overload with normal EVLVI < 7 ml/kg ( surgical oatietn tend to be little higher ( Eichhom , Goepertelenburg , Malbrain et al ,medicine in tensive 2012)


Am Rev Respir Dis. 1987 Sep;136(3):662-8.A prospective study of lung water measurements during patient management in an intensive care unit.Eisenberg PR, Hansbrough JR, Anderson D, Schuster DP.

  • Using EVLW as goal endpoint as compared to PAOP

  • Protocolized patients did better although no mortality differerence

  • EVLW > 14% marker poor prognosis


How can EVLWI help us

  • Differentiate different aetiology for pulmonary oedema : ie cardiac vs non-cardiac when used in tandem with echocardiography

  • Helps target fluid therapy as well as diuretic use : aim for EVLWI < 7-10%

  • If pleural effusion present then EVLWI can normal suggesting non-hydrostatic pleural effusion

  • Excellent research tool


  • Targeting a negative fluid balance can (PAL) therapy with the aid of EVLWI measurement and improved outcomes. ( Cordeman C et al , Annal of intensive care 2012)


Limitations of EVLWI measurement

  • When pulmonary artery occluded the values are unreliable.

  • Pulmonary resection will influence values

  • High PEEP pressure will effect the value and there are conflicting reports.

  • In children poor correlation wirh CXR and PF ratio


Systems we use

  • EV 1000

  • Picco plus system


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