hemodynamic monitoring with the help of extravascular lung water
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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.

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Presentation Transcript
slide2
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
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
gedvi and evlwi
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)
slide7

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
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
slide10

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
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
Systems we use
  • EV 1000
  • Picco plus system
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