Huber W, Höllthaler J, Schuster T, Umgelter A, Franzen M, Saugel B, Cordemans C, Schmid RM, Malbrain MLNG. Association between different indexations of extravascular lung water (EVLW) and PaO2/FiO2: a two-center study in 231 patients.
PLoS One 2014;
9:e103854. [PMID:
25093821 PMCID:
PMC4122373 DOI:
10.1371/journal.pone.0103854]
[Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/03/2014] [Indexed: 02/03/2023] Open
Abstract
Background
Variability of body weight (BW) and height calls for indexation of volumetric hemodynamic parameters. Extravascular lung water (EVLW) has formerly been indexed to actual BW (BWact) termed EVLW-index (EVLWI). In overweight patients indexation to BWact might inappropriately lower indexed EVLWIact. Several studies suggest indexation of EVLWI to predicted BW (EVLWIpred). However, data regarding association of EVLWIact and EVLWpred to mortality and PaO2/FiO2 are inconsistent. Two recent studies based on biometric database-analyses suggest indexation of EVLWI to height (EVLWIheight). Therefore, our study compared the association of un-indexed EVLW, EVLWIheight, EVLWpred and EVLWIact to PaO2/FiO2 and Oxygenation index (OI = mean airway pressure*FiO2*/PaO2).
Methods
A total of 2119 triplicate transpulmonary thermodilutions (TPTDs; PiCCO; Pulsion Medical-Systems, Germany) were performed in 50 patients from the evaluation, and 181 patients from the validation groups. Correlations of EVLW and EVLWI to PaO2/FiO2, OI and ROC-AUC-analyses regarding PaO2/FiO2<200 mmHg (primary endpoint) and OI>10 were performed.
Results
In the evaluation group, un-indexed EVLW (AUC 0.758; 95%-CI: 0.637-0.880) and EVLWIheight (AUC 0.746; 95%-CI: 0.622-0.869) provided the largest ROC-AUCs regarding PaO2/FiO2<200 mmHg. The AUC for EVLWIpred was smaller (0.713). EVLWIact provided the smallest AUC (0.685). This was confirmed in the validation group: EVLWIheight provided the largest AUC (0.735), EVLWIact (0.710) the smallest. In the merged data-pool, AUC was significantly greater for EVLWIheight (0.729; 95%-CI: 0.674–0.784) compared to all other indexations including EVLWIact (ROC-AUC 0.683, p = 0.007) and EVLWIpred (ROC-AUC 0.707, p = 0.015). The association of EVLW(I) was even stronger to OI compared to PaO2/FiO2. In the merged data-pool, EVLWIheight provided the largest AUC regarding “OI>10” (0.778; 95%-CI: 0.713–0.842) compared to 0.739 (95%-CI: 0.669–0.810) for EVLWIact and 0.756 (95%-CI: 0.688–0.824) for EVLWIpred.
Conclusions
Indexation of EVLW to height (EVLWIheight) improves the association of EVLW(I) to PaO2/FiO2 and OI compared to all other indexations including EVLWIpred and EVLWIact. Also considering two recent biometric database analyses, EVLWI should be indexed to height.
Collapse