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Hemodynamic monitoring with the help of Extravascular lung water

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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  1. Hemodynamic monitoring with the help of Extravascular lung water Richard Siebert

  2. 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

  3. 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

  4. EVLWI and PF ratio

  5. 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)

  6. 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

  7. 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

  8. 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)

  9. 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

  10. Systems we use • EV 1000 • Picco plus system

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