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Real-world extravascular lung water index measurements in critically ill patients

Pulse index continuous cardiac output measurements: time course analysis and association with clinical characteristics

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Summary

Background

Pulse index continuous cardiac output (PiCCO) is used for hemodynamic assessment. This study describes real world extravascular lung water index (EVLWI) measurements at three time points and relates them to other hemodynamic parameters and mortality in critically ill patients admitted to a medical intensive care unit (ICU).

Methods

A total of 198 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis. Patients were admitted for various diseases such as sepsis (n = 22), myocardial infarction (n = 53), pulmonary embolism (n = 3), cardiopulmonary resuscitation (n = 15), acute heart failure (AHF; n = 21) and pneumonia (n = 25).

Results

Patients included in this analysis were severely ill as represented by the high simplified acute physiology score 2 (SAPS2, 42 ± 18) and acute physiology and chronic health evaluation score 2 (APACHE2‚ 22 ± 9). Real-world values at three time points are provided. Intra-ICU mortality rates did not differ between the EVLWI > 7 vs. the ELVWI < 7 groups (15% vs. 13%; p = 0.82) and no association between hemodynamic measurements obtained by PiCCO with long-term mortality could be shown.

Conclusion

There were no associations of any PiCCO measurements with mortality most probably due to selection bias towards severely ill patients. Future prospective studies with predefined inclusion criteria and treatment algorithms are necessary to evaluate the value of PiCCO for prediction of mortality against simple clinical tools such as jugular venous pressure, edema and auscultation.

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Abbreviations

CO:

Cardiac output

CVP:

Central venous pressure

EVLWI:

Extravascular lung water index

GEDVI:

Global end-diastolic volume index

ICU:

Intensive care unit

ITBVI:

Intrathoracic blood volume index

PAC:

Pulmonary artery catheter

PICCO:

Pulse index continuous cardiac output

SVRI:

Systemic vascular resistance index

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Acknowledgements

Special thanks to Katharina Bannier and Julian Gonschorrek for their support in collecting the patients’ follow-up data.

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Correspondence to Christian Jung M.D., PhD.

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Conflict of interest

M. Werner, B. Wernly, M. Lichtenauer, M. Franz, B. Kabisch, J. Muessig, M. Masyuk, P.C. Schulze, U.C. Hoppe, M. Kelm, A. Lauten, and C. Jung declare that they have no competing interests.

Ethical standards

The study was approved by the local ethics committee of University Hospital/the Medical Faculty of the University. The local ethics committee of University Hospital waived the need to obtain written informed consent to participate from the patients involved in this study as the data were collected retrospectively. Consent for publication was not needed as the local ethics committee of University Hospital excluded this study from individual consent to participate as data were collected retrospectively.

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All data relevant for this study are available from the authors on specific request without restriction.

Caption Electronic Supplementary Material

Supplemental Fig. 1

Mortality rates between EVLWI > 7 ml/kg vs. ELVWI < 7 ml/kg (log-rank p = 0.93)

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Werner, M., Wernly, B., Lichtenauer, M. et al. Real-world extravascular lung water index measurements in critically ill patients. Wien Klin Wochenschr 131, 321–328 (2019). https://doi.org/10.1007/s00508-019-1501-x

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