Article Data

  • Views 1707
  • Dowloads 131

Original Research

Open Access

Extravascular lung water index as an indicator of lung injury in septic patients


1Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb

2Department of Anaesthesiology, Reanimatology and Intensive care University Hospital Zagreb

3,University of Zagreb School of Medicine

DOI: 10.22514/SV101.042015.6 Vol.10,Issue 1,April 2015 pp.74-92

Published: 30 April 2015

*Corresponding Author(s): ŽELJKO DRVAR E-mail:


Introduction. Transpulmonary thermodilution using PiCCO (Pulse-induced Contour Cardiac Output) is a standard minimally invasive method used for haemodynamic monitoring. Objectives. The goal of this paper is to examine the correlation and dynamics of the ExtraVascular Lung Water Index (EVLWI) as an indicator of acute lung injury in septic patients who underwent major abdominal surgery. Two groups of patients were selected: the ones with ALI (Acute Lung Injury): ALI patient group, and the ones without ALI: non-ALI patient group. A correlation between EVLWI and other haemodynamic and respiratory data in both groups were analyzed.

Materials and methods. The study included 48 patients. Throughout the seven-day period EVLWI, GEDVI (Global End-Diastolic Volume Index), ITBVI (IntraThoracic Blood Volume Index), CI (Cardiac Index), SVRI (Systemic Vascular Resistance Index) were measured in both groups using PiCCO monitoring over 8-hour intervals as well as heart rate, mean arterial pressure, serum albumin concentration, PaCO2 (arterial partial pressure of carbon dioxide), PaO2 (arterial partial pressure of oxygen), PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio, lung compliance, lung resistance and ScvO2 (central venous oxygen saturation). All patients were analgosedated, intubated, mechanically ventilated, in sinus cardiac rhythm. Circulatory unstable patients had vasoactive support and Sequential Organ Failure Assessment (SOFA) scores calculated. Ventilator settings and dosage of vasoactive drugs were kept constant during the study.

Results. EVLWI was significantly higher in ALI patients group compared to non-ALI patients group. In patients with ALI group 11/22 patients died (50%), in the non-ALI patients group 6/26 patients died (23%). EVLWI was significantly higher in patients that died compared to ones who survived.

Conclusion. EVLWI is a good indicator of early acute lung injury in surgical patients with sepsis.


extravascular lung water index, acute lung injury, PiCCO monitoring, sepsis

Cite and Share

ŽELJKO DRVAR,VIŠNJA MAJERIĆ KOGLER,DINKO TONKOVIĆ,MIRJANA MIRIĆ,MARIO PAVLEK,MLADEN PERIĆ. Extravascular lung water index as an indicator of lung injury in septic patients. Signa Vitae. 2015. 10(1);74-92.


1. Chung FT, Lin SM, Lin SY, Lin HC. Impact of extravascular lung water index on outcomes of severe sepsis patients in medical intensive care unit. Respir Med 2008;102(7):956-61.

2. Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, et al. Extravascular water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med 2010;38:114-20.

3. Chew MS,Ihrman L, During J, Bergenzaun L, Ersson A, Unden J, et al. Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock. Crit Care 2012;16:R1.

4. Vish M, Shanley PT. Acute Lung Injury and Acute Respiratory Distress Syndrome. In: Wheeler DS, Wong HR, Shanley TP, editors. The respiratory tract in pediatric critical illness and injury. London: Springer-Verlag; 2009. p. 49-67.

5. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000;342(18):1334-49.

6. Piantadosi CA, Schwartz DA. The acute respiratory distress syndrome. Ann Intern Med 2004;141(6):460-70.

7. Martin GS, Eaton S, Mealer M, Moss M. Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care 2005;9:74-82.

8. Kuzkov V, Kirov M, Sovershaev A. Extravascular lung water deterimned with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit Care Med 2006;122(6):1647-53.

9. Schmidt S, Westhoff TH, Hofmann C, Schaefer JH, Zidek W, Compton F, et al. Effect of the venous catheter site on transpulmonary thermodilution measurement variables. Crit Care Med 2007;35:783-6.

10. Monnet X, Anguel N, Osman D, Hamzaoui O, Richard C, Teboul JL. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Int Care Med 2007;33(3):448-53.

11. Kumar A. Sepsis and septic shock. In: Gabrielli A, Layon AJ, Yu M, editors. Critical Care. Philadelphia: Lippincott & Wilkins; 2009. p. 855-92.

12. Peters CW, Yu M, Sladen RN, Gabrielli A, Layon AJ. Acute lung injury and acute respiratory distress syndrome. In: Gabrielli A, Layon AJ, Yu M, editors. Critical Care. Philadelphia: Lippincott & Wilkins; 2009. p. 2061-80.

13. Johnson ER, Matthay MA. Acute lung injury: epidemiology, pathogenesis and treatment. J Aerosol Med Pulm Drug Deliv 2010;23(4):234-52.

14. Ware LB, Koyama T, Billheimer DD, Wu W, Bernard GR, Thompson BT, et al. Prognostic and pathogenetic value of combining clinical and biochemical indices in patients with acute lung injury. Chest 2010;137(2):288-96.

15. Fernandez-Mondjar E, Guerrero-Lopez F, Colomenero M. How important is the measurement of extravascular lung water? Crit Care 2007;13:79-83.

16. Dellinger P, Mitchell M, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. JAMA 2012;308(16):1641-50.

17. Levy MM, Dellinger P, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. Surviving sepsis campaign. Crit Care Med 2010;38(2):367-74.

18. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001

SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definition Cnoference. Crit Care Med 2003;31(4):1250-6.

19. Bernard GR, Srticas A, Gordon R, Carlet J, Dreyfuss D, Gattinoni L, et al.The American-European Consensus Conference on ARDS. AM J Respir Crit Care Med 1998;157:1332-47.

20. Ranieri VM, Rubenfeled GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA 2012;307:2526-33.

21. Kushimoto S, Tomoyuki E, Satoshi Y, Sakamoto T, Ishikura H, Kitazawa Y, et al. Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin Definition. Crit Care 2013;17(4):R132.

22. Perel A. Extravascular lung water and the pulmonary vascular permeability index may improve the definition of ARDS. Crit Care 2013;17:108.

23. Cordemans C, De Laet I, Van Regenmortel N, Schoonheydt K, Dits H, Huber W, et al. Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak and fluid balance. Annals of Intensive Care 2012;2(1):S1.

24. Zhongheng Z, Balong L, Hongying N. Prognostic value of extravascular lung water index in critically ill patients: a systematice review of the literature. J Crit Care 2012;27(4):420.e1-8.

25. Eichhorn V, Goepfert MS, Eulenburg C, Malbrain M, Reuter DA. Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: A metaanalysis of the literature. Med Intensiva 2012;36(7):467-74.

26. Maharaj R. Extravascular lung water and acute lung injury. Cardiol Res Pract 2012;Article ID 407035.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time