Prognostic value of extravascular lung water index in critically ill patients: a systematic review of the literature.
OBJECTIVE To investigate the prognostic value of extravascular lung water index (EVLWI) in critically ill patients with septic shock in intensive care unit (ICU). METHODS EVLWI was determined by using a PiCCO Monitor, and the daily fluid balance was recorded. RESULTS Fifty patients with septic shock were admitted and twenty-six patients survived. The average EVLWI at baseline was 11.7 ml/kg, and the difference was not different between survivors and nonsurvivors, P = 0.551. The EVLWI of day 3 (EVLWI(d3)) in nonsurvivors was significantly higher than the survivors [(14.3 +/- 8.8) ml/kg vs (8.1 +/- 2.7) ml/kg, P = 0.001]. If the patients were divided into three groups by the EVLWI(d3), group one 0-7 ml/kg (4/16), group two 8-14 ml/kg (10/24), and group three > 14 ml/kg (10/10), the hospital mortality of the third group was significantly higher than the other two groups (P = 0.000, 0.002). There was a significant difference between the survivors and the nonsurvivors in the fluid balance at the first day and the following three days (P = 0.000, 0.000). Negative fluid balance was associated with a lower mortality. By using receiver operating characteristic analysis, the area under the curve was 0.740 +/- 0.072 to EVLWI(d3). If EVLWI > 7.5 ml/kg, the sensitivity and the specificity of accurate judgment were 83.3% and 53.8%. CONCLUSION Dynamic observation of EVLWI can be one of the factors for predicting the prognosis of patients with septic shock. A reduction of EVLWI at early treatment and a negative fluid balance were associated with a better prognosis.