Agua extravascular pulmonar como predictor de SDRA y mortalidad en pacientes con choque circulatorio

Abstract

Objective

Establish the early association between levels of Extravascular Lung Water indexed to predicted weight (EVLWI), with subsequent development of Acute Respiratory Distress Syndrome (ARDS) and Mortality in patients with circulatory shock.

Methods

We retrospectively evaluated the clinical records of 147 adult patients (age 50.5 years ± 19.9) in circulatory shock, admitted to Adult Intensive Care Unit of a third-level Hospital. Measurements: Extravascular lung water index, was measured by transpulmonary thermodilution (PiCCO System, Pulsion Medical Systems) from the beginning of the shock state and then every 8 hours during the first 5 days.

Results

Patients who evolved to SDRA had higher levels of EVLWI vs. patients who did not evolve to SDRA. Median EVLWI 14 ml/kg (RIC: 10 ml/kg) vs. 8 ml/kg (RIC: 4 ml/kg) SDRA vs. no SDRA respectively, (RR: 2.66; 95% CI: 1.68-4.22; P .00). We found no association between EVLWI high on the first day of the state of circulatory shock with respect to mortality at 28 days (RR: 1.17; 95% CI: 0.88-1.56; P .26).

Conclusions

The high EVLWI on the first day of the state of shock was associated with evolution to SDRA. We did not find an association of EVLWI high on the first day of the state of shock with mortality on day 28. Prospective studies are required to prove this association.