• Sandrine Boussat, Thierry Jacques, Bruno Levy, Evelyne Laurent, Antoine Gache, Gilles Capellier, and Alain Neidhardt.
• Polyvalent Intensive Care Unit, University Hospital of Besançon, Boulevard Fleming, 25030 Besançon Cedex, France. s.boussat@chu-nancy.fr
• Intensive Care Med. 2002 Jun 1;28(6):712-8.

ObjectiveTo evaluate whether different indicators using for guiding volume expansion are valuable tools to assess edematous lung injury in patients with septic shock.Design And SettingProspective observational clinical study in a university intensive care unit.PatientsSixteen consecutive mechanically ventilated patients developing septic shock with evidence of pulmonary edema on chest radiograph and severe hypoxemia (PaO(2)/FIO(2) <250 mmHg).Measurements And ResultsA pulmonary artery catheter was used for the measurement of cardiac index (CI), central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP). A fiberoptic catheter was placed in the descending aorta. Measurements of extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI), and total end-diastolic volume index (TEDVI) were obtained using the thermal dye dilution technique. Measurements were taken just after placement of catheters and 24 h later. Fluid balance was also estimated within the first 24 h. TEDVI and ITBVI were significantly correlated with EVLWI, but not CVP and PAOP. Analysis of 24-h changes showed that the changes in TEDVI and in ITBVI reflected the change in EVLWI, whereas PAOP, CVP, and fluid balance did not.ConclusionsVolume variables (TEDVI, ITBVI) are more useful indicators than pressure variables (CVP, PAOP) for assessment of EVLWI in septic patients with pulmonary edema.

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