1. Richard Siebert

2. EVLW Extravasular lung water measures fluid in the pulmonary interstitium, alveoli and intracellular space but not pleural effusions EVLWI corrects for total body surface. LVEDI asses fluid status and possibly fluid responsiveness

3. How is EVLW determined ? ( ITTV)Intrathoracic thermal volume =volume of blood in RA,RV,Pulmonary blood vessels, EVLW, LA and LV (Measured by thermodilation) (ITBV) intrathoracic blood volume= Volume of blood in the RA,RV,Lung blood vessels, LA and LV. ( GEDV X 1.25) EVLW=ITTV-ITBV

5. EVLWI and PF ratio

6. GEDVI and EVLWI GEDVI has been used to predict fluid responsiveness but thi has been challenged ( Mavik. P Journal of ICM EVLWI has been used to predict fluid overload with normal EVLVI < 7 ml/kg ( surgical oatietn tend to be little higher ( Eichhom, Goepert elenburg, Malbrain et al,medicine in tensive 2012)

7. Am Rev Respir Dis.Am Rev Respir Dis. 1987 Sep;136(3):662-8. A prospective study of lung water measurements during patient management in an intensive care unit. Eisenberg PR, Hansbrough JR, Anderson D, Schuster DP. Eisenberg PRHansbrough JRAnderson DSchuster DP Using EVLW as goal endpoint as compared to PAOP Protocolized patients did better although no mortality differerence EVLW > 14% marker poor prognosis

9. How can EVLWI help us Differentiate different aetiology for pulmonary oedema : ie cardiac vs non-cardiac when used in tandem with echocardiography Helps target fluid therapy as well as diuretic use : aim for EVLWI < 7-10% If pleural effusion present then EVLWI can normal suggesting non-hydrostatic pleural effusion Excellent research tool

10. Targeting a negative fluid balance can (PAL) therapy with the aid of EVLWI measurement and improved outcomes. ( Cordeman C et al, Annal of intensive care 2012)

11. Limitations of EVLWI measurement When pulmonary artery occluded the values are unreliable. Pulmonary resection will influence values High PEEP pressure will effect the value and there are conflicting reports. In children poor correlation wirh CXR and PF ratio

12. Systems we use EV 1000 Picco plus system