Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis.

Autor: Gavelli F; Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France.; Emergency Medicine Unit, Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy., Shi R; Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France. rui.shi@universite-paris-saclay.fr.; Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France. rui.shi@universite-paris-saclay.fr., Teboul JL; Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France.; Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France., Azzolina D; Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy., Mercado P; Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile., Jozwiak M; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire l'Archet 1, 151 route Saint Antoine de Ginestière, 06200, Nice, France.; Equipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France., Chew MS; Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden., Huber W; II. Medizinische Klinik Und Poliklinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany., Kirov MY; Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia., Kuzkov VV; Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia., Lahmer T; II. Medizinische Klinik Und Poliklinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany., Malbrain MLNG; First Department Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland.; International Fluid Academy, Lovenjoel, Belgium., Mallat J; Department of Anesthesiology and Critical Care Medicine, Schaffner Hospital, Lens, France.; Department of Critical Care Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates., Sakka SG; Department of Intensive Care Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, Academic Teaching Hospital of the Johannes Gutenberg University Mainz, Koblenz, Germany., Tagami T; Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan., Pham T; Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France.; Université Paris-Saclay, UVSQ Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France., Monnet X; Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, 78, Rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France.; Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2022 Jul 06; Vol. 26 (1), pp. 202. Date of Electronic Publication: 2022 Jul 06.
DOI: 10.1186/s13054-022-04061-6
Abstrakt: Background: The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients.
Methods: Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity.
Results: Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], p < 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of -4.97 mL/kg (95% CI [-6.54; -3.41], p < 0.001). The results regarding OR and mean differences were consistent in subgroup analyses.
Conclusions: The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence. Trial registration the study protocol was prospectively registered on PROSPERO: CRD42019126985.
(© 2022. The Author(s).)
Databáze: MEDLINE
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