Michard Frédéric
Department of Anesthesia and Critical Care, Béclère Hospital-University Paris XI, France.
Crit Care Med. 2007 Apr;35(4):1186-92. doi: 10.1097/01.CCM.0000259539.49339.66.
To review the advantages and limitations of dilution methods to assess extravascular lung water (EVLW) at the bedside and to discuss the clinical value of EVLW measurements.
Experimental and clinical studies were searched in PUBMED by using "extravascular lung water" and "dilution method" as keywords and further selected as studies investigating either the reliability or the clinical usefulness of dilution methods to assess EVLW. Related articles and the reference lists of selected studies were scanned for additional relevant references.
Both the double-indicator (thermo-dye) dilution and the single-indicator (cold saline) dilution methods showed close agreement with gravimetric measurement of EVLW (the reference ex vivo method) and have the advantage of being available at the bedside. Most limitations of dilution methods have been described in experimental conditions and lead to an underestimation of EVLW. These limitations include large pulmonary vascular obstruction, focal lung injury, and lung resection. Dilution methods provide an easy and clinically acceptable estimation of EVLW in most critically ill patients, including those with acute respiratory distress syndrome (ARDS). Assessing EVLW may be useful to predict outcome, to diagnose pulmonary edema, to better characterize patients with ARDS, to guide fluid therapy, and to assess the value of new treatments or ventilatory strategies in patients with pulmonary edema.
回顾床边评估血管外肺水（EVLW）的稀释法的优缺点，并探讨EVLW测量的临床价值。
在PUBMED中检索以“血管外肺水”和“稀释法”为关键词的实验和临床研究，并进一步筛选出研究稀释法评估EVLW的可靠性或临床实用性的研究。扫描相关文章和所选研究的参考文献列表以获取其他相关参考文献。
双指示剂（热-染料）稀释法和单指示剂（冷盐水）稀释法与EVLW的重量测量法（参考离体方法）显示出密切一致性，并且具有可在床边进行的优点。稀释法的大多数局限性已在实验条件下得到描述，并导致对EVLW的低估。这些局限性包括大的肺血管阻塞、局灶性肺损伤和肺切除术。稀释法为大多数危重症患者，包括急性呼吸窘迫综合征（ARDS）患者提供了一种简单且临床上可接受的EVLW估计方法。评估EVLW可能有助于预测预后、诊断肺水肿、更好地对ARDS患者进行特征描述、指导液体治疗以及评估肺水肿患者新治疗方法或通气策略的价值。
