EVLW and its importance in fluid management

Abstract

Fluid management and optimization is one of the most frequently observed problems in anesthesiology and critical care. An ideal hemodynamic management increases oxygen supply to tissues, improves postoperative outcomes and decreases surgical costs. Extravascular lung water (EVLW) measurement has gained widespread acceptance in the early prediction and management of adverse effects caused by fluid treatment. The fundamental aim of acute circulatory failure treatment is to improve tissue perfusion and oxygenation while avoiding fluid overload. EVLW consists of extravascular interstitial, intracellular, alveolar and lymphatic fluid in the lungs and its normal values are 3-7 ml kg-1. Studies have reported that values above 10 ml kg-1 as a cut-off value points to pulmonary edema. Although the gold standard in EVLW measurement is the gravimetric method, lung ultrasound and transpulmonary thermodilution is more widely utilized since gravimetric measurement can only be performed post-mortem. EVLW measurement is expected to gain importance in the hemodynamic measurement of ALI/ARDS patients and future studies will benefit from focusing on EVLW based fluid therapy.