Prognostic value of extravascular lung water index in critically ill children with acute respiratory failure

In critically ill adults, a reduction in the extravascular lung water index (EVLWi) decreases time on mechanical ventilation and improves survival. The purpose of this study is to assess the prognostic value of EVLWi in critically ill children with acute respiratory failure and investigate its relationships with PaO2, PaO2/FiO(2) ratio, A-aDO(2), oxygenation index (OI), mean airway pressure, cardiac index, pulmonary permeability, and percent fluid overload. Twenty-seven children admitted to PICU with acute respiratory failure received volumetric hemodynamic and blood gas monitoring following initial stabilization and every 4 h thereafter, until discharge from PICU or death. All patients are grouped in two categories: nonsurvivors and survivors. Children with a fatal outcome had higher values of EVLWi on admission to PICU, as well as higher A-aDO(2) and OI, and lower PaO2 and PaO2/FIO2 ratio. After 24 h EVLWi decreased significantly only in survivors. As a survival indicator, EVLWi has good sensitivity and good specificity. Changes in EVLWi, OI, and mean airway pressure had a time-dependent influence on survival that proved significant according to the Cox test. Survivors spent fewer hours on mechanical ventilation. We detected a correlation of EVLWi with percent fluid overload and pulmonary permeability. Like OI and mean airway pressure, EVLWi on admission to PICU is predictive of survival and of time needed on mechanical ventilation.