@article{oai:nagasaki-u.repo.nii.ac.jp:00004940,
 author = {Tagami, Takashi and Nakamura, Toshiaki and Kushimoto, Shigeki and Tosa, Ryoichi and Watanabe, Akihiro and Kaneko, Tadashi and Fukushima, Hidetada and Rinka, Hiroshi and Kudo, Daisuke and Uzu, Hideaki and Murai, Akira and Takatori, Makoto and Izumino, Hiroo and Kase, Yoichi and Seo, Ryutarou and Takahashi, Hiroyuki and Kitazawa, Yasuhide and Yamaguchi, Junko and Sugita, Manabu and Takahashi, Hiroyuki and Kuroki, Yuichi and Kanemura, Takashi and Morisawa, Kenichiro and Saito, Nobuyuki and Irahara, Takayuki and Yokota, Hiroyuki},
 journal = {Annals of Intensive Care},
 month = {Aug},
 note = {Background: The features of early-phase acute respiratory distress syndrome (ARDS) are leakage of fluid into the extravascular space and impairment of its reabsorption, resulting in extravascular lung water (EVLW) accumulation. The current study aimed to identify how the initial EVLW values and their change were associated with mortality. Methods: This was a post hoc analysis of the PiCCO Pulmonary Edema Study, a multicenter prospective cohort study that included 23 institutions. Single-indicator transpulmonary thermodilution-derived EVLW index (EVLWi) and conventional prognostic factors were prospectively collected over 48 h after enrollment. Associations between 28-day mortality and each variable including initial (on day 0), mean, maximum, and Δ (subtracting day 2 from day 0) EVLWi were evaluated. Results: We evaluated 192 ARDS patients (median age, 69 years (quartile, 24 years); Sequential Organ Failure Assessment (SOFA) score on admission, 10 (5); all-cause 28-day mortality, 31%). Although no significant differences were found in initial, mean, or maximum EVLWi, Δ-EVLWi was significantly higher (i.e., more reduction in EVLWi) in survivors than in non-survivors (3.0 vs. ?0.3 mL/kg, p = 0.006). Age, maximum, and Δ-SOFA scores and Δ-EVLW were the independent predictors for survival according to the Cox proportional hazard model. Patients with Δ-EVLWi > 2.8 had a significantly higher incidence of survival than those with Δ-EVLWi ? 2.8 (log-rank test, χ2 = 7.08, p = 0.008). Conclusions: Decrease in EVLWi during the first 48 h of ARDS may be associated with 28-day survival. Serial EVLWi measurements may be useful for understanding the pathophysiologic conditions in ARDS patients. A large multination confirmative trial is required., Annals of Intensive Care, 4, 27; 2014},
 title = {Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients},
 volume = {4},
 year = {2014}
}