CME: Extravascular Lung Water: Clinical Implications
ACCREDITATION EXPIRED: February 15, 2014
Activity Description / Statement of Need:
In this online CME self-learning program:
When patients suffer an acute, intense inflammatory response, as in the cases of shock, sepsis, late hemorrhagic shock, and other circumstances, they have a high chance of incurring a permeability injury in their capillaries both systemically and in the lungs, which lends itself to the development of pulmonary edema. The risk of pulmonary edema may be heightened – or baseline pulmonary exacerbated – during the necessary course of fluid resuscitation, which may lead to extended courses of mechanical ventilation. It stands to reason, then, that if pulmonary edema is a concern during resuscitative and post-resuscitative care, that the medical team may curtail these risks by monitoring therapy via estimates of extravascular lung water (EVLW) – defined as fluid inside the lung tissue aside from that found in the vascular and pleural spaces.
In a hypotensive, hypoperfused patient, the benefit of giving a fluid challenge in determining next steps of care is in outlining the patient’s degree of cardiac stroke volume responsiveness. If it is, give fluid, and if not, then giving additional fluid, regardless of central venous pressure (CVP) – a popular measure that nonetheless does not predict fluid responsiveness. As fluid responsiveness begins to plateau, EVLW beings to steeply increase. A better approach may be monitoring estimates of EVLW. At the plateau of the Frank-Starling curve, EVLW begins to climb steeply. Thus, using an increase in EVLW as a threshold to stop volume resuscitation, marginal increases in cardiac output are sacrificed with the benefit of minimizing the risk of pulmonary edema. This program discusses an emerging, alternative guidance strategy.
Agenda:
- - Patient case: shock
- - Permeability injuries and their effect on extravascular lung water (EVLW)
- - Best parameters for preload monitoring in shock
- - Fluid resuscitation of the patient in shock
- - EVLW as a preload metric
- - Summary of the evidence
Target Audience:
This program has been designed for a multidisciplinary physician and nurse audience including: ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care
This program is supported by Educational Grants from Edwards Lifesciences
Release Date: February 15, 2012 -- Expiration Date: February 15, 2014
Faculty: Charles Phillips, MD
Agenda
Learning Objectives
By the end of the session the participant will be able to:
- Define EVLW and its relationship with pulmonary edema
- Describe the importance of EVLW estimation in critically ill patients experiencing an acute inflammatory response
- Describe a way in which one may reliably estimate changes in EVLW.
- Apply knowledge of EVLW and fluid management techniques in a critically ill patient in a manner that reduces the risk of pulmonary edema.
Accreditation
ACCREDITATION FOR THIS COURSE HAS EXPIRED. YOU MAY VIEW THE PROGRAM, BUT CME / CE IS NO LONGER AVAILABLE AND NO CERTIFICATE WILL BE ISSUED.
Faculty Disclosure and Resolution of COI
As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved through content review ScientiaCME.
Faculty Disclosure: Charles Phillips, MD discloses that he receives honoraria and expense reimbursement from Edwards Lifesciences.
Disclosures of Educational Planner: Steven Sachse is an officer and part owner of ScientiaCME, LLC, which has received a grant from the commercial supporter of this program: Edwards Lifesciences.
Commercial Support Disclosure: This program is supported by an educational grant from Edwards Lifesciences, a manufacturer of medical devices.
Instructions
- Read the learning objectives above
- Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
- View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
- Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
- Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.
System Requirements
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh
*Required to view Printable PDF Version
Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.