Despite the relatively small number of patients, ours still represents one of the largest studies selleck screening library of VPW measurements to date. In addition to confirming a relationship between VPW and intravascular pressure measurements, this investigation also introduces the novel idea that VPW can be used to identify when conservative fluid management targets have been reached. The nature of the data collected allowed us to compare VPW with both PAOP and CVP and to compare the effect of other possible confounders, such as cumulative fluid balance, PEEP, and serum albumin on the relationship.The FACTT study demonstrated that patients with ALI treated with a conservative fluid strategy had significantly more days alive and free from mechanical ventilation and alive and out of the ICU compared to those managed with a more liberal fluid management strategy [4].

Despite these important outcome benefits, widespread implementation of a conservative fluid strategy in practice has been relatively slow [31]. The reasons for this delayed acceptance are likely multifactorial, including lack of survival benefit and the relative complexity of the management algorithm, which includes the need for some assessment of intravascular pressure. Invasive measurements were utilized in the clinical trial, with similar outcomes resulting from CVP and PAOP measurements [1]. While this likely will contribute to a further reduction in the insertion of PACs, obtaining CVP measurements still requires an invasive procedure and risk for complications.

Although many patients with ALI have central venous catheters placed for routine care, the frequency of invasive procedures is decreasing in clinical practice and 8.1% of patients were excluded from the parent study due to physicians not intending to place central venous access [1]. The ability to utilize non-invasive measures of intravascular volume may obviate the need for a CVC in some patients and further reduce the risk of complications. The use of the non-invasive VPW may enhance implementation and acceptance of the conservative fluid strategy into routine clinical practice. It remains to be established whether fluid adjustments made on the basis of VPW measurements achieve similar outcomes as strategies guided by invasive hemodynamic measurements.ConclusionsVPW correlated moderately well with PAOP and less well with CVP in patients with ALI enrolled in a clinical trial of different fluid management strategies.

VPW had a higher correlation with the historical standard of PAOP than did cumulative fluid balance or PEEP. Although the actual correlation between VPW and direct Carfilzomib intravascular volume measurements remains unknown, these data confirm previous studies that show the utility of VPW as a noninvasive measure and the best radiographic sign of patients’ intravascular volume status.