ĐÁNH GIÁ SỰ BIẾN ĐỔI VÀ GIÁ TRỊ TIÊN LƯỢNG TỬ VONG CỦA CHỈ SỐ LƯỢNG NƯỚC NGOÀI MẠCH PHỔI (EVLWI) Ở BỆNH NHÂN SỐC NHIỄM KHUẨN BỎNG BẰNG PHƯƠNG PHÁP PiCCO

Abstract

Objective: To evaluate the changes in the extravascular lung water index (EVLWI) and its prognostic value for mortality in burn patients with septic shock using the PiCCO system. Subjects and Methods: A prospective study was conducted on 22 severe burn patients with septic shock treated at the Intensive Care Unit of the National Burn Hospital Le Huu Trac. EVLWI was measured at T0 (at the diagnosis of septic shock), T6, T12, T24, and T48 hours. Correlations between EVLWI and lactate, ScvO₂, procalcitonin (PCT), central venous pressure (CVP), and norepinephrine dose were analyzed. Mortality prediction was assessed using ROC curve analysis. Results: EVLWI remained elevated during the first 48 hours. In survivors, EVLWI decreased from 11.49 to 8.25 ml/kg, whereas in non-survivors it increased from 14.42 to 15.78 ml/kg. EVLWI showed positive correlations with lactate, PCT, CVP, and norepinephrine dose, and a negative correlation with ScvO₂ (p < 0.001). The area under the ROC curve for mortality prediction was 0.875, with an optimal cutoff value of 13.05 ml/kg (sensitivity 81.25%, specificity 83.33%). Conclusion: EVLWI is elevated in burn patients with septic shock and is closely associated with hemodynamic disturbances. Monitoring EVLWI using PiCCO may help assess pulmonary edema, follow disease progression, and predict mortality.