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Comparative assessment of extravascular lung water index in ARDS patients on veno-venous ECMO: transpulmonary thermodilution versus AI-driven chest CT segmentation

In severe acute respiratory distress syndrome (ARDS) patients on veno-venous extracorporeal membrane oxygenation (VV ECMO), restrictive fluid management reduces pulmonary edema, quantified by extravascular lung water index (EVLWI), and improves outcomes. Bedside EVLWI is commonly assessed using sing...

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Main Authors: Otto, Matthias (Author) , Mohr, David (Author) , Zimmermann, Julia (Author) , Rathmann, Nils-Andreas (Author) , Bösing, Christoph (Author) , Thiel, Manfred (Author) , Krebs, Jörg (Author) , Lücke, Thomas (Author) , Rocco, Patricia R.M. (Author) , Conrad, Alice (Author)
Format: Article (Journal)
Language:English
Published: 07 April 2026
In: BMC pulmonary medicine
Year: 2026, Volume: 26, Pages: 1-9
ISSN:1471-2466
DOI:10.1186/s12890-026-04260-9
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1186/s12890-026-04260-9
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Author Notes:Matthias Otto, David Mohr, Julia Zimmermann, Nils Rathmann, Christoph Boesing, Manfred Thiel, Joerg Krebs, Thomas Luecke, Patricia R.M. Rocco and Alice Marguerite Conrad
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Summary:In severe acute respiratory distress syndrome (ARDS) patients on veno-venous extracorporeal membrane oxygenation (VV ECMO), restrictive fluid management reduces pulmonary edema, quantified by extravascular lung water index (EVLWI), and improves outcomes. Bedside EVLWI is commonly assessed using single-indicator transpulmonary thermodilution (TPTD), which is increasingly employed to guide fluid therapy. However, TPTD-derived EVLWI values can be significantly affected by extracorporeal blood flow (ECBF), leading to inaccurate estimates during ECMO. In contrast, artificial intelligence (AI)-based automated lung segmentation of chest computed tomography (CT) enables reliable ECBF-independent visualization and quantification of pulmonary edema (EVLWICT). The primary objective was to compare EVLWI measured by TPTD (EVLWITPTD) with EVLWICT in ARDS patients on VV ECMO. The secondary objective was to derive and validate an ECBF-dependent correction factor to improve the accuracy of EVLWITPTD.
Item Description:Gesehen am 30.04.2026
Physical Description:Online Resource
ISSN:1471-2466
DOI:10.1186/s12890-026-04260-9

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