President IFA | Book author | Internist Intensivist | Medisch Adviseur AZ Oudenaarde | Healthcare Consultant | Crisis and Change Management | CMO Medaman | Research professor Medical University Lublin | Keynote speaker
AZ Oudenaarde KU Leuven Bierbeek, Flemish Region, Belgium
A 55-year-old male presents to the ICU with sepsis and septic shock secondary to bacterial pneumonia. Despite initial fluid resuscitation and vasopressor support, he remains hypotensive. Over the next 24 hours, the patient develops hypoalbuminemia and exhibits signs of fluid overloadaccumulation, including peripheral oedema and worsening oxygenation, while maintaining a normal CVP.
A chest X-ray reveals bilateral infiltrates, and there is a progressive increase in interstitial fluid accumulation. Given his deteriorating condition, capillary leak syndrome is suspected. The clinical team must now reassess the fluid management strategy, carefully balancing the need for adequate perfusion against the risk of exacerbating fluid overloadaccumulation.
A 55-year-old male presents to the ICU with sepsis and septic shock secondary to bacterial pneumonia. Despite initial fluid resuscitation and vasopressor support, he remains hypotensive. Over the next 24 hours, the patient develops hypoalbuminemia and exhibits signs of fluid overloadaccumulation, including peripheral oedema and worsening oxygenation, while maintaining a normal CVP.
A chest X-ray reveals bilateral infiltrates, and there is a progressive increase in interstitial fluid accumulation. Given his deteriorating condition, capillary leak syndrome is suspected. The clinical team must now reassess the fluid management strategy, carefully balancing the need for adequate perfusion against the risk of exacerbating fluid overloadaccumulation.
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Is there any specific test or marker to identify the presence or resolution of capillary leak syndrome in critically ill patient.
Hi Naveen – very good question. There are, as of today no easy markers that can be used at the bedside.
I would suggest a combination of parameters like:
Clinical: cumulative fluid balance and body weight
Biochemical: capillary leak index (serum CRP divided by serum albumin), hemodilution (hgb, albumin and protein levels)
Urinary: albumin over creatinine ratio
Radiological: Kerley B lines on chest X-ray, pleural effusion, B-lines on lung POCUS
Hemodynamic and organ monitoring: extravascular lunh water and pulmonary capillary leak index, intra-abdominal pressure, EIT, BIA (volume excess and ECW/ICW ratio), isotope labeled albumin dilution techniques, etc…