Extravascular lung water (EVLW) remains a useful guide for monitoring pulmonary edema (PO) and vascular permeability in sepsis, acute respiratory distress syndrome (ARDS), and heart failure. In addition, EVLW has a prognostic potential in shock, cardiothoracic surgery, multiple trauma, neurocritical care, and other conditions. Despite a number of limitations, EVLW measured with transpulmonary thermodilution (TPTD) has documented high correlation with postmortem gravimetry and other methods in both experimental and clinical settings. Therefore, in the twenty-first century, TPTD is still referred to as a “clinical gold standard” and a reference technique for EVLW measurement despite strong competition from non-invasive methods, including lung ultrasound, bioimpedance tomography and computed tomography.

Bedside assessment of EVLW has the potential to provide additional information regarding fluid status and to personalize therapy in a wide spectrum of ICU patients. Thus, EVLW plays an important diagnostic and prognostic role in sepsis, ARDS, circulatory shock, complicated perioperative period, and other high-risk patients, and was included into the current standards of their management. Assessment of EVLW should be an integral part of personalized resuscitation to improve outcome in patients at risk of PO with fluid restriction when EVLW exceeds 10 mL/kg. While TPTD remains a bedside “gold standard” in critically ill patients, evaluation of EVLW by using ultrasound has a great potential for further progress in other clinical scenarios.

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