End-diastolic volume. A better indicator of preload in the critically ill.
The relative value of pulmonary artery wedge pressure (PAWP) and right ventricular end-diastolic volume index (RVEDVI) as a reflection of the preload status of the critically ill was determined in 29 patients. Regression analysis of 131 hemodynamic studies demonstrated that cardiac index (CI) correlated better with RVEDVI (r = .61) than did PAWP (r = .42). Comparisons of PAWP and RVEDVI showed that possible misleading information concerning filling volume was provided by the PAWP at some time in 15 (52%) of these patients. In 15 patients given 22 fluid challenges, patients with a high PAWP (greater than or equal to 18 mm Hg) "responded" with a rise in CI more frequently than did patients with a low PAWP (less than 12 mm Hg). However, all eight patients with a RVEDVI less than 90 mL/m2 responded with a rise in CI, but all seven patients with a RVEDVI greater than or equal to 139 mL/m2 failed to respond. Thus, RVEDVI more accurately predicted preload recruitable increases in cardiac output.
Diebel
L N
LN
Department of Surgery, Wayne State University, Detroit, MI 48201.
Wilson
R F
RF
Tagett
M G
MG
Kline
R A
RA
D000328:Adult; D000368:Aged; D002302:Cardiac Output; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012044:Regression Analysis; D013318:Stroke Volume; D016278:Ventricular Function, Right