title: Transesophageal echocardiography: an objective tool in defining maximum ventricular response to intravenous fluid therapy.
abstract: Ventricular preload is an important determinant of cardiac function, which is indirectly measured in the clinical setting by the pulmonary capillary wedge pressure (PCWP). Transesophageal echocardiography (TEE) is rapidly gaining acceptance as a monitor of cardiac function. Although it provides high-resolution images of cardiac structures, clinical assessment of ventricular preload using TEE has been subjective, since quantitative measurements have been difficult to perform in a timely fashion. Automated border detection (ABD) is a new technology used in conjunction with TEE that allows quantitative real-time, two-dimensional measurement of cavity areas. To determine whether enddiastolic area (EDA) measured by ABD can be used to determine an appropriate end point for intravenous fluid administration, nine mongrel dogs were studied. Anesthetized animals were hemorrhaged to achieve a central venous pressure of 0-5 mm Hg. Each animal was then given intravenous fluid (autologous blood followed by hetastarch) until a peak in thermodilution cardiac output (CO) was achieved. Measures of PCWP, EDA, CO, and left ventricular stroke work (LVSW) were obtained after each fluid bolus. Bivariate plots displaying administered volume versus CO, LVSW, and EDA revealed parallel curves for each of these variables with peaks evident at cumulative volumes of 50-55 mL/kg. Multiple regression with mixed model analysis of covariance was performed to determine the significance of EDA in relation to changes in CO and LVSW. Analysis was likewise performed comparing the relationship between PCWP and changes in CO or LVSW. A significant relationship was demonstrated when comparing EDA to changes in CO and LVSW (P = 0.03 and P < 0.0001, respectively). Similar analysis comparing PCWP to changes in CO and LVSW failed to demonstrate a significant relationship (P = 0.54 and P = 0.36, respectively). These data suggest that changes in EDA measured using TEE with ABD are related to trends in cardiac function and can suggest an appropriate end point for intravenous fluid administration as defined by maximum CO and LVSW. PCWP did not demonstrate a significant relationship to changes in CO and LVSW.
authors.affiliation: Department of Anesthesiology, University of Utah Medical Center, Salt Lake City 84132, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Swenson
authors.forename: C
authors.initials: C
authors.lastname: Harkin
authors.forename: N L
authors.initials: NL
authors.lastname: Pace
authors.forename: K
authors.initials: K
authors.lastname: Astle
authors.forename: P
authors.initials: P
authors.lastname: Bailey
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001804:Blood Transfusion, Autologous; D002302:Cardiac Output; D002496:Central Venous Pressure; D003971:Diastole; D004285:Dogs; D017548:Echocardiography, Transesophageal; D005440:Fluid Therapy; D006321:Heart / Q000502:physiology; D006470:Hemorrhage / Q000503:physiopathology / Q000628:therapy; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007089:Image Enhancement; D007262:Infusions, Intravenous; D010952:Plasma Substitutes / Q000627:therapeutic use; D011669:Pulmonary Wedge Pressure; D012044:Regression Analysis; D013318:Stroke Volume; D013815:Thermodilution; D016276:Ventricular Function; D016277:Ventricular Function, Left
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes