Right ventricular volumes overestimate left ventricular preload in critically ill patients.
BACKGROUND
Studies have shown right ventricular end-diastolic volume (RVEDV) to be a more accurate estimate of left ventricular preload than pulmonary artery wedge pressure. We prospectively evaluated the ability of RVEDV to predict left ventricular end-diastolic volume (LVEDV) in critically ill patients.


METHODS
Thirty critically ill patients in the surgical intensive care unit underwent concurrent measurement of RVEDV and LVEDV. RVEDV was measured using a residual fraction Swan-Ganz catheter (RF Swan). LVEDV was measured using transesophageal echocardiography with acoustic quantification. Intracardiac, intra-abdominal, and ventilatory pressures were also measured.


RESULTS
RVEDV as measured by the RF Swan was significantly larger (by a factor of 2) than LVEDV (p < 0.0001 analysis of variance). However, the RVEDV and LVEDV were strongly correlated (r = 0.71, p < 0.0001, Pearson's correlation).


CONCLUSIONS
RVEDV from the RF Swan markedly overestimated left ventricular preload. If RVEDV is used as an absolute value for determining preload, patients may be underresuscitated. Transesophageal echocardiography in conjunction with RF Swan can be used to more accurately determine preload and cardiac performance than RF Swan alone in critically ill patients.
Kraut
E J
EJ
Department of Surgery, University of California, Davis Medical Center, Sacramento 95817-2214, USA.
Owings
J T
JT
Anderson
J T
JT
Hanowell
L
L
Moore
P
P
D000704:Analysis of Variance; D015982:Bias; D002407:Catheterization, Swan-Ganz; D016638:Critical Illness; D003971:Diastole; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D015203:Reproducibility of Results; D013318:Stroke Volume; D016276:Ventricular Function