Right ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure.
OBJECTIVE
To evaluate the clinical utility of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery occlusion pressure (PAOP) as measures of preload status in patients with acute respiratory failure receiving treatment with positive end-expiratory pressure.


METHODS
Prospective, cohort study.


METHODS
Surgical intensive care unit in a Level I trauma center/university hospital.


METHODS
Sixty-four critically ill surgical patients with acute respiratory failure.


METHODS
All patients were treated for acute respiratory failure with titrated levels of positive end-expiratory pressure (PEEP) with the goal of increasing arterial oxygen saturation to > or =0.92, reducing FIO2 to <0.5, and reducing intrapulmonary shunt to < or =0.2. Serial determinations of RVEDVI, PAOP, and cardiac index (CI) were recorded.


RESULTS
Two hundred-fifty sets of hemodynamic variables were measured in 64 patients. The level of PEEP ranged from 5 to 50 cm H2O (mean 12+/-9 [SD] cm H2O). At all levels of PEEP, CI correlated significantly better with RVEDVI than with PAOP. At levels of PEEP > or =15 cm H2O, CI was inversely correlated with PAOP, but remained positively correlated with RVEDVI.


CONCLUSIONS
CI correlates significantly better with RVEDVI than PAOP at all levels of PEEP up to 50 cm H2O. RVEDVI is a more reliable predictor of volume depletion and preload recruitable increases in CI, especially in patients receiving higher levels of PEEP where PAOP is difficult to interpret.
Cheatham
M L
ML
Department of Surgical Education, Orlando Regional Medical Center, FL 32806, USA. mikec@orhs.org
Nelson
L D
LD
Chang
M C
MC
Safcsak
K
K
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy; D013318:Stroke Volume; D016278:Ventricular Function, Right