Intrathoracic blood volume index measured by thermodilution for preload monitoring after cardiac surgery.
OBJECTIVE
To investigate the accuracy of measurement of intrathoracic blood volume index by single thermodilution (ITBVI*) and its sensitivity to detect changes in preload after cardiac surgery compared with conventional transpulmonary arterial dye dilution ITBVI and with conventional monitoring (central venous pressure [CVP] and left ventricular end-diastolic area index [EDAI] by transesophageal echocardiography).


METHODS
Prospective clinical study.


METHODS
University hospital.


METHODS
Nineteen patients immediately after cardiac surgery.


METHODS
Volume loading was administered with 20 mL of oxypoligelatine (Haemaccel [Behringwerke Aktiengesellschaft Corp, Marburg, Germany]) 3.5% times body mass index over 10 minutes.


RESULTS
Intrathoracic blood volume index was measured by dye dilution (ITBVI) and thermodilution (ITBVI*) immediately before and after volume loading. Measurements of ITBVI and ITBVI* correlated closely (r = 0.94; p < 0.0001). With volume loading, ITBVI and ITBVI* increased significantly from 877 +/- 195 mL/m(2) to 967 +/- 180 mL/m(2) and from 889 +/- 195 mL/m(2) to 954 +/- 185 mL/m(2). Percent changes in ITBVI (deltaITBVI) and ITBVI* (deltaITBVI*) did not differ significantly and correlated closely (r = 0.90; p < 0.0001). Percent changes in cardiac index (CI) as a result of volume loading (deltaCI) revealed significant correlation to deltaITBVI (r = 0.85; p < 0.0001) and to deltaITBVI* (r = 0.76; p < 0.0005). No significant correlation could be found between deltaCI and deltaEDAI or deltaCVP.


CONCLUSIONS
In patients undergoing cardiac surgery, determination of ITBVI* revealed close agreement with measurements derived by ITBVI. Enhancement in cardiac preload was adequately detected by ITBVI*.
Reuter
Daniel A
DA
Department of Anesthesiology, Ludwig-Maximiliaus University GroBhadern University Hospital, Munich, Germany.
Felbinger
Thomas W
TW
Moerstedt
Karl
K
Weis
Florian
F
Schmidt
Christian
C
Kilger
Erich
E
Goetz
Alwin E
AE
D001810:Blood Volume; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002496:Central Venous Pressure; D004396:Coloring Agents; D017548:Echocardiography, Transesophageal; D006801:Humans; D007201:Indicator Dilution Techniques; D007208:Indocyanine Green; D016343:Monitoring, Intraoperative; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011446:Prospective Studies; D011652:Pulmonary Circulation; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013815:Thermodilution; D013909:Thorax
D004396:Coloring Agents; D010952:Plasma Substitutes; D007208:Indocyanine Green