Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock.
OBJECTIVE
To assess the value of the global end-diastolic volume (GEDV) evaluated by transpulmonary thermodilution as an indicator of cardiac preload.


METHODS
Prospective clinical study.


METHODS
Medical ICU of a university hospital (20 beds).


METHODS
Thirty-six patients with septic shock.


METHODS
Volume loading and dobutamine infusion.


RESULTS
Hemodynamic parameters were evaluated in triplicate by the transpulmonary thermodilution technique: (1) before and after 66 fluid challenges in 27 patients, and (2) before and after 28 increases in dobutamine infusion rate in 9 patients. Volume loading induced a significant (p < 0.001) increase in central venous pressure (CVP) from 10 +/- 4 to 13 +/- 4 mm Hg, in GEDV index from 711 +/- 164 to 769 +/- 144 mL/m(2), in stroke volume index (SVI) from 36 +/- 12 to 42 +/- 12 mL/m(2), and in cardiac index (CI) from 3.4 +/- 1.1 to 3.9 +/- 1.2 L/min/m(2) (mean +/- SD). Changes in GEDV index were correlated (r = 0.72, p < 0.001) with changes in SVI, while changes in CVP were not. The increase in SVI was > 15% in 32 of 66 instances (positive response). The preinfusion GEDV index was lower (637 +/- 134 mL/m(2) vs 781 +/- 161 mL/m(2), p < 0.001) in the cases of positive response, and was negatively correlated with the percentage increase in GEDV index (r = - 0.65, p < 0.001) and in SVI (r = - 0.5, p < 0.001). Dobutamine infusion induced an increase in SVI (32 +/- 11 mL/m(2) vs 35 +/- 12 mL/m(2), p < 0.05) and in CI (2.8 +/- 0.6 L/min/m(2) vs 3.2 +/- 0.6 L/min/m(2), p < 0.001) but no significant change in CVP (13 +/- 3 mm Hg vs 13 +/- 3 mm Hg) and in GEDV index (823 +/- 221 mL/m(2) vs 817 +/- 202 mL/m(2)).


CONCLUSIONS
In patients with septic shock, our findings demonstrate that, in contrast to CVP, the transpulmonary thermodilution GEDV index behaves as an indicator of cardiac preload.
Michard
Frédéric
F
Medical Intensive Care Unit, Bicêtre Hospital, University Paris XI, France. michard.frederic@free.fr
Alaya
Sami
S
Zarka
Véronique
V
Bahloul
Mabrouk
M
Richard
Christian
C
Teboul
Jean-Louis
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D002302:Cardiac Output; D002306:Cardiac Volume; D002496:Central Venous Pressure; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D005440:Fluid Therapy; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy; D013318:Stroke Volume; D013815:Thermodilution; D013909:Thorax; D014655:Vascular Resistance
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D004280:Dobutamine