Continuously assessed right ventricular end-diastolic volume as a marker of cardiac preload and fluid responsiveness in mechanically ventilated cardiac surgical patients.
BACKGROUND
Assessing cardiac preload and fluid responsiveness accurately is important when attempting to avoid unnecessary volume replacement in the critically ill patient, which is associated with increased morbidity and mortality. The present clinical trial was designed to compare the reliability of continuous right ventricular end-diastolic volume (CEDV) index assessment based on rapid response thermistor technique, cardiac filling pressures (central venous pressure [CVP] and pulmonary capillary wedge pressure [PCWP]), and transesophageal echocardiographically derived evaluation of left ventricular end-diastolic area (LVEDA) index in predicting the hemodynamic response to volume replacement.


METHODS
We studied 21 patients undergoing elective coronary artery bypass grafting. After induction of anesthesia, hemodynamic parameters were measured simultaneously before (T1) and 12 min after volume replacement (T2) by infusion of 6% hydroxyethyl starch 200/0.5 (7 ml/kg) at a rate of 1 ml/kg per min.


RESULTS
The volume-induced increase in thermodilution-derived stroke volume index (SVITD) was 10% or greater in 19 patients and under 10% in two. There was a significant correlation between changes in CEDV index and changes in SVITD (r2 = 0.55; P < 0.01), but there were no significant correlations between changes in CVP, PCWP and LVEDA index, and changes in SVITD. The only variable apparently indicating fluid responsiveness was LVEDA index, the baseline value of which was weakly correlated with percentage change in SVITD (r2 = 0.38; P < 0.01).


CONCLUSIONS
An increased cardiac preload is more reliably reflected by CEDV index than by CVP, PCWP, or LVEDA index in this setting of preoperative cardiac surgery, but CEDV index did not reflect fluid responsiveness. The response of SVITD following fluid administration was better predicted by LVEDA index than by CEDV index, CVP, or PCWP.
Wiesenack
Christoph
C
Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany. christoph.wiesenack@klinik.uni-regensburg.de
Fiegl
Christoph
C
Keyser
Andreas
A
Laule
Sven
S
Prasser
Christopher
C
Keyl
Cornelius
C
D000368:Aged; D001026:Coronary Artery Bypass; D003422:Critical Care; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000494:pharmacology*; D012121:Respiration, Artificial; D013318:Stroke Volume / Q000187:drug effects*; D013815:Thermodilution
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes