Goal-directed therapy of cardiac preload in induced whole-body hyperthermia.
OBJECTIVE
To optimize volume therapy during induced whole-body hyperthermia (WBH) < or = 42.2 degrees C, pulmonary capillary wedge pressure (PCWP) and intrathoracic blood volume index (ITBVI) were compared as goal parameters.


METHODS
Prospective clinical study.


METHODS
ICU at university hospital.


METHODS
Twenty-three patients with metastatic cancers.


METHODS
Radiant WBH in combination with induced hyperglycemia, hyperoxemia, and chemotherapy was applied. Volume therapy was directed to the PCWP (group A, 8 to 12 mm Hg [20 treatments]), or to ITBVI (group B, 800 to 1,100 mL/m2 [19 treatments]) following a standardized protocol. Goals other than PCWP and ITBVI were cardiac index of > 3.5 L/min/m2 and mean arterial pressure of > 55 mm Hg.


RESULTS
In addition to the primary goals PCWP and ITBVI, at defined temperatures, central venous pressure (CVP), extravascular lung water index, the number of infusions, and packed RBCs, as well as serum lactate level, norepinephrine dosage, and levels of liver enzymes, bilirubin, creatinine, and urea were measured. Patients in group A received a significantly greater mean (+/- SD) amount of crystalloids compared to those in group B (6,175 +/- 656 vs 3,947 +/- 375 mL, respectively) and required significantly lower dosages of vasoconstrictors compared with patients in group B. Except for the lower values of CVP in patients in group A during hyperthermia, all of the other hemodynamic and laboratory parameters showed no significant differences between the groups or stayed in a normal range.


CONCLUSIONS
PCWP and ITBVI are useful parameters to assess preload in induced WBH. Differences in crystalloids and vasopressor dosages may suggest an appropriate ITBVI of > 1,100 mL/m2 for patients with good cardiopulmonary health under such extremely hypercirculatory conditions.
Deja
Maria
M
Department of Anesthesiology and Critical Care Medicine, Charité Medical Center, Campus Virchow-Clinic, Augustenburger Platz 1, 13353 Berlin, Germany. maria.deja@charite.de
Hildebrandt
Bert
B
Ahlers
Olaf
O
Riess
Hanno
H
Wust
Peter
P
Gerlach
Herwig
H
Kerner
Thoralf
T
D001810:Blood Volume; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure