Volumetric assessment of left heart preload by thermodilution: comparing the PiCCO-VoLEF system with transoesophageal echocardiography.
The new Volumetric Ejection Fraction monitoring system (VoLEF), when combined with the Pulse Contour Cardiac Output monitoring system (PiCCO) system, allows measurement of left and right heart end-diastolic volumes by thermodilution. The aim of this study was to evaluate whether the left heart end-diastolic volume index determined by the VoLEF system (LHEDI) better reflects left ventricular end-diastolic area index (LVEDAI) measured by transoesophageal echocardiography than does global end-diastolic volume index (GEDI) measured by the PiCCO system alone. Following induction of anaesthesia, PiCCO, VoLEF and transoesophageal echocardiography measurements were performed before and after a fluid challenge in 20 patients scheduled for elective cardiac surgery. Both left ventricular end-diastolic area index and global end-diastolic volume index, but not left heart end-diastolic volume index, significantly increased after fluid administration. Mean bias +/- 2 SD for DeltaLHEDI-DeltaLVEDAI was -2.2 +/- 32.0% and for DeltaGEDI-DeltaLVEDAI -0.6 +/- 16.8%. In contrast to global end-diastolic volume index, the use of left heart end-diastolic volume index determined by the VoLEF system cannot be recommended as an estimate of left ventricular preload.
Hofer
C K
CK
Consultant, Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstr. 497, 8063 Zurich, Switzerland. christoph.hofer@triemli.stzh.ch
Ganter
M T
MT
Matter-Ensner
S
S
Furrer
L
L
Klaghofer
R
R
Genoni
M
M
Zollinger
A
A
D000368:Aged; D002302:Cardiac Output; D047549:Coronary Artery Bypass, Off-Pump; D017548:Echocardiography, Transesophageal; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D013318:Stroke Volume; D013815:Thermodilution / Q000379:methods; D016277:Ventricular Function, Left