title: Transpulmonary thermodilution measurements are not affected by continuous veno-venous hemofiltration at high blood pump flow.
abstract: OBJECTIVE
  To assess whether continuous veno-venous hemofiltration (CVVH) with high blood pump flow alters the measurements of cardiac index (CI), global end-diastolic volume indexed (GEDVI), and extravascular lung water indexed (EVLWI) performed by transpulmonary thermodilution.
  
  
  METHODS
  Sixty-nine patients were included if they were monitored by a PiCCO2 device and received CVVH through a femoral (n = 62) or an internal jugular (n = 7) dialysis catheter. The blood pump flow was set at 250 mL/min (n = 31) or 350 mL/min (n = 38) and the filtration flow at 6,000 mL/h. A first set of data was collected with a first transpulmonary thermodilution (TD(on)). The blood pump was stopped and the continuous CI derived from pulse contour analysis was recorded (PC(off)). A second data set (TD(off)) was collected before and a last one (TD(on-last)) after restarting the blood pump.
  
  
  RESULTS
  [Formula: see text], [Formula: see text], [Formula: see text] , and [Formula: see text] were not significantly different in patients with a femoral dialysis catheter (3.49 ± 0.96, 3.51 ± 0.96, 3.51 ± 0.99, and 3.44 ± 1.00 L min(-1) m(-2), respectively). This was observed with a blood pump flow at 350 mL/min and at 250 mL/min. In these patients with a femoral dialysis catheter, GEDVI did not significantly change when the blood pump was stopped. EVLWI significantly decreased when the blood pump was stopped but to a non-clinically relevant extent (-0.3 ± 0.8 mL/kg). No significant changes in CI, GEDVI, and EVLWI were observed in patients with an internal jugular dialysis catheter over the study period.
  
  
  CONCLUSIONS
  CVVH with a high blood flow pump does not alter the transpulmonary thermodilution measurements of CI, GEDVI, and EVLWI.
authors.affiliation: AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dufour
authors.forename: Marianne
authors.initials: M
authors.lastname: Delville
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
authors.forename: Laurent
authors.initials: L
authors.lastname: Camous
authors.forename: Aude
authors.initials: A
authors.lastname: Favier du Noyer
authors.forename: Christian
authors.initials: C
authors.lastname: Richard
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
mesh_terms: D001810:Blood Volume / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods*; D015633:Extravascular Lung Water / Q000502:physiology*; D005268:Femoral Vein; D006440:Hemofiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007601:Jugular Veins; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods; D013815:Thermodilution / Q000009:adverse effects / Q000379:methods*