title: Room-temperature vs iced saline indicator injection for transpulmonary thermodilution.
abstract: OBJECTIVE
  Ice-cold injectate is assumed to provide best accuracy for transpulmonary thermodilution (TPTD)-derived cardiac index (CI), global end-diastolic volume index (GEDVI), and extravascular lung-water index (EVLWI). Room-temperature injectate might facilitate TPTD. Therefore, this study compares TPTD-results derived from iced injectate with room-temperature injectate TPTDs (TPTDRoom).
  
  
  METHODS
  Forty-five adult intensive care unit patients with PiCCO monitoring (Pulsion Medical Systems, Munich, Germany) were included in this observational study. Four hundred one sets of TPTDs were recorded. Each set consisted of four 15 mL TPTDs (twice with 21°C and subsequently twice with 4°C saline). Means of 2 TPTDRoom were compared with means of 2 cold TPTDs (primary end point).
  
  
  RESULTS
  Mean CI (4.70±1.60 vs 4.54±1.52 L/min per square meter; P<.001), GEDVI (985±294 vs 954±269 mL/m2; P<.001), and EVLWI (14.4±7.8 vs 13.8±7.3 mL/kg; P<.001) were significantly higher for TPTDRoom compared with TPTD-results derived from iced injectate. Mean bias and percentage error were 0.15±0.52 L/min per square meter and 21.9% for CI, 30±145 mL/m2 and 29.3% for GEDVI, and 0.59±2.1 mL/kg and 29.3% for EVLWI. Percentage error values were higher in case of femoral compared with jugular indicator injection for CI (25% vs 20%), GEDVI (35% vs 25%), and EVLWI (41% vs 23%).
  
  
  CONCLUSIONS
  Room-temperature injectate TPTDs results in slight but significant overestimation of CI, GEDVI, and EVLWI. Percentage error values for GEDVIRoom and EVLWIRoom are acceptable only in case of "jugular" indicator injection.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 München, Germany. Electronic address: wolfgang.huber@lrz.tu-muenchen.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 München, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Kraski
authors.affiliation: Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 München, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 München, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mair
authors.affiliation: Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr, 52 20246 Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Saugel
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 München, Germany.
authors.forename: Analena
authors.initials: A
authors.lastname: Beitz
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 München, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.affiliation: Department of Intensive Care, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen 6, Belgium.
authors.forename: Manu L N G
authors.initials: ML
authors.lastname: Malbrain
mesh_terms: D000328:Adult; D000368:Aged; D001830:Body Surface Area; D002302:Cardiac Output / Q000502:physiology*; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D007053:Ice; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012965:Sodium Chloride; D013696:Temperature; D013815:Thermodilution / Q000379:methods*
chemical_list: D007053:Ice; D012965:Sodium Chloride
keywords: Cardiac output; Extravascular lung water; Global end-diastolic volume; Room-temperature injectate; Transpulmonary thermodilation