title: Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView(®): do the same criteria apply as for the PiCCO(®)?
abstract: OBJECTIVE
  Comparison of global end-diastolic volume index (GEDVI) obtained by femoral and jugular transpulmonary thermodilution (TPTD) indicator injections using the EV1000/VolumnView(®) device (Edwards Lifesciences, Irvine, USA).
  
  
  METHODS
  In an 87-year-old woman with hypovolemic shock and equipped with both jugular and femoral vein access and monitored with the EV1000/VolumeView(®) device, we recorded 10 datasets, each comprising duplicate TPTD via femoral access and duplicate TPTD (20 ml cold saline) via jugular access.
  
  
  RESULTS
  Mean femoral GEDVI ((674.6±52.3) ml/m(2)) was significantly higher than jugular GEDVI ((552.3±69.7) ml/m(2)), with P=0.003. Bland-Altman analysis demonstrated a bias of (+122±61) ml/m(2), limits of agreement of -16 and +260 ml/m(2), and a percentage error of 22%. Use of the correction-formula recently suggested for the PiCCO(®) device significantly reduced bias and percentage error. Similarly, mean values of parameters derived from GEDVI such as pulmonary vascular permeability index (PVPI; 1.244±0.101 vs. 1.522±0.139; P<0.001) and global ejection fraction (GEF; (24.7±1.6)% vs. (28.1±1.8)%; P<0.001) were significantly different in the case of femoral compared to jugular indicator injection. Furthermore, the mean cardiac index derived from femoral indicator injection ((4.50±0.36) L/(min·m²)) was significantly higher (P=0.02) than that derived from jugular indicator injection ((4.12±0.44) L/(min·m²)), resulting in a bias of (+0.38±0.37) L/(min·m²) and a percentage error of 19.4%.
  
  
  CONCLUSIONS
  Femoral access for indicator injection results in markedly altered values provided by the EV1000/VolumeView(®), particularly for GEDVI, PVPI, and GEF.
authors.affiliation: Second Medical Department, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
authors.affiliation: Second Medical Department, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Phillip
authors.affiliation: Second Medical Department, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Höllthaler
authors.affiliation: Second Medical Department, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Schultheiss
authors.affiliation: Second Medical Department, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Saugel
authors.affiliation: Second Medical Department, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
mesh_terms: D000369:Aged, 80 and over; D002199:Capillary Permeability; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage*; D007267:Injections; D008176:Lung Volume Measurements; D013318:Stroke Volume; D013815:Thermodilution / Q000295:instrumentation / Q000379:methods*
chemical_list: D007202:Indicators and Reagents
keywords: Central venous catheter; EV1000/VolumeView; Femoral vein; Global end-diastolic volume; Hemodynamic monitoring; Jugular vein; PiCCO; Transpulmonary thermodilution