Right ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure.

Abstract:

OBJECTIVE:To evaluate the clinical utility of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery occlusion pressure (PAOP) as measures of preload status in patients with acute respiratory failure receiving treatment with positive end-expiratory pressure. DESIGN:Prospective, cohort study. SETTING:Surgical intensive care unit in a Level I trauma center/university hospital. PATIENTS:Sixty-four critically ill surgical patients with acute respiratory failure. INTERVENTIONS:All patients were treated for acute respiratory failure with titrated levels of positive end-expiratory pressure (PEEP) with the goal of increasing arterial oxygen saturation to > or =0.92, reducing FIO2 to <0.5, and reducing intrapulmonary shunt to < or =0.2. Serial determinations of RVEDVI, PAOP, and cardiac index (CI) were recorded. MEASUREMENTS AND MAIN RESULTS:Two hundred-fifty sets of hemodynamic variables were measured in 64 patients. The level of PEEP ranged from 5 to 50 cm H2O (mean 12+/-9 [SD] cm H2O). At all levels of PEEP, CI correlated significantly better with RVEDVI than with PAOP. At levels of PEEP > or =15 cm H2O, CI was inversely correlated with PAOP, but remained positively correlated with RVEDVI. CONCLUSIONS:CI correlates significantly better with RVEDVI than PAOP at all levels of PEEP up to 50 cm H2O. RVEDVI is a more reliable predictor of volume depletion and preload recruitable increases in CI, especially in patients receiving higher levels of PEEP where PAOP is difficult to interpret.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Cheatham ML,Nelson LD,Chang MC,Safcsak K

doi

10.1097/00003246-199811000-00017

subject

Has Abstract

pub_date

1998-11-01 00:00:00

pages

1801-6

issue

11

eissn

0090-3493

issn

1530-0293

journal_volume

26

pub_type

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