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.
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.
Authors: Inneke E De Laet; Mariska Ravyts; Wesley Vidts; Jody Valk; Jan J De Waele; Manu L N G Malbrain Journal: Langenbecks Arch Surg Date: 2008-06-17 Impact factor: 3.445
Authors: Thomas Luecke; Harry Roth; Peter Herrmann; Alf Joachim; Gerald Weisser; Paolo Pelosi; Michael Quintel Journal: Intensive Care Med Date: 2003-09-03 Impact factor: 17.440