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Published on: January 12, 2024
Relationship between global end-diastolic volume and cardiac output in critically ill infants and children
Corrado Cecchetti1, Riccardo Lubrano, Sebastian Cristaldi
1Terapia Intensiva Pediatrica, Dipartimento di Emergenza ed Accettazione, IRCS Bambino Gesù, Piazzale S Onofrio 5, Roma, Italia.
Insights
Global end-diastolic volume (GEDV) correlates with cardiac function in pediatric shock. This preload index may guide fluid resuscitation in hemorrhagic and cardiogenic shock, but is less reliable in other critical conditions.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Pediatric Cardiology
Background:
- Assessing fluid responsiveness in critically ill children is challenging.
- Global end-diastolic volume (GEDV) is a measure of preload.
- Understanding the relationship between preload and cardiac function is crucial for guiding fluid therapy.
Purpose of the Study:
- To investigate the correlation between global end-diastolic volume (GEDV) and cardiac function indexes (cardiac index, stroke volume index) in critically ill pediatric patients.
- To evaluate the utility of GEDV in guiding volume loading decisions.
Main Methods:
- Prospective clinical study conducted in a pediatric intensive care unit.
- Seventy critically ill pediatric patients across various shock types were enrolled.
- Volumetric hemodynamic monitoring was performed using global end-diastolic volume (GEDV) measurements.
Main Results:
- A statistically significant linear correlation was found between GEDV and cardiac index (R2 = .647, p < .0001) and stroke volume index (R2 = .738, p < .0001) in hemorrhagic shock.
- Similar significant correlations were observed in cardiogenic shock (GEDV vs. CI: R2 = .645, p < .0001; GEDV vs. SVI: R2 = .841, p < .0001).
- Weak correlations were noted in other shock categories, suggesting less preload dependency.
Conclusions:
- Global end-diastolic volume (GEDV) shows potential as a guide for fluid resuscitation in preload-dependent conditions like hemorrhagic and cardiogenic shock.
- In other conditions, non-preload-dependent factors significantly influence cardiac output.
- GEDV may aid in decision-making for volume loading in specific pediatric critical care scenarios.
Objective:
The objective of this study was to investigate possible correlations between the preload index global end-diastolic volume (GEDV) and the indexes of cardiac function, cardiac index, and stroke volume index in critically ill pediatric patients. The aim was to evaluate whether GEDV may help in the decision-making process concerning volume loading.
Design:
Prospective clinical study.
Setting:
Pediatric intensive care unit of the Bambino Gesù Children's Research Hospital.
Patients:
Seventy patients, 40 male and 30 female, mean age 62 +/- 41 months (range 5-156 months), divided into six groups: group A, hemorrhagic shock, ten cases; group B, head injury, 21 cases; group C, septic shock, ten cases; group D, encephalitis, ten cases; group E, respiratory failure, nine cases; group F, cardiogenic shock, ten cases.
Interventions:
All patients received volumetric hemodynamic monitoring following initial resuscitation and every 4 hrs thereafter or whenever a hemodynamic deterioration was suspected. During the cumulative in-hospital stay, a total 1,184 sets of measurements were done.
Measurements And Main Results:
Findings are consistent with a statistically significant linear correlation of GEDV with cardiac index and stroke volume index in hemorrhagic shock (group A) (R2 = .647, p < .0001; R2 = .738, p < .0001) and cardiogenic shock (group F) (R2 = .645, p < .0001; R2 = .841, p < .0001).
Conclusions:
GEDV may potentially be a useful guide to treatment in preload-dependent conditions, such as hemorrhagic and cardiogenic shock. In the other groups where there is little relationship between preload and cardiac function indexes, the influence of non-preload-dependent mechanisms on cardiac output is certainly more significant.
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