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Room-temperature vs iced saline indicator injection for transpulmonary thermodilution
Wolfgang Huber1, Thilo Kraski1, Bernhard Haller2
1II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 München, Germany.
Journal of Critical Care
|September 22, 2014
Summary
Using room-temperature injectate for transpulmonary thermodilution (TPTD) slightly overestimates cardiac index (CI), global end-diastolic volume index (GEDVI), and extravascular lung-water index (EVLWI). Accuracy is acceptable with jugular injection, but not femoral.
Area of Science:
- Critical Care Medicine
- Hemodynamic Monitoring
- Physiology
Background:
- Transpulmonary thermodilution (TPTD) is crucial for hemodynamic monitoring in intensive care.
- Ice-cold injectate is traditionally used for TPTD to ensure accuracy.
- Room-temperature injectate offers potential convenience but its impact on accuracy is debated.
Purpose of the Study:
- To compare the accuracy of TPTD-derived measurements using room-temperature injectate versus traditional ice-cold injectate.
- To evaluate the influence of injectate temperature on cardiac index (CI), global end-diastolic volume index (GEDVI), and extravascular lung-water index (EVLWI).
Main Methods:
- An observational study involving 45 adult ICU patients with PiCCO monitoring.
- 401 sets of TPTD measurements were recorded, using both 21°C (room-temperature) and 4°C (ice-cold) saline injectates.
- Mean values from two room-temperature TPTDs were compared against mean values from two ice-cold TPTDs.
Main Results:
- Room-temperature TPTD (TPTDRoom) showed statistically significant overestimations for CI, GEDVI, and EVLWI compared to ice-cold TPTD.
- Mean bias and percentage errors were within acceptable limits for CI, but higher for GEDVI and EVLWI.
- Percentage errors were notably higher with femoral indicator injection compared to jugular injection for all measured parameters.
Conclusions:
- Room-temperature injectate in TPTD leads to a slight but significant overestimation of key hemodynamic parameters (CI, GEDVI, EVLWI).
- The accuracy of room-temperature TPTD for GEDVI and EVLWI is acceptable only when using jugular indicator injection.
- Clinical decisions based on TPTD using room-temperature injectate require careful consideration of the injection site and potential overestimation.
Keywords:
Cardiac outputExtravascular lung waterGlobal end-diastolic volumeRoom-temperature injectateTranspulmonary thermodilationMore Related Videos
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