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Assessment of cardiovascular volume status by transoesophageal echocardiography and dye dilution during cardiac
F Hinder1, J I Poelaert, C Schmidt
1Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Germany.
Insights
Assessing cardiovascular volume status in critically ill patients is challenging. Left ventricular end diastolic area index and intrathoracic blood volume index show promise as reliable indicators, especially when systemic inflammation causes hemodynamic changes.
Area of Science:
- Cardiovascular Physiology
- Critical Care Medicine
- Hemodynamics
Background:
- Conventional methods for assessing cardiovascular volume status using filling pressures are often unreliable in critically ill patients.
- Systemic inflammation following cardiopulmonary bypass can induce significant hemodynamic changes, further complicating volume status evaluation.
- Newer indices like left ventricular end diastolic area index (LVEDAI) and intrathoracic blood volume index (ITBVI) offer potential alternatives.
Purpose of the Study:
- To analyze the relationship between different cardiovascular volume status indices during pronounced hemodynamic changes.
- To define the correlation between LVEDAI, ITBVI, central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP) in patients undergoing coronary artery bypass grafting.
- To evaluate the potential of LVEDAI and ITBVI as interchangeable measures for cardiovascular volume status.
Main Methods:
- Correlational analysis using Spearman's coefficient was performed on data from 15 patients.
- Measurements included LVEDAI (transesophageal echocardiography), ITBVI (dye indicator dilution), CVP, and PCWP.
- Data were collected post-anesthesia induction and in the intensive care unit.
Main Results:
- A strong correlation (r=0.87, P<0.05) was found between perioperative absolute changes in LVEDAI and ITBVI.
- An increase in ITBVI of 125 mL m-2 was required to maintain baseline LVEDAI.
- Absolute values of CVP and PCWP varied widely and only correlated with each other; changes in CVP/PCWP did not correlate with changes in LVEDAI or ITBVI.
Conclusions:
- LVEDAI and ITBVI may serve as interchangeable indicators for cardiovascular volume status in patients with stable cardiac function.
- Simultaneous baseline measurements are crucial for this substitution.
- A supranormal ITBVI may be necessary to compensate for hemodynamic changes during systemic inflammation.
Abstract:
Conventional evaluation of cardiovascular volume status by filling pressures is unreliable in critically ill patients. Measurements of left ventricular end diastolic area index by transoesophageal echocardiography and of intrathoracic blood volume index by dye indicator dilution are new approaches to this problem. In this study, different indices of cardiovascular volume status were analysed to define their relation during the pronounced haemodynamic changes associated with systemic inflammation after cardiopulmonary bypass. Correlations were performed with left ventricular end diastolic area index, intrathoracic blood volume index, central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). Data from 15 patients receiving coronary artery bypass grafts were compared after induction of anaesthesia and in the intensive care unit. Spearman's correlation coefficient for perioperative absolute changes in left ventricular end diastolic area index and intrathoracic blood volume index was 0.87 (P < 0.05). However, an increase in intrathoracic blood volume index by 125 mL m-2 was necessary to maintain a baseline left ventricular end diastolic area index. Absolute values of all variables varied widely, with the only significant correlation found between CVP and PCWP. Changes in CVP and PCWP did not correlate with changes in left ventricular end diastolic area index or intrathoracic blood volume index. Provided simultaneous baseline measurements are available and a supranormal intrathoracic blood volume index compensates for the haemodynamic changes in systemic inflammation, left ventricular end diastolic area index and intrathoracic blood volume index may substitute for each other during the evaluation of cardiovascular volume status in patients with stable cardiac function.