Related Experiment Videos
Preload assessment in patients with an open abdomen
M L Cheatham1, K Safcsak, E F Block
1Department of Surgical Education, Surgical Critical Care, Orlando Regional Medical Center, Florida 32806, USA. mikec@orhs.org
The Journal of Trauma
|February 5, 1999
Summary
In surgical patients with intra-abdominal hypertension, right ventricular end-diastolic volume index (RVEDVI) accurately estimates preload status. This finding suggests RVEDVI is superior to pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) in open abdomen cases.
Area of Science:
- Critical care medicine
- Surgical physiology
- Hemodynamic monitoring
Background:
- Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high morbidity and mortality in surgical and trauma patients.
- Accurate assessment of intravascular preload is crucial for managing IAH and ACS.
- Previous studies have questioned the reliability of pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) in these patients.
Purpose of the Study:
- To compare the accuracy of different hemodynamic parameters in estimating preload status in patients with IAH and an open abdomen.
- To determine if right ventricular end-diastolic volume index (RVEDVI) is a superior predictor of preload compared to PAOP and CVP.
Main Methods:
- A prospective study involving 20 surgical and trauma patients with IAH undergoing open abdominal decompression.
- Monitoring included volumetric thermodilution pulmonary artery catheters for hemodynamic, oxygenation, inspiratory, and intravesicular pressure measurements.
- Comparison of PAOP, CVP, and RVEDVI as estimates of preload status.
Main Results:
- Multiple regression analysis revealed a significant correlation between cardiac index and RVEDVI (r = 0.69).
- Cardiac index showed poor correlation with PAOP (r = -0.27) and CVP (r = -0.28).
- These correlations were statistically significant (p < 0.0001) during resuscitation after open abdominal decompression.
Conclusions:
- Right ventricular end-diastolic volume index (RVEDVI) is a more accurate estimate of preload status than PAOP and CVP in patients with an open abdomen.
- RVEDVI can be a valuable tool for guiding fluid management in critically ill surgical patients with IAH.