Comparison of global end-diastolic volume index derived from jugular and femoral indicator injection: a prospective observational study in patients equipped with both a PiCCO-2 and an EV-1000-device

Abstract

Transpulmonary thermodilution (TPTD)-derived global end-diastolic volume index (GEDVI) is a static marker of preload which better predicted volume responsiveness compared to filling pressures in several studies. GEDVI can be generated with at least two devices: PiCCO and EV-1000. Several studies showed that uncorrected indicator injection into a femoral central venous catheter (CVC) results in a significant overestimation of GEDVI by the PiCCO-device. Therefore, the most recent PiCCO-algorithm corrects for femoral indicator injection. However, there are no systematic data on the impact of femoral indicator injection for the EV-1000 device. Furthermore, the correction algorithm of the PiCCO is poorly validated. Therefore, we prospectively analyzed 14 datasets from 10 patients with TPTD-monitoring undergoing central venous catheter (CVC)- and arterial line exchange. PiCCO was replaced by EV-1000, femoral CVCs were replaced by jugular/subclavian CVCs and vice-versa. For PiCCO, jugular and femoral indicator injection derived GEDVI was comparable when the correct information about femoral catheter site was given (p = 0.251). By contrast, GEDVI derived from femoral indicator injection using the EV-1000 was obviously not corrected and was substantially higher than jugular GEDVI measured by the EV-1000 (846 ± 250 vs. 712 ± 227 ml/m2; p = 0.001). Furthermore, measurements of GEDVI were not comparable between PiCCO and EV-1000 even in case of jugular indicator injection (p = 0.003). This is most probably due to different indexations of the raw value GEDV. EV-1000 could not be recommended to measure GEDVI in case of a femoral CVC. Furthermore, different indexations used by EV-1000 and PiCCO should be considered even in case of a jugular CVC when comparing GEDVI derived from PiCCO and EV-1000.

Fluid therapy for severe malaria

“…They concluded mean GEDVI decreases to 473-650 mL/m 2 (680 to 800mL/m 2 is considered normal) in most patients. 21,22,23,24,25 Consistent with this, Kingston and colleagues found IVC inspiratory diameters to be smaller and IVC collapsibility greater in severe malaria compared to healthy individuals. 26 This decrease in preload is likely due to fluid losses caused by fever, vomiting, diarrhoea and diminished fluid intake with impaired consciousness.…”

Effects of changes in veno-venous extracorporeal membrane oxygenation blood flow on the measurement of intrathoracic blood volume and extravascular lung water index: a prospective interventional study

“…We observed a similar impact on CO TPTD , but not at the same magnitude as indicated by the enlarged area under the curve that would result from an increase in MTt and DSt. This could be due to the mathematic correction performed by the PiCCO software that takes a certain amount of recirculation into account [ 31 , 32 ]. This finding is in line with our previous report, where we found no influence of ECBF on the difference in measurements of cardiac SV by echocardiography and TPTD in patients with severe ARDS managed with V-V ECMO [ 15 ].…”

CRRT influences PICCO measurements in febrile critically ill patients

“…Previous studies have suggested that measurement errors may be caused by a “loss of indicator” due to modifications of the distribution of the cold bolus injected into the venous bloodstream [ 23 , 24 , 25 ]. The loss of an indicator in PICCO, such as a mispositioning of the central venous catheter tip, might have influenced CI measurements [ 11 ].…”