Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: A metaanalysis of the literature

Abstract

Introduction: Hemodynamic parameters such as the global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI), derived by transpulmonary thermodilution, have gained increasing interest for guiding fluid therapy in critically ill patients. The proposed normal values (680---800 ml/m 2 for GEDVI and 3---7 ml/kg for EVLWI) are based on measurements in healthy individuals and on expert opinion, and are assumed to be suitable for all patients. We analyzed the published data for GEDVI and EVLWI, and investigated the differences between a cohort of septic patients (SEP) and patients undergoing major surgery (SURG), respectively. Methods: A PubMed literature search for GEDVI, EVLWI or transcardiopulmonary single/double indicator thermodilution was carried out, covering the period from 1990 to 2010. Intervention: Meta-regression analysis was performed to identify any differences between the surgical (SURG) and non-surgical septic groups (SEP Conclusions:The published data for GEDVI and EVLWI are heterogeneous, particularly in critically ill patients, and often exceed the proposed normal values derived from healthy individuals. In the group of septic patients, GEDVI and EVLWI were significantly higher than in the group of patients undergoing major surgery. This points to the need for defining different therapeutic targets for different patient populations. © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved. PALABRAS CLAVEMonitorización hemodinámica; Precarga; Edema pulmonar; Volumen diastólico final global; Agua pulmonar extravascularComparación de valores del volumen diastólico final global y el algua pulmonar extravascular, medidos mediante termodilución transcardiopulmonar en pacientes críticamente enfermos: metaanálisis bibliográfico Resumen Introducción: Parámetros hemodinámicos como el índice de volumen diastólico final global (GEDVI) y el índice de agua pulmonar extravascular (EVLWI), obtenidos mediante termodilución transpulmonar, suscitan un interés creciente como guía de la terapia de fluidos en pacientes críticamente enfermos. Los valores normales propuestos (680---800 ml/m 2 para el GEDVI y 3-7 ml/kg para el EVLWI) se basan en mediciones realizadas a individuos sanos y en la opinión de expertos, y se asume que son adecuados para todos los pacientes. Analizamos los datos publicados sobre el GEDVI y el EVLWI e investigamos las diferencias entre una cohorte de pacientes septicémicos (SEP) y pacientes sometidos a cirugía mayor (SURG) respectivamente. Métodos: Se realizó una búsqueda bibliográfica en PubMed de GEDVI, EVLWI o termodilución trasncardiopulmonar de indicador único/doble referida al periodo comprendido entre 1990 y 2010. Intervenciones: Se realizó un análisis de metarregresión para identificar las diferencias entre los grupos quirúrgico (SURG) y no quirúrgico septicémico (SEP [6,9; 7,6] frente a SEP 11,0 ml/kg, IC del 95 %: [9,1;13,0], p=0,001). Conclusiones: Los datos publicados del GEDVI y el EVLWI son heterogéneos, especialmente en pacientes críticamente e...

Early Intensive Versus Minimally Invasive Approach to Postoperative Hemodynamic Management After Subarachnoid Hemorrhage

“…), global end-diastolic volume index (GEDI; 680-800 mL/m 2 ), 26,27 and extravascular lung water index (3-7 mL/kg). 26,28 Hemodynamic stability was defined as CI ≥3 L·min , and extravascular lung water index ≤12 mL/kg (the upper limits were defined as the values associated with a higher risk of mortality in patients with pulmonary edema [29][30][31] ; Figure II1A in the online-only Data Supplement).…”

“…26,28 Hemodynamic stability was defined as CI ≥3 L·min , and extravascular lung water index ≤12 mL/kg (the upper limits were defined as the values associated with a higher risk of mortality in patients with pulmonary edema [29][30][31] ; Figure II1A in the online-only Data Supplement). Blood pressure, heart rate, central venous pressure, systemic vascular resistance, and fluid balance were also monitored (Table in the online-only Data Supplement) but were not considered during therapeutic decision making.…”

Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables

“…MTt means the time that half of the injected cold saline has passed the thermistor, and DSt means the duration of the exponential decrease of the dilution curve (Sakka et al, 1999;Reuter et al, 2005). Cardiac output (CO), global end-diastolic volume (GEDV), intra-thoracic blood volume (ITBV), and extra-vascular lung water (EVLW) are calculated according to the three values described above: both GEDV and ITBV are the preload indicators, and EVLW is a sensitive indicator of pulmonary edema (Katzenelson et al, 2004;Michard et al, 2005;Kuzkov et al, 2006;Khan et al, 2007;Bendjelid et al, 2010;Belda et al, 2011;Eichhorn et al, 2012;Kiefer et al, 2012). The combined measurement of CO, GEDV, and EVLW could provide a synthetic platform for hemodynamic management in critically ill patients.…”

Initial resuscitation from severe sepsis: one size does not fit all

“…Correction of the GEDVI for the corresponding global ejection fraction can further improve its predictive value [69]. One must, however, take into account that no good normal values exist for GEDVI in different patient populations [70]. The same static volumetric targets, although better than those which are barometric, may not apply to all patients [71].…”

“…The same static volumetric targets, although better than those which are barometric, may not apply to all patients [71]. A recent meta-analysis showed that baseline values for GEDVI are around 694 mL m -2 in surgical and 788 mL m -2 in septic patients [70] and thus below the upper limit of normal of 850 mL m -2 , as was recently used as target for initiating a fluid challenge [72]. We must remember that no single parameter can improve outcome.…”