How to measure and interpret volumetric measures of preload

Rocca, Giorgio Della; Costa, M. G.; Pietropaoli, P

doi:10.1097/mcc.0b013e32811d6ce3

Cited by 39 publications

(16 citation statements)

References 43 publications

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“…It is known that neither PAC nor volumetric monitoring "per se" improves outcome in critically ill patients. 18 Furthermore, hypovolemia is often exaggerated from the early stage of SAH without a significant impact on CO 22 or on brain tissue perfusion, 2,34 suggesting the need for careful fluid management to avoid hypovolemia for reducing the risk of delayed cerebral ischemia. Taken together, the better clinical course of our patients receiving the new management paradigm might be explained by placement of the PiCCO from the early phase is effective for stabilization of cardiac performance under normovolemia safely and appropriately before the onset of cerebral vasospasm without overloading them.…”

Section: Discussionmentioning

confidence: 99%

Performance of Bedside Transpulmonary Thermodilution Monitoring for Goal-Directed Hemodynamic Management After Subarachnoid Hemorrhage

Mutoh

Kazumata

Ishikawa

et al. 2009

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114

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Background and Purpose-Early goal-directed hemodynamic therapy is of particular importance for adequate cerebral circulation of patients with vasospasm after subarachnoid hemorrhage but is often precluded by the invasiveness of established cardiac output determination using a pulmonary artery catheter. This study was undertaken to validate the usefulness of less invasive goal-directed hemodynamic monitoring by transpulmonary thermodilution technique in patients after subarachnoid hemorrhage. Methods-One hundred sixteen patients with subarachnoid hemorrhage who underwent surgical clipping within 24 hours of ictus were investigated. Validation of transpulmonary thermodilution-derived intermittent/continuous cardiac output and cardiac preload (global end diastolic volume) were compared with pulmonary artery catheter-derived reference cardiac output and pulmonary capillary wedge pressure or central venous pressure in 16 patients diagnosed with vasospasm. In a subsequent trial of 100 consecutive cases, clinical results between the new and standard management paradigms were compared. Results-Transpulmonary thermodilution-derived intermittent cardiac output and transpulmonary thermodilution-derived continuous cardiac output showed close agreement to catheter-derived reference cardiac output with high correlation (rϭ0.85 and 0.77) and low percentage error (13.5% and 18.0%). Fluid responsiveness to defined volume loading was predicted better with global end diastolic volume than with pulmonary capillary wedge pressure and central venous pressure for larger receiver operating characteristic curve area. Patients receiving early goal-directed management by transpulmonary thermodilution experienced reduced frequencies of vasospasm and cardiopulmonary complications compared with those managed with standard therapy (PϽ0.05), whereas their functional outcomes at 3 months were not different (Pϭ0.06). Conclusions-Goal-directed hemodynamic management guided by transpulmonary thermodilution appears to have a therapeutic advantage for optimizing the prognosis of patients with subarachnoid hemorrhage with vasospasm over conventional methods.

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Section: Discussionmentioning

confidence: 99%

Performance of Bedside Transpulmonary Thermodilution Monitoring for Goal-Directed Hemodynamic Management After Subarachnoid Hemorrhage

Mutoh

Kazumata

Ishikawa

et al. 2009

Stroke

114

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“…Recently, international guidelines and reviews [10][11][12][13][14] have emphasized the importance of monitoring cardiac output and its related variables under special clinical conditions but call for well conducted, randomized, controlled studies to be performed to prove the exact role of these parameters in the outcome in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Precision of transpulmonary thermodilution: how many measurements are necessary?

Gyökeres

Marjanek²,

Kisvarga³

et al. 2009

European Journal of Anaesthesiology

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“…), 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).…”

Section: Treatment Algorithmsmentioning

confidence: 99%

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

Mutoh

Kazumata

Terasaka

et al. 2014

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The results of previous studies suggest that early goal-directed fluid therapy (EGDT) reduces the incidence of DCI after aneurysmal SAH, 10,14 but the effects of EGDT on clinical outcomes are still unclear. This prospective study aimed to determine whether EGDT improves outcomes compared with standard less-invasive hemodynamic therapy. The outcomes after EGDT were also evaluated in subgroups of patients with poor clinical grade 10,11,15 or concurrent cardiopulmonary complications, [16][17][18] which are well-known risk factors for DCI and poor outcome. Methods Patient SelectionThis 2-center, prospective, randomized, nonblinded clinical trial enrolled patients who were admitted for the treatment of SAH at Teine Keijinkai Hospital and the Research Institute for Brain and Blood Vessels-AKITA between April 2009 and September 2013. Patients were screened for enrollment after obliteration of the causative aneurysm. The inclusion and exclusion criteria are shown in Figure I and Background and Purpose-The results of previous studies suggest that early goal-directed fluid therapy (EGDT) reduces delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage, but the effects of EGDT on clinical outcomes are still unclear. This study aimed to determine whether EGDT improves outcomes compared with standard less-invasive hemodynamic therapy. Methods-This study included 160 patients treated within 24 hours after subarachnoid hemorrhage, randomized to receive either (1) EGDT guided by preload volume and cardiac output monitored by transpulmonary thermodilution (treatment group) or (2) standard therapy guided by fluid balance or central venous pressure, assisted by uncalibrated less-invasive cardiac output monitoring during hyperdynamic therapy in patients with clinical or radiological indications of DCI (control group). DCI determined by clinical or radiological findings and functional outcome determined by the modified Rankin Scale score at 3 months were compared between groups. Results-For all clinical grades combined, there were no significant differences in the rates of DCI (33% versus 42%; P=0.33) or modified Rankin Scale score of 0 to 3 at 3 months (67% versus 57%; P=0.

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How to measure and interpret volumetric measures of preload

Cited by 39 publications

References 43 publications

Performance of Bedside Transpulmonary Thermodilution Monitoring for Goal-Directed Hemodynamic Management After Subarachnoid Hemorrhage

Performance of Bedside Transpulmonary Thermodilution Monitoring for Goal-Directed Hemodynamic Management After Subarachnoid Hemorrhage

Precision of transpulmonary thermodilution: how many measurements are necessary?

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

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