Use of initial distribution volume of glucose to determine fluid volume loading in pulmonary thromboembolism and right ventricular myocardial infarction

Abstract

We report a case of acute right ventricular myocardial infarction (right AMI) following pulmonary thromboembolism (PTE). Following percutaneous coronary intervention, the patient was treated in our intensive care unit (ICU) with intraortic balloon pumping, anticoagulants, and plasma expansion. Fluid overload may cause a further leftward shift of the interventricular septum in patients with PTE, resulting in decreased cardiac output (CO). The initial distribution volume of glucose (IDVG) has been reported to indicate central extracellular fluid volume. As both PTE and right AMI affect cardiac filling pressures, such as central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP), we measured IDVG in order to evaluate the patient's cardiac preload, comparing it with the cardiac filling pressures. Fluid volume loading over 12 h yielded an obvious increase in IDVG. However, low arterial blood pressure and CO, associated with high CVP, remained unchanged and were accompanied by deteriorating pulmonary oxygenation. Accordingly, volume loading was discontinued and the rates of infusion of catecholamines were increased instead. At 12 h thereafter, IDVG became normal, and both CO and blood pressure became improved. However, the cardiac filling pressures remained increased. Although the patient died on the subsequent day, this case report could support the usefulness of IDVG as a fluid volume marker in critically ill patients, especially those with right AMI.

The pleth variability index as an indicator of the central extracellular fluid volume in mechanically ventilated patients after anesthesia induction: Comparison with initial distribution volume of glucose

“…Data from the present study support these findings. When PPV over 11% is arbitrarily selected as the threshold of hypovolemia prediction based on literature reports [15,18], the optimal cutoff value of IDVG comparable to PPV in this study is 94.5 mL/kg, which is less than the lower limit of the normal IDVG range (110–130 mL/kg) [12,22]. Although PPV and SPV dynamic indices from respiratory variations strongly correlate with IDVG, the major limitations of routine clinical use of these indices are invasive arterial catheterization, expensive instruments, or specific software [18].…”

“…More than 4000 IDVG determinations in an intensive care unit setting demonstrated that patients with an IDVG less than 100 mL/kg generally require fluid therapy [22]. Therefore, IDVG less than 100mL/kg was selected as the threshold for hypovolemia in this study.…”

“…The gold standards of measuring circulating blood volume by 131I-labeled human serum albumin or indocyanine green are not available in our institute; therefore, it is hard to define hypovolemia. In the present study, we arbitrarily assumed an IDVG less than 100 mL/kg or a PPV over 11% as thresholds for hypovolemia according to previous reports [12,22]. PVI is based on peripheral volume and vascular tone-dependent dynamic preload variables [28,29], but we did not do a fluid challenge or manipulate vascular tone to confirm whether this linear relationship remained the same.…”