A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

Huber, Wolfgang; Mair, Sebastian; Götz, Simon Q.; Tschirdewahn, Julia; Frank, Johanna; Höllthaler, Josef; Phillip, Veit; Schmid, Roland M.; Saugel, Bernd

doi:10.1007/s10877-016-9833-9

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…In line, data from a recent study in pigs with severe acute pancreatitis as a paradigm for severe systemic infection showed that a “maximized” utilization of the cardiac preload reserve is not an “optimized” fluid management approach [ 85 ]. Normal values of hemodynamic variables show marked interindividual variability and are dependent on a variety of biometric and pathophysiologic factors [ 86 – 91 ]. Therefore, a “one size fits all” approach will always be deemed to fail in the hemodynamic management of critically ill patients [ 78 ].…”

Section: Hemodynamic Management In Septic Shock: Open Research Quementioning

confidence: 99%

Advanced Hemodynamic Management in Patients with Septic Shock

Saugel

Huber

Nierhaus

et al. 2016

BioMed Research International

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In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and “hemodynamic management” using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to “usual care” in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation. “Hemodynamic management” comprises (a) making the diagnosis of septic shock as one differential diagnosis of circulatory shock, (b) assessing the hemodynamic status including the identification of therapeutic conflicts, and (c) guiding therapeutic interventions. We propose two algorithms for hemodynamic management using transpulmonary thermodilution-derived variables aiming to optimize the cardiocirculatory and pulmonary status in adult ICU patients with septic shock. The complexity and heterogeneity of patients with septic shock implies that individualized approaches for hemodynamic management are mandatory. Defining individual hemodynamic target values for patients with septic shock in different phases of the disease must be the focus of future studies.

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Section: Hemodynamic Management In Septic Shock: Open Research Quementioning

confidence: 99%

Advanced Hemodynamic Management in Patients with Septic Shock

Saugel

Huber

Nierhaus

et al. 2016

BioMed Research International

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“…While non-correction for femoral indicator injection can be considered as a substantial deficiency of the EV-1000, clinically relevant differences between GEDVI derived from PiCCO and EV-1000 should be interpreted cautiously regarding superiority of one approach. A recent large database analysis investigating 3812 TPTD measurements in 234 patients suggests slightly higher coefficients of correlation with unindexed GEDV for BSA_pred compared to BSA_act 22 . Furthermore, the ROC-AUC regarding a decreased GEDV < 1260 ml was larger for BSA_pred than for BSA_act (AUC = 0.842 vs. AUC = 0.733) in this study 22 .…”

Section: Discussionmentioning

confidence: 97%

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

Herner

Heilmaier

Mayr

et al. 2020

Sci Rep

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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.

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“…However, it was recently shown that GEDVI did not reflect even markedly enlarged left-ventricular end-diastolic volumes measured by cardiac angiography [7]. Furthermore, reference values for GEDVI proposed by expert opinion vary and a reference range applicable to all subjects was repeatedly questioned [8][9][10]. A meta-analysis including 64 studies recognized significantly higher mean GEDVI in septic patients compared with patients undergoing major surgery and concluded the need to adapt therapeutic targets for different patient populations [8].…”

Section: Introductionmentioning

confidence: 99%

“…A meta-analysis including 64 studies recognized significantly higher mean GEDVI in septic patients compared with patients undergoing major surgery and concluded the need to adapt therapeutic targets for different patient populations [8]. Huber et al noticed a dependence of GEDV on age, sex, body height, and body weight in patients in a medical intensive care unit and proposed sexspecific formulas to alleviate the problem of indexation [9]. A prospective observational trial found a large inter-individual variability of GEDV and GEDVI and hypothesized that the aortic volume might be the source of the observed heterogeneity [10].…”

Section: Introductionmentioning

confidence: 99%

Aortic volume determines global end-diastolic volume measured by transpulmonary thermodilution

Akohov

Barner

Grimmer

et al. 2020

ICMx

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Background: Global end-diastolic volume (GEDV) measured by transpulmonary thermodilution is regarded as indicator of cardiac preload. A bolus of cold saline injected in a central vein travels through the heart and lung, but also the aorta until detection in a femoral artery. While it is well accepted that injection in the inferior vena cava results in higher values, the impact of the aortic volume on GEDV is unknown. In this study, we hypothesized that a larger aortic volume directly translates to a numerically higher GEDV measurement. Methods: We retrospectively analyzed data from 88 critically ill patients with thermodilution monitoring and who did require a contrast-enhanced thoracoabdominal computed tomography scan. Aortic volumes derived from imaging were compared with GEDV measurements in temporal proximity. Results: Median aortic volume was 194 ml (interquartile range 147 to 249 ml). Per milliliter increase of the aortic volume, we found a GEDV increase by 3.0 ml (95% CI 2.0 to 4.1 ml, p < 0.001). In case a femoral central venous line was used for saline bolus injection, GEDV raised additionally by 2.1 ml (95% CI 0.5 to 3.7 ml, p = 0.01) per ml volume of the vena cava inferior. Aortic volume explained 59.3% of the variance of thermodilution-derived GEDV. When aortic volume was included in multivariate regression, GEDV variance was unaffected by sex, age, body height, and weight. Conclusions: Our results suggest that the aortic volume is a substantial confounding variable for GEDV measurements performed with transpulmonary thermodilution. As the aorta is anatomically located after the heart, GEDV should not be considered to reflect cardiac preload. Guiding volume management by raw or indexed reference ranges of GEDV may be misleading.

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A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

Cited by 13 publications

References 29 publications

Advanced Hemodynamic Management in Patients with Septic Shock

Advanced Hemodynamic Management in Patients with Septic Shock

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

Aortic volume determines global end-diastolic volume measured by transpulmonary thermodilution

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