Cardiac Preload Responsiveness in Children With Cardiovascular Dysfunction or Dilated Cardiomyopathy

Abstract

This study provides "normal" values for global end-diastolic volume index and limits of cardiac preload responsiveness in pediatric patients with cardiovascular dysfunction and dilated cardiomyopathy: 1.33 times normal global end-diastolic volume index represents the upper limit of patent cardiac preload responsiveness, with the highest expected responsiveness being below 0.67 times normal global end-diastolic volume index. The maximum response of the Frank-Starling relationship and therefore the level of no additional preload reserve is 1.33 to 1.51 times normal global end-diastolic volume index. Above 1.51 times normal global end-diastolic volume index preload responsiveness is unlikely, and the risk of pulmonary edema is maximal.

Transpulmonary thermodilution (PiCCO) measurements in children without cardiopulmonary dysfunction: large interindividual variation and conflicting reference values

“…The GEDVI reference values are too high, and EVLWI values are too low. This is line with findings from previous studies (7,14,15). CI measurements however, overlapped well with current reference range ( Table 2).…”

Fluid responsiveness in the pediatric population

“…Patients with poor baseline contractility need more fluid to increase stroke volume. The clinical implications are important for patients with reduced contractility, who will require increased volume administration if a stroke volume increase of > 15% is targeted, but are also at a higher risk of inadequate fluid clearance and hence fluid overload [56].…”

Otto Frank y Ernest Starling. Más allá de una ley o un mecanismo. Breve reseña histórica

“…En más de una oportunidad, en la práctica de reanimación con fluidos, tanto clínicos como investigadores mencionan al rol de la «ley de Frank-Starling» o «ley del corazón», la cual establece que el volumen eyectivo del corazón incrementa en respuesta a un aumento del volumen de llenado de este (volumen de fin de diástole), siempre que todos los otros factores permanezcan inalterados 1,2 . Sin embargo, se debe señalar que ni Otto Frank (1865Frank ( -1944 como tampoco Ernest Henry Starling (1866Starling ( -1927 fueron sus descubridores 3,4 , mas la participación de ambos en este epónimo es indiscutible, perdurando sus nombres por más de un siglo en las disciplinas de cardio-fisiología 5 , hemodinamia 6 , cardiología 7 , nefrología 8 y cuidados intensivos 9 , entre otras.…”