Central venous pressure, pulmonary capillary wedge pressure and intrathoracic blood volumes as preload indicators in cardiac surgery patients

Abstract

Central venous pressure, capillary wedge pressure, right atrial and right ventricular end diastolic volumes are no suitable preload parameters in cardiac surgery intensive care, compared to intrathoracic and global end diastolic blood volumes. The latter show a higher clinical value and can be obtained by less invasive methods, as no pulmonary artery catheter is required.

Blood N-Terminal proBNP as a Potential Indicator of Cardiac Preload in Patients with High Volume Load

“…The GEDVI, corresponding to ventricular end-diastolic volume, has been shown to be well correlated to CI (Gödje et al 1998;Sakka et al 1999). In this assessment (Fig.…”

Normovolaemia defined by central blood volume and venous oxygen saturation

“…77 Also with changes in CBV as elicited by head-up and head-down tilting, SV of the heart changed with the thoracic fluid content rather than with the central vascular pressures. These findings question CVP/PAWP as useful predictors of ventricular preload 78 and support that the function of the heart relates to its volume rather than to its so-called filling pressures.…”

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

“…Our study does not address the effect of mathematical coupling of GEDVI to CI, when volumes are derived from the same transpulmonary dilution curve as cardiac output. The often observed superiority of cardiac volumes over filling pressures in predicting and monitoring cardiac output responses, that is, fluid responsiveness, may indeed be overestimated by the phenomenon, as recently described by our group also [1,6-8,10-16,18,19,27]. In hearts with systolic dysfunction and dilatation, a right- and downward shift on the Frank-Starling curve and along the curvilinear pressure-volume relationship at end-diastole, preload recruitability may be more dependent on and thus predicted and monitored by pressures than by volumes [5,22].…”

“…Pressures were measured with patients in the supine position after calibration, zeroing to atmospheric pressure and, for PAOP, after proper wedging, at the midchest level at end-expiration (Tramscope ® , Marquette, GE, Milwaukee, WI, USA). For the measurements of cardiac output and GEDV, the transpulmonary thermal-dye indicator dilution technique was used [1,6]. These measurements involve a central venous injection of 15 mL of ice-cold indocyanine green in 5% glucose solution and concomitant registration of the dilution curves in the femoral artery, by a 3F catheter equipped with a thermistor (PV 2024, Pulsion Medical Systems, Munich, Germany).…”

“…Static filling volumes, such as the transpulmonary dilution-derived global end-diastolic volume, have been suggested to better predict fluid responsiveness than filling pressures such as the central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) obtained from a pulmonary artery catheter [6-19]. Most studies, however, often included patients with relatively normal left ventricular systolic function, undergoing coronary artery surgery [6-13,15,16,19]. Mundigler et al suggested that pressures were superior to transpulmonary thermodilution-derived volumes for monitoring changes in cardiac preload during fluid loading in non-surgical patients with left ventricular systolic dysfunction, measured by transesophageal echocardiography [20].…”