Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: A metaanalysis of the literature

Abstract

Introduction: Hemodynamic parameters such as the global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI), derived by transpulmonary thermodilution, have gained increasing interest for guiding fluid therapy in critically ill patients. The proposed normal values (680---800 ml/m 2 for GEDVI and 3---7 ml/kg for EVLWI) are based on measurements in healthy individuals and on expert opinion, and are assumed to be suitable for all patients. We analyzed the published data for GEDVI and EVLWI, and investigated the differences between a cohort of septic patients (SEP) and patients undergoing major surgery (SURG), respectively. Methods: A PubMed literature search for GEDVI, EVLWI or transcardiopulmonary single/double indicator thermodilution was carried out, covering the period from 1990 to 2010. Intervention: Meta-regression analysis was performed to identify any differences between the surgical (SURG) and non-surgical septic groups (SEP). Results: Data from 1925 patients corresponding to 64 studies were included. On comparing both groups, mean GEDVI was significantly higher by 94 ml/m 2 (95%CI: [54; 134] Conclusions:The published data for GEDVI and EVLWI are heterogeneous, particularly in critically ill patients, and often exceed the proposed normal values derived from healthy individuals. In the group of septic patients, GEDVI and EVLWI were significantly higher than in the group of patients undergoing major surgery. This points to the need for defining different therapeutic targets for different patient populations. © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved. PALABRAS CLAVEMonitorización hemodinámica; Precarga; Edema pulmonar; Volumen diastólico final global; Agua pulmonar extravascularComparación de valores del volumen diastólico final global y el algua pulmonar extravascular, medidos mediante termodilución transcardiopulmonar en pacientes críticamente enfermos: metaanálisis bibliográfico Resumen Introducción: Parámetros hemodinámicos como el índice de volumen diastólico final global (GEDVI) y el índice de agua pulmonar extravascular (EVLWI), obtenidos mediante termodilución transpulmonar, suscitan un interés creciente como guía de la terapia de fluidos en pacientes críticamente enfermos. Los valores normales propuestos (680---800 ml/m 2 para el GEDVI y 3-7 ml/kg para el EVLWI) se basan en mediciones realizadas a individuos sanos y en la opinión de expertos, y se asume que son adecuados para todos los pacientes. Analizamos los datos publicados sobre el GEDVI y el EVLWI e investigamos las diferencias entre una cohorte de pacientes septicémicos (SEP) y pacientes sometidos a cirugía mayor (SURG) respectivamente. Métodos: Se realizó una búsqueda bibliográfica en PubMed de GEDVI, EVLWI o termodilución trasncardiopulmonar de indicador único/doble referida al periodo comprendido entre 1990 y 2010. Intervenciones: Se realizó un análisis de metarregresión para identificar las diferencias entre los grupos quirúrgico (SURG) y no quirúrgico septicémico (SEP [6,9; 7,6] fren...

The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome

“…In this regard, more than 15% of the ALI/ARDS patients included in this study had a combined mechanism of an elevated left ventricular preload and vascular permeability; this may have contributed to the difference in EVLWI between the two groups. One should also consider that the heterogeneity of the patients' condition may affect the value of the EVLWI, as shown in a recent meta-analysis where the EVLWI in septic patients was higher than in surgical patients (11.0 ml/kg vs. 7.2 ml/kg) [58]. …”

Results of questionable management protocols are inherently questionable

“…Evaluating their patient-centered benefit would require a different study. Conversely, the relatively high upper limit of global enddiastolic volume index we have chosen, based upon our own observations as well as other studies, does not yet completely exclude (particularly in septic shock) an increase in cardiac index with fluid loading when needed in the treatment of shock (5)(6)(7)(8). Furthermore, fluid administration with the PiCCO algorithm was not greater, even on the first day, than in the PAC group, although fluid balance was, unexpectedly, somewhat higher.…”