Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView®: do the same criteria apply as for the PiCCO®?

Huber, Wolfgang; Phillip, Veit; Höllthaler, Josef; Schultheiß, Caroline; Saugel, Bernd; Schmid, Roland M.

doi:10.1631/jzus.b1500244

Cited by 12 publications

(18 citation statements)

References 21 publications

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“…It is well accepted and confirmed by our data that femoral central venous lines should be accounted for when interpreting GEDV measurements [23][24][25]. However, our results show that the aortic volume had an even larger, predominant influence by explaining roughly 60% of GEDV variance.…”

Section: Relevance Of Central Venous and Aortic Volumes For Gedv Meassupporting

confidence: 85%

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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Section: Relevance Of Central Venous and Aortic Volumes For Gedv Meassupporting

confidence: 85%

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

Akohov

Barner

Grimmer

et al. 2020

ICMx

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“…Hemodynamic monitoring devices using transpulmonary thermodilution (TPTD) are increasingly used for hemodynamic evaluations in critically ill patients and have been associated with improved prognosis . Nevertheless, correct monitoring is extremely important; there have been discrepancies reported in the TPTD values when intravenous cold saline injection was administered via the jugular vein versus the femoral vein . Furthermore, wide margins of errors were reported in the TPTD values when blood purification was both performed and discontinued .…”

mentioning

confidence: 99%

Influence of Blood Purification and Differential Injection Sites of Cold Saline on Transpulmonary Thermodilution Values

et al. 2018

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We aimed to investigate the effects of blood purification and cold saline injection sites on the transpulmonary thermodilution values. We measured the cardiac output of eight pigs in every combination of cold saline injection (left jugular and femoral veins) and blood purification sites (right jugular and femoral veins), with or without blood purification. We examined the influence of the difference between the presence and absence of blood purification, vascular sites for blood purification, and sites for cold saline injection on the transpulmonary thermodilution values. Cardiac output measured during blood purification using transpulmonary thermodilution was underestimated; however, there was no difference between vascular sites. Cardiac output measured via injection of cold saline into the femoral vein was higher than that obtained through injection of cold saline into the jugular vein, with or without blood purification.

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“…This prospective observational study was conducted in an eight bed general ICU at a university hospital between March 18, 2013 and April 30, 2016. None of the patients has been included in one of the studies or databases previously used for comparison of TPTD-parameters derived from jugular to femoral indicator injection [ 5 , 24 , 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

“…Both principles have been used separately in the 1 st generation COLD-device (TPTD) [ 1 ] or the FloTrac and ProAqt-technology (PCA) [ 2 , 3 ]. At least three commercially available devices combine TPTD and PCA (PiCCO [ 4 ], EV-1000 [ 5 ] and LiDCO [ 6 ]). Combination of TPTD and PCA provides intermittent calibration of cardiac index CI by TPTD as well as continuous assessment of CI, variabilities of the arterial pressure curve such as stroke volume variation (SVV) and pulse pressure variation (PPV).…”

Section: Introductionmentioning

confidence: 99%

“…PVPI, GEF and CFI have been associated to the aetiology of pulmonary oedema and systolic cardiac function, respectively. However, a number of studies demonstrated that the use of femoral venous access results in a marked overestimation of GEDV [ 5 , 24 , 25 ]. Overestimation of GEDV also falsely reduces PVPI, GEF and CFI [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of pulmonary vascular permeability index PVPI and global ejection fraction GEF derived from jugular and femoral indicator injection using the PiCCO-2 device: A prospective observational study

et al. 2017

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BackgroundTranspulmonary thermodilution (TPTD) is used to derive cardiac output CO, global end-diastolic volume GEDV and extravascular lung water EVLW. To facilitate interpretation of these data, several ratios have been developed, including pulmonary vascular permeability index (defined as EVLW/(0.25*GEDV)) and global ejection fraction ((4*stroke volume)/GEDV). PVPI and GEF have been associated to the aetiology of pulmonary oedema and systolic cardiac function, respectively. Several studies demonstrated that the use of femoral venous access results in a marked overestimation of GEDV. This also falsely reduces PVPI and GEF. One of these studies suggested a correction formula for femoral venous access that markedly reduced the bias for GEDV. Consequently, the last PiCCO-algorithm requires information about the CVC, and correction for femoral access has been shown. However, two recent studies demonstrated inconsistencies of the last PiCCO algorithm using incorrected GEDV for PVPI, but corrected GEDV for GEF. Nevertheless, these studies were based on mathematical analyses of data displayed in a total of 15 patients equipped with only a femoral, but not with a jugular CVC.Therefore, this study compared PVPI_fem and GEF_fem derived from femoral TPTD to values derived from jugular indicator injection in 25 patients with both jugular and femoral CVCs.Methods54 datasets in 25 patients were recorded. Each dataset consisted of three triplicate TPTDs using the jugular venous access as the gold standard and the femoral access with (PVPI_fem_cor) and without (PVPI_fem_uncor) information about the femoral indicator injection to evaluate, if correction for femoral GEDV pertains to PVPI_fem and GEF_fem.ResultsPVPI_fem_uncor was significantly lower than PVPI_jug (1.48±0.47 vs. 1.84±0.53; p<0.001). Similarly, PVPI_fem_cor was significantly lower than PVPI_jug (1.49±0.46 vs. 1.84±0.53; p<0.001). This is explained by the finding that PVPI_fem_uncor was not different to PVPI_fem_cor (1.48±0.47 vs. 1.49±0.46; n.s.). This clearly suggests that correction for femoral CVC does not pertain to PVPI.GEF_fem_uncor was significantly lower than GEF_jug (20.6±5.1% vs. 25.0±6.1%; p<0.001). By contrast, GEF_fem_cor was not different to GEF_jug (25.6±5.8% vs. 25.0±6.1%; n.s.). Furthermore, GEF_fem_cor was significantly higher than GEF_fem_uncor (25.6±5.8% vs. 20.6±5.1%; p<0.001). This finding emphasizes that an appropriate correction for femoral CVC is applied to GEF_fem_cor.The extent of the correction (25.5/20.6; 124%) for GEF and the relation of PVPI_jug/PVPI_fem_uncor (1.84/1.48; 124%) are in the same range as the ratio of GEDVI_fem_uncor/GEDVI_fem_cor (1056ml/m2/821mL/m2; 129%). This further emphasizes that GEF, but not PVPI is corrected in case of femoral indicator injection.ConclusionsFemoral indicator injection for TPTD results in significantly lower values for PVPI and GEF. While the last PiCCO algorithm appropriately corrects GEF, the correction is not applied to PVPI. Therefore, GEF-values can be used in case of femoral CVC, but PVPI-va...

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Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView®: do the same criteria apply as for the PiCCO®?

Abstract: Femoral access for indicator injection results in markedly altered values provided by the EV1000/VolumeView(®), particularly for GEDVI, PVPI, and GEF.

Cited by 12 publications

References 21 publications

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

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

Influence of Blood Purification and Differential Injection Sites of Cold Saline on Transpulmonary Thermodilution Values

Comparison of pulmonary vascular permeability index PVPI and global ejection fraction GEF derived from jugular and femoral indicator injection using the PiCCO-2 device: A prospective observational study

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