Global end-diastolic volume acquired by transpulmonary thermodilution depends on age and gender in awake and spontaneously breathing patients

Abstract

IntroductionVolumetric parameters acquired by transpulmonary thermodilution had been repeatedly proven superior to filling pressures for estimation of cardiac preload. Up to now, the proposed normal ranges were never studied in detail. We investigated the relationship of the global end-diastolic volume (GEDV) acquired by transpulmonary thermodilution with age and gender in awake and spontaneously breathing patients.MethodsPatients requiring brain tumor surgery were equipped prospectively with a transpulmonary thermodilution device. On postoperative day one, thermodilution measurements were performed in 101 patients ready for discharge from the ICU. All subjects were awake, spontaneously breathing, hemodynamically stable and free of catecholamines.ResultsMain finding was a dependence of GEDV on age and gender, height and weight of the patient. Age was a highly significant non-linear coefficient for GEDV with large inter-individual variance (p < 0.001). On average, GEDV was 131.1 ml higher in males (p = 0.027). Each cm body height accounted for 13.0 ml additional GEDV (p < 0.001). GEDV increased by 2.90 ml per kg actual body weight (p = 0.043). Each cofactor, including height and weight, remained significant after indexing GEDV to body surface area using predicted body weight.ConclusionsThe volumetric parameter GEDV shows a large inter-individual variance and is dependent on age and gender. These dependencies persist after indexing GEDV to body surface area calculated with predicted body weight. Targeting resuscitation using fixed ranges of preload volumes acquired by transpulmonary thermodilution without concern to an individual patient's age and gender seems not to be appropriate.

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

“…In addition to the impact of sex on GEDV, the strong impact of age on GEDV revealed in our study seems to be of high clinical relevance. This is in accordance with previous data suggesting an increase in GEDV with older age [31].…”

“…With regard to a mean GEDV of 1415 mL and a reduction of predicted GEDV by about 150 mL in female patients, appropriate adjustment for sex indexation should correct GEDVI for about 10 %. This is also in accordance with data from a study in elective neurosurgical patients [31] that demonstrated a nearly identical sex -specific difference in GEDVI of 131 mL. In addition to the impact of sex on GEDV, the strong impact of age on GEDV revealed in our study seems to be of high clinical relevance.…”

Simultaneous Confidence Bands for Penalized Spline Estimators

“…The GEDV represents a hypothetical measurement of the cardiac volume that assumes all four cardiac chambers to be in diastole simultaneously. Data on 101 patients has been collected one day after a brain tumor surgery, see Wolf et al (2009) for a detailed description of the data. One of the aims of the study was to characterize the dependence of GEDV on age for the population of patients.…”

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

“…29 These data from noncritically ill patients demonstrate surprising heterogeneity of values. Tagami et al recently defined a normal EVLWI of 7.3 ± 3.3 ml/kg in a human autopsy study showing that the proposed normal values of 3---7 ml/kg are possibly not appropriate for most clinical scenarios.…”