Global End-Diastolic Volume as an Indicator of Cardiac Preload in Patients With Septic Shock *

Michard, Frédèric; Alaya, Sami; Zarka, Véronique; Bahloul, Mabrouk; Richard, Christian; Teboul, Jean‐Louis

doi:10.1378/chest.124.5.1900

Cited by 316 publications

(157 citation statements)

References 41 publications

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“…However, there is data demonstrating a poor capacity of CVP to predict the hemodynamic response to a fluid challenge [13]. Regarding more invasive techniques, transpulmonary thermodilution and pulse contour analysis are established for assessment of cardiac index, preload, volume responsiveness and pulmonary hydration [14-16]: Besides cardiac index, these techniques provide volumetric parameters such as GEDVI as well as dynamic variables of preload such as SVV for the assessment of volume responsiveness. The use of dynamic variables of preload is restricted to patients with sinus rhythm and controlled ventilation.…”

Section: Resultsmentioning

confidence: 99%

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Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management

Saugel

Umgelter

Fortin

et al. 2010

Scandinavian Journal of Trauma, Resuscitation and Emergency Med

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Systemic Capillary Leak Syndrome (SCLS) is a rare disorder characterized by increased capillary hyperpermeability leading to hypovolemic shock due to a markedly increased shift of fluid and protein from the intravascular to the interstitial space. Hemoconcentration, hypoalbuminemia and a monoclonal gammopathy are characteristic laboratory findings. Here we present a patient who suffered from SCLS with hypovolemic shock and compartment syndrome of both lower legs and thighs. Volume and catecholamine management was guided using transpulmonary thermodilution. Extended hemodynamic monitoring for volume and catecholamine management as well as monitoring of muscle compartment pressure is of crucial importance in SCLS patients.

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Section: Resultsmentioning

confidence: 99%

“…In numerous studies transpulmonary thermodilution-derived dynamic and volumetric variables of preload have been demonstrated as superior indicators of volume responsiveness as compared to pressures such as pulmonary artery wedge pressure and central venous pressure [14,18,19]. …”

Section: Resultsmentioning

confidence: 99%

Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management

Saugel

Umgelter

Fortin

et al. 2010

Scandinavian Journal of Trauma, Resuscitation and Emergency Med

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“…The volumetric indicators of cardiac preload are mainly the right ventricular end-diastolic volume (RVEDV), which is evaluated by specific pulmonary artery catheters; [17][18][19] the left ventricular end-diastolic area (LVEDA), which is measured by transthoracic or transesophageal echocardiography; 20 and the global end-diastolic volume (GEDV) and intrathoracic blood volume (ITBV), which are evaluated by transpulmonary thermodilution. [21][22][23][24] Several studies have demonstrated that these volumetric parameters can be useful for predicting fluid responsiveness-but only when they are very low or very high. 17,18,24 For example, it has been shown that the rate of positive response to a fluid challenge is high when the RVEDV index is below 90 mL/m 2 , but low when the RVEDV index is greater than 140 mL/m 2 .…”

Section: Static Indicators Of Cardiac Preload and Fluid Responsivenessmentioning

confidence: 99%

“…[21][22][23][24] Several studies have demonstrated that these volumetric parameters can be useful for predicting fluid responsiveness-but only when they are very low or very high. 17,18,24 For example, it has been shown that the rate of positive response to a fluid challenge is high when the RVEDV index is below 90 mL/m 2 , but low when the RVEDV index is greater than 140 mL/m 2 . 17,18 Similar findings have been recently reported with the GEDV index, which reflects the volume of blood contained in the 4 heart chambers during diastole.…”

Section: Static Indicators Of Cardiac Preload and Fluid Responsivenessmentioning

confidence: 99%

Volume Management in Critically Ill Patients: New Insights

Lopes

Auler

Michard

2006

Clinics

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Lopes MR, Auler JOC, Michard F. Volume management in critically ill patients: new insights. Clinics. 2006;61(4):345-50.In order to turn a fluid challenge into a significant increase in stroke volume and cardiac output, 2 conditions must be met: 1) fluid infusion has to significantly increase cardiac preload and 2) the increase in cardiac preload has to induce a significant increase in stroke volume. In other words, a patient can be nonresponder to a fluid challenge because preload does not increase during fluid infusion or/and because the heart (more precisely, at least 1 of the ventricles) is operating on the flat portion of the Frank-Starling curve. Volumetric markers of cardiac preload are therefore useful for checking whether cardiac preload effectively increases during fluid infusion. If this is not the case, giving more fluid, using a venoconstricting agent (to avoid venous pooling), or reducing the intrathoracic pressure (to facilitate the increase in intrathoracic blood volume) may be useful for achieving increased cardiac preload. Arterial pulse pressure variation is useful for determining whether stroke volume can/will increase when preload does increase. If this is not the case, only an inotropic drug can improve cardiac output. Therefore, the best option for determining the usefulness of, and monitoring fluid therapy in critically ill patients is the combination of information provided by the static indicators of cardiac preload and arterial pulse pressure variation.

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“…Hypovolemic patients with decreased cardiac preload present with lower values of GEDVI and are more likely to respond to a volume challenge with a significant increase in CO. 6 Because of decreased invasiveness compared to pulmonary artery catheterization, and its greater operator-independency compared to echocardiography, the method has gained increasing acceptance over the last decade among physicians for determining cardiac output and preload and is made commercially available by Pulsion Medical Systems (Munich, Germany). 7,8 Also available, the LiDCO plus uses lithium for calibration and provides a reliable CO monitoring (LiDCO, Cambridge, UK).…”

Section: Introductionmentioning

confidence: 99%

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

Eichhorn

Goepfert

Eulenburg

et al. 2012

Medicina Intensiva (English Edition)

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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...

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Global End-Diastolic Volume as an Indicator of Cardiac Preload in Patients With Septic Shock *

Cited by 316 publications

References 41 publications

Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management

Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management

Volume Management in Critically Ill Patients: New Insights

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

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