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Aortic volume determines global end-diastolic volume measured by transpulmonary thermodilution
Intensive Care Medicine Experimental Pub Date : 2020-01-02 , DOI: 10.1186/s40635-019-0284-8
Aleksej Akohov 1 , Christoph Barner 1 , Steffen Grimmer 1, 2 , Roland Ce Francis 1 , Stefan Wolf 3
Affiliation  

BackgroundGlobal 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.MethodsWe retrospectively analyzed data from 88 critically ill patients with thermodilution monitoring and who did require a contrast-enhanced thoraco-abdominal computed tomography scan. Aortic volumes derived from imaging were compared with GEDV measurements in temporal proximity.ResultsMedian 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.ConclusionsOur 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.

中文翻译:

主动脉容积决定由经肺热稀释法测量的全球舒张末容积

背景通过经肺热稀释法测量的全球舒张末期容积 (GEDV) 被认为是心脏前负荷的指标。注入中央静脉的冷盐水推注穿过心脏和肺,但也穿过主动脉,直到在股动脉中检测到。虽然下腔静脉注射会产生更高的值是公认的,但主动脉容积对 GEDV 的影响尚不清楚。在这项研究中,我们假设更大的主动脉容积直接转化为数值更高的 GEDV 测量值。方法我们回顾性分析了来自 88 名接受热稀释监测且确实需要对比增强的胸腹计算机断层扫描的危重患者的数据。将来自成像的主动脉容积与时间接近度的 GEDV 测量值进行比较。结果中位主动脉容积为 194 ml(四分位距为 147 至 249 ml)。主动脉容积每增加毫升,我们发现 GEDV 增加 3.0 毫升(95% CI 2.0 至 4.1 毫升,p < 0.001)。如果股骨中心静脉线用于盐水推注,每毫升下腔静脉体积的 GEDV 额外增加 2.1 ml(95% CI 0.5 至 3.7 ml,p = 0.01)。主动脉容积解释了热稀释衍生的 GEDV 方差的 59.3%。当主动脉容积包含在多元回归中时,GEDV 方差不受性别、年龄、身高和体重的影响。结论我们的结果表明,对于使用经肺热稀释进行的 GEDV 测量,主动脉容积是一个重要的混杂变量。由于主动脉在解剖学上位于心脏之后,因此不应认为 GEDV 反映了心脏前负荷。
更新日期:2020-01-02
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