Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheterReport as inadecuate




Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheter - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 14:R95

First Online: 25 May 2010Received: 19 January 2010Revised: 25 March 2010Accepted: 25 May 2010

Abstract

IntroductionAdvanced hemodynamic monitoring using transpulmonary thermodilution TPTD is established for measurement of cardiac index CI, global end-diastolic volume index GEDVI and extra-vascular lung water index EVLWI. TPTD requires indicator injection via a central venous catheter usually placed via the jugular or subclavian vein. However, superior vena cava access is often not feasible due to the clinical situation. This study investigates the conformity of TPTD using femoral access.

MethodsThis prospective study involved an 18-month trial at a medical intensive care unit at a university hospital. Twenty-four patients with both a superior and an inferior vena cava catheter at the same time were enrolled in the study.

ResultsTPTD-variables were calculated from TPTD curves after injection of the indicator bolus via jugular access TPTDjug and femoral access TPTDfem. GEDVIfem and GEDVIjug were significantly correlated rm = 0.88; P < 0.001, but significantly different 1,034 ± 275 vs. 793 ± 180 mL-m; P < 0.001. Bland-Altman analysis demonstrated a bias of +241 mL-m limits of agreement: -9 and +491 mL-m. GEDVIfem, CIfem and ideal body weight were independently associated with the bias GEDVIfem-GEDVIjug. A correction formula of GEDVIjug after femoral TPTD, was calculated. EVLWIfem and EVLWIjug were significantly correlated rm = 0.93; P < 0.001. Bland-Altman analysis revealed a bias of +0.83 mL-kg limits of agreement: -2.61 and +4.28 mL-kg. Furthermore, CIfem and CIjug were significantly correlated rm = 0.95; P < 0.001. Bland-Altman analysis demonstrated a bias of +0.29 L-min-m limits of agreement -0.40 and +0.97 L-min-m; percentage-error 16%.

ConclusionsTPTD after femoral injection of the thermo-bolus provides precise data on GEDVI with a high correlation, but a self-evident significant bias related to the augmented TPTD-volume. After correction of GEDVIfem using a correction formula, GEDVIfem shows high predictive capabilities for GEDVIjug. Regarding CI and EVLWI, accurate TPTD-data is obtained using femoral access.

AbbreviationsBWbody weight

CIcardiac index

CIfemcardiac index after femoral injection of the indicator bolus

CIjugcardiac index after jugular injection of the indicator bolus

CVCcentral venous catheter

CVPcentral venous pressure

EVLWextra-vascular lung water

EVLWIextra-vascular lung water index

EVLWIfemextra-vascular lung water index after femoral injection of the indicator bolus

EVLWIjugextra-vascular lung water index after jugular injection of the indicator bolus

GEDVglobal end-diastolic volume

GEDVIglobal end-diastolic volume index

GEDVIfemglobal end-diastolic volume index after femoral injection of the indicator bolus

GEDVIjugglobal end-diastolic volume index after jugular injection of the indicator bolus

GEEgeneral estimation equation

IBWideal body weight

ICUintensive care unit

ITTVintrathoracic thermal volume

NPVnegative predictive value

PBVpulmonary blood volume

PPVpositive predictive value

PTVpulmonary thermovolume

rmSpearman correlation coefficient

RMSCVroot mean square coefficient of variation

SAPS IISimplified Acute Physiology Score II

SDstandard deviation

SEstandard error

SVVstroke volume variation

TPTDtranspulmonary thermodilution

TDTDfemtranspulmonary thermodilution variable after femoral injection of the indicator bolus

TDTDjugtranspulmonary thermodilution variable after jugular injection of the indicator bolus

TISSTherapeutic Intervention Scoring System.

Electronic supplementary materialThe online version of this article doi:10.1186-cc9030 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Author: Bernd Saugel - Andreas Umgelter - Tibor Schuster - Veit Phillip - Roland M Schmid - Wolfgang Huber

Source: https://link.springer.com/







Related documents