Cp. Tousignant et al., The use of transesophageal echocardiography for preload assessment in critically ill patients, ANESTH ANAL, 90(2), 2000, pp. 351-355
Citations number
18
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
IV volume is often administered to patients in an intensive care unit (ICU)
to improve cardiovascular function. We investigated the relationship betwe
en stroke volume (SV) and left ventricular (LV) size by using transesophage
al echocardiography (TEE) in a population of 20 ICU patients and 21 postope
rative cardiac surgical patients. We also examined whether LV end diastolic
area (EDA), by TEE, could identify patients who increased SV by 20% or mor
e (responders) after 500 mL of pentastarch administration. There was only a
modest relationship (r = 0.60) between the EDA and the SV in all patients.
No relationship could be found between the pulmonary capillary wedge press
ure (PCWP) and the EDA in all patients. Both responder and nonresponder PCW
P increased significantly after volume administration. Only responder EDA i
ncreased significantly after volume administration. Responders had signific
antly lower EDA (15.3 +/- 5.4 cm(2)) and PCWP (12.2 +/- 2.2 mmHg) when comp
ared with nonresponders (20.2 +/- 4.8 cm(2)) and 15.9 +/- 3.1 mm Hg, respec
tively). Pew ICU patients and only those with a small EDA responded to volu
me administration. It was not possible to identify an overall optimal LV ED
A below which most patients demonstrate volume-recruitable increases in SV.
Implications: In a ventilated intensive care unit and cardiac surgical pop
ulation, transesophageal echocardiography and pulmonary artery catheter are
sensitive in detecting changes in preload after volume administration. Few
patients demonstrate volume-recruitable increases in stroke volume when co
mpared to cardiac surgical patients. It is not possible to establish an ove
rall end diastolic threshold below which a large proportion of ventilated p
atients respond to volume administration.