Intensive Care Medicine

, Volume 26, Issue 2, pp 180–187 | Cite as

Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution

  • S. G. Sakka
  • C. C. Rühl
  • U. J. Pfeiffer
  • R. Beale
  • A. McLuckie
  • K. Reinhart
  • A. Meier-Hellmann

Abstract

Objective: Transpulmonary double-indicator dilution is a useful monitoring technique for measurement of intrathoracic blood volume (ITBV) and extravascular lung water (EVLW). In this study, we compared a simpler approach using single arterial thermodilution derived measurements of ITBV and EVLW with the double-indicator dilution technique.¶Design: Prospective observational clinical study.¶Setting: Surgical intensive care units of two university hospitals.¶Patients and methods: Global end-diastolic volume (GEDV) derived from single thermodilution was used for calculation of ITBV. Structural regression analysis of the first two thermo-dye dilution measurements in a derivation population of 57 critically ill patients (38 male, 19 female, 18–79 years, 56 ± 15 years) revealed ITBV = (1.25 · GEDV)–28.4 (ml). This equation was then applied to all first measurements in a validation population of 209 critically ill patients (139 male, 70 female, 10–88 years, mean 53 ± 19 years), and single-thermodilution ITBV (ITBVST) and EVLW (EVLWST) was calculated and compared to thermo-dye dilution derived values (ITBVTD, EVLWTD). For inter-individual comparison, absolute values for ITBV and EVLW were normalised as indexed by body surface area (ITBVI) and body weight (EVLWI), respectively.¶Measurements and results: Linear regression analysis yielded a correlation of ITBVIST = (1.05 · ITBVITD)–58.0 (ml/m2), r = 0.97, P < 0.0001. Bias between ITBVITD and ITBVIST was 7.6 (ml/m2) with a standard deviation of 57.4 (ml/m2). Single-thermodilution EVLWI (EVLWIST) was calculated using ITBVIST and revealed the correlation EVLWIST = (0.83 · EVLWITD) + 1.6 (ml/kg), r = 0.96, P < 0.0001. Bias between EVLWITD and EVLWIST was –0.2 (ml/kg) with a standard deviation of 1.4 (ml/kg). In detail, EVLWIST systematically overestimated EVLWITD at low-normal values for EVLWI and underestimated EVLWI at higher values (above 12 ml/kg).¶Conclusion: Determinations of ITBV and EVLW by single thermodilution agreed closely with the corresponding values from the double-indicator technique. Since transpulmonary single thermodilution is simple to apply, less invasive and cheaper, all these features make it a promising technique for the bedside. Nevertheless, further validation studies are needed in the future.

Key words Intrathoracic blood volume Extravascular lung water Double-indicator dilution technique Thermodilution 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • S. G. Sakka
    • 1
  • C. C. Rühl
    • 3
  • U. J. Pfeiffer
    • 4
  • R. Beale
    • 2
  • A. McLuckie
    • 2
  • K. Reinhart
    • 1
  • A. Meier-Hellmann
    • 1
  1. 1.Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Bachstrasse 18, 07 740 Jena, Germany e-mail: Meier-Hellmann@anae1.med. uni-jena.de Tel.: + 49-36 41-93 30 41 Fax: + 49-36 41-93 32 56DE
  2. 2.Department of Intensive Care Medicine, Guy's Hospital, London, UKGB
  3. 3.Institute for Experimental Surgery, Technical University of Munich, Munich, GermanyDE
  4. 4.Technical University of Munich and Pulsion Medical Systems AG, Munich, GermanyDE

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