Influence of an acute increase in systemic vascular resistance on transpulmonary thermodilution-derived parameters in critically ill patients

摘要: The transpulmonary thermodilution technique enables measurement of cardiac index (CI), intrathoracic blood volume (ITBV), global end-diastolic (GEDV), and extravascular lung water (EVLW). In this study, we analyzed the robustness during an acute increase in systemic vascular resistance (SVR). Prospective, clinical study. Surgical intensive care unit a university hospital. Twenty-four mechanically ventilated septic shock patients, who for indications underwent extended hemodynamic monitoring by continuously received norepinephrine. After baseline measurements, mean arterial pressure was increased briefly increasing norepinephrine dosage measurements were repeated before a control obtained. At each time point, 15 cc 0.9% saline (< 8 °C) administered central venous injection triplicate. Fluid status respirator adjustments kept constant. ANOVA with all-pairwise comparison method used statistical analysis. Heart rate, pressure, EVLW remained constant throughout, while SVR significantly changed from 551 ± 106 to 746 ± 91 dyn*s*cm−5 again 566 ± 138 dyn*s*cm−5 (p < 0.05). However, CI volumes showed a reversible significant increase, i.e., ITBV went 816 ± 203 867 ± 195 ml/m2 then 821 ± 205 ml/m2 GEDV 703 ± 178 747 ± 175 ml/m2 finally 704 ± 170 ml/m2, respectively. eight 2-D echocardiography applied revealed left-ventricular area. An results (ITBV, GEDV) as measured supported echocardiography.