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Right Ventricular End-Diastolic Volume as a Predictor of the Hemodynamic Response to a Fluid Challenge

John G. Wagner; James W. Leatherman
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis


1998 by the American College of Chest Physicians


Chest. 1998;113(4):1048-1054. doi:10.1378/chest.113.4.1048
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Abstract

Objective: To compare thermodilution right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery occlusion pressure (Ppao) as predictors of the hemodynamic response to a fluid challenge.

Design: Prospective cohort study.

Setting: Medical ICU of a university-affiliated county hospital and medical-surgical ICU of a community hospital.

Patients: Twenty-five critically ill patients who had one or more clinical conditions that suggested the possibility of inadequate preload.

Interventions: Thirty-six fluid challenges. Fluid (saline or colloid) was administered rapidly until the Ppao rose by at least 3 mm Hg. When a patient underwent more than one fluid challenge, these were given on separate days and for different clinical indications.

Measurements and Results: Responders (n=20; ≥10% increase in stroke volume [SV]) and nonresponders (n=16; <10% increase in SV) differed with respect to baseline Ppao (10.0±3.4 vs 14.2±3.6 mm Hg; p=0.001), but not with respect to baseline RVEDVI (105±31 vs 119±33 mL/m2; p=0.22). There was a moderate correlation between RVEDVI and fluid-induced change in SV (r=0.44); the relationship between Ppao and change in SV was stronger (r=0.58). A positive response to fluid was observed in 4 of 9 cases in which RVEDVI exceeded 138 mL/m2, a threshold value that has been suggested to reliably predict a poor response to fluid.

Conclusion: RVEDVI was not a reliable predictor of the response to fluid. As a predictor of fluid responsiveness, Ppao was superior to RVEDVI. In an individual patient, adequacy of preload is best assessed by an empiric fluid challenge.


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