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Clinical Investigations in Critical Care |

Global End-Diastolic Volume as an Indicator of Cardiac Preload in Patients With Septic Shock*

Frédéric Michard; Sami Alaya; Véronique Zarka; Mabrouk Bahloul; Christian Richard; Jean-Louis Teboul
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*From the Medical Intensive Care Unit, Bicêtre Hospital, University Paris XI, France.

Correspondence to: Frédéric Michard, MD, PhD, Service de Réanimation Médicale, CHU de Bicêtre, 78 rue du Général Leclerc, 94275, le Kremlin-Bicêtre cedex, France; e-mail: michard.frederic@free.fr



Chest. 2003;124(5):1900-1908. doi:10.1378/chest.124.5.1900
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Study objective: To assess the value of the global end-diastolic volume (GEDV) evaluated by transpulmonary thermodilution as an indicator of cardiac preload.

Design: Prospective clinical study.

Setting: Medical ICU of a university hospital (20 beds).

Patients: Thirty-six patients with septic shock.

Interventions: Volume loading and dobutamine infusion.

Measurements and results: Hemodynamic parameters were evaluated in triplicate by the transpulmonary thermodilution technique: (1) before and after 66 fluid challenges in 27 patients, and (2) before and after 28 increases in dobutamine infusion rate in 9 patients. Volume loading induced a significant (p < 0.001) increase in central venous pressure (CVP) from 10 ± 4 to 13 ± 4 mm Hg, in GEDV index from 711 ± 164 to 769 ± 144 mL/m2, in stroke volume index (SVI) from 36 ± 12 to 42 ± 12 mL/m2, and in cardiac index (CI) from 3.4 ± 1.1 to 3.9 ± 1.2 L/min/m2 (mean ± SD). Changes in GEDV index were correlated (r = 0.72, p < 0.001) with changes in SVI, while changes in CVP were not. The increase in SVI was > 15% in 32 of 66 instances (positive response). The preinfusion GEDV index was lower (637 ± 134 mL/m2 vs 781 ± 161 mL/m2, p < 0.001) in the cases of positive response, and was negatively correlated with the percentage increase in GEDV index (r = − 0.65, p < 0.001) and in SVI (r = − 0.5, p < 0.001). Dobutamine infusion induced an increase in SVI (32 ± 11 mL/m2 vs 35 ± 12 mL/m2, p < 0.05) and in CI (2.8 ± 0.6 L/min/m2 vs 3.2 ± 0.6 L/min/m2, p < 0.001) but no significant change in CVP (13 ± 3 mm Hg vs 13 ± 3 mm Hg) and in GEDV index (823 ± 221 mL/m2 vs 817 ± 202 mL/m2).

Conclusion: In patients with septic shock, our findings demonstrate that, in contrast to CVP, the transpulmonary thermodilution GEDV index behaves as an indicator of cardiac preload.

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