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Clinical Investigations in Critical Care |

Goal-Directed Therapy of Cardiac Preload in Induced Whole-Body Hyperthermia*

Maria Deja, MD; Bert Hildebrandt, MD; Olaf Ahlers, MD; Hanno Riess, MD; Peter Wust, MD; Herwig Gerlach, MD; Thoralf Kerner, MD
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*From the Departments of Anesthesiology and Critical Care Medicine (Drs. Deja, Ahlers, and Kerner) and Radiology (Dr. Wust), Medical Clinic for Hematology and Oncology (Drs. Hildebrandt and Riess), Charité Medical Center, Campus Virchow-Clinic, Humboldt-University, Berlin, Germany; and the Department of Anesthesiology, Critical Care Medicine and Pain Management (Dr. Gerlach), Vivantes-Klinikum Neukölln, Berlin, Germany.

Correspondence to: Maria Deja, MD, Department of Anesthesiology and Critical Care Medicine, Charité Medical Center, Campus Virchow-Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; e-mail: maria.deja@charite.de



Chest. 2005;128(2):580-586. doi:10.1378/chest.128.2.580
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Objectives: To optimize volume therapy during induced whole-body hyperthermia (WBH) ≤ 42.2°C, pulmonary capillary wedge pressure (PCWP) and intrathoracic blood volume index (ITBVI) were compared as goal parameters.

Design: Prospective clinical study.

Setting: ICU at university hospital.

Patients: Twenty-three patients with metastatic cancers.

Interventions: Radiant WBH in combination with induced hyperglycemia, hyperoxemia, and chemotherapy was applied. Volume therapy was directed to the PCWP (group A, 8 to 12 mm Hg [20 treatments]), or to ITBVI (group B, 800 to 1,100 mL/m2 [19 treatments]) following a standardized protocol. Goals other than PCWP and ITBVI were cardiac index of > 3.5 L/min/m2 and mean arterial pressure of > 55 mm Hg.

Measurements and results: In addition to the primary goals PCWP and ITBVI, at defined temperatures, central venous pressure (CVP), extravascular lung water index, the number of infusions, and packed RBCs, as well as serum lactate level, norepinephrine dosage, and levels of liver enzymes, bilirubin, creatinine, and urea were measured. Patients in group A received a significantly greater mean (± SD) amount of crystalloids compared to those in group B (6,175 ± 656 vs 3,947 ± 375 mL, respectively) and required significantly lower dosages of vasoconstrictors compared with patients in group B. Except for the lower values of CVP in patients in group A during hyperthermia, all of the other hemodynamic and laboratory parameters showed no significant differences between the groups or stayed in a normal range.

Conclusion: PCWP and ITBVI are useful parameters to assess preload in induced WBH. Differences in crystalloids and vasopressor dosages may suggest an appropriate ITBVI of > 1,100 mL/m2 for patients with good cardiopulmonary health under such extremely hypercirculatory conditions.

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