Critical Care: Critical Care |

Unusual High Global End Diastolic Index Associated With Optimal Cardiac Index in Special Critically Ill Patients FREE TO VIEW

Duan Jun, MD; Li Gang, MD
Author and Funding Information

China-Japan Friendship Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A138. doi:10.1016/j.chest.2016.02.144
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SESSION TITLE: Critical Care

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: The optimal management of hemodynamic disorders among critically ill patients requires an accurate assessment of hemodynamic status. Global end diastolic index (GEDI) is taken for a more reliable indicator of preload in critically ill patients than CVP and doctors tend to arrange it among the normal ranges (680~800 ml/m2). Here we report a case with a relatively extremely high GEDI that initially erroneously led to a fluid restrictive treatment.

CASE PRESENTATION: An 83 year man was admitted to the ICU for dyspnea and severe hypoxemia following inefficient antibiotics treatment of bilateral pneumonia in emergency room. Failed with NPPV, He was intubated and PiCCO system was installed. Result shows extremely high GEDI 1620 ml/m2, therefore CRRT was initiated for negative fluid balance. When GEDI was reduced below 1300 ml/m2, CI decreased simultaneously. According to the Frank-Starling curve, GEDI of 1300 ml/m2 was seemed as being associated with a maximal CI for the patient. Next chest roentgenogram and abdomen CT scan showed three aneurysms which were responsible for the extremely high GEDI values.

DISCUSSION: In principle, volumetric parameter like GEDI and ITBI, are calculated by mean transit time (MTT) in Newman model, which may change in special clinical situation. Three great aneurysms of the case were responsible for the extremely high GEDI values obviously due to longer MTT. In such case, ventricular function curve will be useful and recommended to assess the individually most appropriate GEDI.

CONCLUSIONS: The knowledge of the extremely high GEDI allows a fully understanding of the optimal preload which match with the optimal cardiac output, and will also help doctors to make the right therapeutic decision.

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Reference #2: Michard F, Alaya S, Zarka V, et al. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 2003;124:1900-8.

Reference #3: Newman EV, Merrell M, Genecin A, et al. The dye dilution method for describing the central circulation: an analysis of factors shaping the time-concentration curves. Circulation 1951;4:735-46.

DISCLOSURE: The following authors have nothing to disclose: Duan Jun, Li Gang

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