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

Global End-Diastolic Volume as an Indicator of Cardiac Preload in Patients With Septic Shock,Frederic Michard,Sami Alaya,Veronique Zarka,Mabrouk Bahlo

Global End-Diastolic Volume as an Indicator of Cardiac Preload in Patients With Septic Shock   (Citations: 45)
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from 10 4t o 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 3m m 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. (CHEST 2003; 124:1900 -1908)
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    • ...Preclinical Tests of Adsorber ColumnsPreceding the clinical use, biocompatibility and adsorption capacity of the adsorber materials had been evaluated in several in vitro experiments. Static adsorption experiments with plasma derived from donated citrate anticoagulated whole blood were performed at 37°C. 50 mg adsorbents were incubated with 1 ml plasma spiked with various amounts of Escherichia coli endotoxin (BioWhittaker, Inc., Walkersville, Md., USA). After 2 h incubation, equilibrium endotoxin concentrations were measured in the supernatant using the chromogenic Limulus amebocyte lysate test (Charles River Endosafe, Inc.) as previously described [,...

    Andreas Umgelteret al. Treatment of Septic Patients with an Arginine-Based Endotoxin Adsorber...

    • ...Now, in patients receiving mechanical ventilation, it has been demonstrated that in patients who responded to volume resuscitation, the GEDV was lower than in nonresponders and that the lowest the preinfusion GEDV, the more likely the positive hemodynamic response [17]...
    • ...However, GEDV values of responders and nonresponders overlapped and no cut-off value could identify responders and nonresponders with high sensitivity and specificity values [17]...
    • ...In this regard, in the study by Michard et al [17] (in patients receiving mechanical ventilation), the rate of positive response to fluid was markedly higher (77 %) in the subgroup of patients with low GEDV index values (< 610 mL/m2) in comparison with the subgroup of patients with intermediate GEDV index values (between 610 and 815 mL/m2) and the subgroup of patients with high GEDV index values (> 815 mL/m2) (rate of response: 43 % ...
    • ...Interestingly, the all four patients with GEDV index < 500 mL/m2 responded to volume loading while all five patients with GEDV index > 950 mL/m2 did not respond to volume loading [17]...
    • ...In this regard, in the study by Michard et al [17], the percentage of positive response to fluid was very low in the subgroup of patients with high GEDV index values (> 850 mL/m2)...

    Hotel Méridien Etoile. Haemodynamic monitoring in shock and implications for management

    • ...In later analyses this was compared with the invasively obtained value for GEDVI, which has been used as a surrogate for volume status [5, 6]. Normal GEDVI for a comparable paediatric population, which included 48 patients, was defined as 390–590 ml/ m2 [7], which was considered as euvolaemia for the purposes of comparison...
    • ...ITBVI is closely related to GEDVI, and the relationship between them is linear; both have been used in comparison to “preload” or “volume status” in adult and paediatric studies [5, 6, 8]. Both GEDVI and ITBVI have been shown to increase in response to volume loading [5, 6]...
    • ...ITBVI is closely related to GEDVI, and the relationship between them is linear; both have been used in comparison to “preload” or “volume status” in adult and paediatric studies [5, 6, 8]. Both GEDVI and ITBVI have been shown to increase in response to volume loading [5, 6]...

    Jonathan R. Eganet al. Clinical assessment of cardiac performance in infants and children fol...

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