CORSO TEORICO-PRATICO

NAPOLI 9-10 GIUGNO 2005

La Termodiluizione Transpolmonare ed I

Volumi in Anestesia e Rianimaizone

Prof Giorgio Della Rocca

Clinica di Anestesia e Rianimazione

APUGD (Azienda Policlinico Universitario a Gestione Diretta)

University of Udine. Udine, Italy

Iced Versus Room Temperature Injectate for Assessment of

Cardiac Output, Intrathoracic Blood Volume, and Extravascular

lung Water by Single Transpulmonary ThermodilutionP Faybik, H Hetz, A Baker, E Yankovskaya, CG Krenn andf H Steltzer

15 critically ill pts

Surgical Intensive Care Unit

PiCCO System

Triplicate STPD with a 20 mL of Room Temperature and

iced saline solution

Septic shock 8

Pancreatitis 2

Acute liver failure 2

OLTx 1

J Crit Care 2004; 19(2):103-7

J Crit Care 2004; 19(2):103-7

144 data pairs

ITBVI r=0.91 bias -4.9 2SD 194 mL m-2 EVLWI r=0.97 bias -0.535 2SD 1.5 mL kg-1

CI r=0.95 bias -0.2 2SD 0.7 L min-1 m-2

Reliability of a new algorithm for continuous cardiac output

determination by pulse-contour analysis during hemodynamic

instabilityO Godje, K Hoke, AE Goetz, TW Felbinger, DA Reuter, B Reichart, R Frield, A Hannekum, UJ Pfeiffer

Wesseling Algorithm New Algorithm

COPCnew= HR · Asys/Zao

Where Zao = SVpc/SVtd

Crit Care Med 2002; 30(1): 52-8

Wesseling Algorithm New Algorithm

Crit Care Med 2002; 30(1): 52-8

Reliability of a new algorithm for continuous cardiac output

determination by pulse-contour analysis during hemodynamic

instabilityO Godje, K Hoke, AE Goetz, TW Felbinger, DA Reuter, B Reichart, R Frield, A Hannekum, UJ Pfeiffer

CONCLUSIONS

Pulse contour cardiac output measurements provides an

easy and reliable method for the continuous monitoring of

cardiac output in critically ill patients.

Crit Care Med 2002; 30(1): 52-8

Intra Thoracic Blood Volume:preload?

Clinical application-Preload

ITBV TBV

ITBV

3=

ITBV = 1.25*GEDV

Preload index: PAOP versus intrathoracic blood volume

monitoring during lung transplantation

G Della Rocca, MG Costa, C Coccia, L Pompei, P Di Marco, P Pietropaoli

r2= 0.41 p<0.0001

0 10 20 30 40 50 60 70 800

500

1000

1500

SVIpa (mL m-2)

ITB

VI (

mL

m-2

)

0 10 20 30 40 50 60 70 800

10

20

30

40

SVIpa (mL m-2)

PAO

P (m

mH

g)

r2= - 0.01 ns

Anesth Analg 2002; 95: 835-43

ITBVI: misinterpretations

• Huge aneurismatic lesions strongly increase

ITBVI

• ITBV indicates the amount of “central blood” and

you have to give a clinical meaning in “that”

patient

(i. e. ITBVI = 1600 ml/m2:

hyperdinamic state or cardiac failure?)

EVLW was significantly higher in NS than in S

15.6±7.8ml/kg [median, 14.3] vs 12.2±6.4ml/kg [median 10.2]

Prognostic Values of Extravascular Lung Water

in Critically Ill patients

SG Sakka, M Klein, K Reinhart, A Meier-Hellman

Chest 2002; 122:2080-2086

Extravascular lung water in patients with severe sepsis:

a prospective cohort studyGS Martin, S Eaton, M Mealer, M Moss

1. The majority of severe sepsis pts have increased amounts

of EVLW including those who do not meet clinical criteria

definig ARDS

2. Increased EVLW is associated with worse survival in

patients with severe sepsis and viceversa

3. Chronic alcohol abuse is associated with increased

quantities of EVLW (alveolar-capillary barrier

dysfunction?)

Critical Care 2005; 9(2):R74-R82

SVV: The percentage of variations among the

max and the min Stroke Volumes on the mean of

the min and the max during 12 sec of measure

AP

t

Stroke volume variation

Pulse pressure variation (PPV)

∆PP(%)=100*[(PPmax-PPmin)/(PPmax+PPmin)]:2

PP= APsyst - APdiast

PP

Assessing fluid-responsiveness by a standardized ventilatory

maneuver: The respiratory systolic variation testA Perel, L Minkovich, S Preisman, M Abiad, E Segal, P Coriat

Schematic representation of the respiratory Systolic Variation Test (RSVT) maneuver.

The smallest 4 systolic pressure values (identified by the x) are plotted against their respectiveairway pressures to obtain the slopeof the RSVT (mmHg/cmH20).

Anesth Analg 2005; 100: 942-5

Assessing fluid-responsiveness by a standardized ventilatory

maneuver: The respiratory systolic variation testA Perel, L Minkovich, S Preisman, M Abiad, E Segal, P Coriat

1. The AUC (ROC) for a ≥15 change of CI: PAOP = 0.771

(95% CI, 0.486-1.055), EDAI = 0.875 (95% CI, 0.683-

1.067), and RSVT = 0.896 (95% CI, 0.726-1.065)

2. RSVT value ≥ 0.24 mmHg/cmH2O predicted a change

≥15% in CI with a sensitivity of 87.5% and a

specificity of 83%.

3. EDAI value≤10.2 cm2/m2 predicted a change ≥15% in

CI with a sensitivity of 87.5% and a specificity of 67%.

Anesth Analg 2005; 100: 942-5