Abstract: Objective: Comparison of global end-diastolic volume index (GEDVI) obtained by femoral and jugular transpulmonary thermodilution (TPTD) indicator injections using the EV1000/VolumnView^® device (Edwards Lifesciences, Irvine, USA). Methods: In an 87-year-old woman with hypovolemic shock and equipped with both jugular and femoral vein access and monitored with the EV1000/VolumeView^® device, we recorded 10 datasets, each comprising duplicate TPTD via femoral access and duplicate TPTD (20 ml cold saline) via jugular access. Results: Mean femoral GEDVI ((674.6±52.3) ml/m²) was significantly higher than jugular GEDVI ((552.3±69.7) ml/m²), with P=0.003. Bland-Altman analysis demonstrated a bias of (+122±61) ml/m², limits of agreement of −16 and +260 ml/m², and a percentage error of 22%. Use of the correction-formula recently suggested for the PiCCO^® device significantly reduced bias and percentage error. Similarly, mean values of parameters derived from GEDVI such as pulmonary vascular permeability index (PVPI; 1.244±0.101 vs. 1.522±0.139; P<0.001) and global ejection fraction (GEF; (24.7±1.6)% vs. (28.1±1.8)%; P<0.001) were significantly different in the case of femoral compared to jugular indicator injection. Furthermore, the mean cardiac index derived from femoral indicator injection ((4.50±0.36) L/(min·m²)) was significantly higher (P=0.02) than that derived from jugular indicator injection ((4.12±0.44) L/(min·m²)), resulting in a bias of (+0.38±0.37) L/(min·m²) and a percentage error of 19.4%. Conclusions: Femoral access for indicator injection results in markedly altered values provided by the EV1000/VolumeView^®, particularly for GEDVI, PVPI, and GEF.

Key words: Hemodynamic monitoring, Transpulmonary thermodilution, Central venous catheter, Femoral vein, Jugular vein, Global end-diastolic volume, EV1000/VolumeView^®, PiCCO^®

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