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Journal of Zhejiang University SCIENCE B
ISSN 1673-1581(Print), 1862-1783(Online), Monthly
2016 Vol.17 No.7 P.561-567
Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView®: do the same criteria apply as for the PiCCO®?
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®
方法:通过EV1000/VolumeView®设备对一例低容量休克患者(87岁,女性)进行经肺热稀释检测,分别通过颈内静脉和股静脉注射冰盐水指示剂,对所测得的两组数据进行对比,分析股静脉注射指示剂对全心舒张末容积指数(GEDVI)、血管外肺水指数(ELWI)、心指数(CI)、肺血管通透性指数(PVPI)和全心射血分数(GEF)等参数的影响。
结论:经股静脉注射指示剂同样会影响EV1000/VolumeView®设备所检测的热稀释数据,尤其会高估GEDVI和CI值,而PVPI和GEF也会受到影响,用适合PiCCO®的校正公式校正数据后则可以明显减少偏差。
(感谢浙江大学附属第二医院俞文桥主治医师提供中文概要)
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DOI:
10.1631/jzus.B1500244
CLC number:
R472
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On-line Access:
2024-08-27
Received:
2023-10-17
Revision Accepted:
2024-05-08
Crosschecked:
2016-06-20