Abstract
Objective:
Although hypovolaemia is still the main cause of hemodynamic instability, uncritical volume can even harm the patient [1]. To this extent, postoperative volume management must be performed in cardiac and thoracic surgery patients.
Methods:
Transpulmonary thermodilution allows determination of volumetric parameters such as the intrathoracic blood volume (ITBV) and the global end-diastolic volume (GEDV) for the assessment of the cardiac preload. Alternatively, the so-called dynamic variables such as stroke volume variation (SVV), pulse pressure variation (PPV) and systolic pressure variation (SPV) are determined, which are determined from the arterial blood pressure curve [2] and do not require extended hemodynamic monitoring.
Results:SVV and PPV were significantly better able to predict the response of the heart to a volume than GEDV or CVP [3] postoperatively in cardiosurgical patients. A threshold of 12% for the SIA is for patients who are most likely to benefit from a volume.
Conclusion:
The minimally invasive dynamic variable (SVV, PPV) are more suitable for estimating the reactions of the organism to liquid doses,As volumetric variables (GEDV) obtained with the aid of transpulmonary thermodilution, as well as the classical filling pressures (CVP, PCWP). Therefore transpulmonary thermodilution appears to be dispensable for the control of volume therapy in the postoperative cardiac and thoracic surgical patients.
References:
1. Vincent JL et al. Crit Care Med 2006;3:344-353.
2. Michard F. Anesthesiology. 2005;103:419-428.
3. Hofer CK et al. Crit Care 2008;12:R82.
Although hypovolaemia is still the main cause of hemodynamic instability, uncritical volume can even harm the patient [1]. To this extent, postoperative volume management must be performed in cardiac and thoracic surgery patients.
Methods:
Transpulmonary thermodilution allows determination of volumetric parameters such as the intrathoracic blood volume (ITBV) and the global end-diastolic volume (GEDV) for the assessment of the cardiac preload. Alternatively, the so-called dynamic variables such as stroke volume variation (SVV), pulse pressure variation (PPV) and systolic pressure variation (SPV) are determined, which are determined from the arterial blood pressure curve [2] and do not require extended hemodynamic monitoring.
Results:SVV and PPV were significantly better able to predict the response of the heart to a volume than GEDV or CVP [3] postoperatively in cardiosurgical patients. A threshold of 12% for the SIA is for patients who are most likely to benefit from a volume.
Conclusion:
The minimally invasive dynamic variable (SVV, PPV) are more suitable for estimating the reactions of the organism to liquid doses,As volumetric variables (GEDV) obtained with the aid of transpulmonary thermodilution, as well as the classical filling pressures (CVP, PCWP). Therefore transpulmonary thermodilution appears to be dispensable for the control of volume therapy in the postoperative cardiac and thoracic surgical patients.
References:
1. Vincent JL et al. Crit Care Med 2006;3:344-353.
2. Michard F. Anesthesiology. 2005;103:419-428.
3. Hofer CK et al. Crit Care 2008;12:R82.
| Translated title of the contribution | Hemodynamic management of cardiac surgical intensive care patients: Transpulmonary thermodilution for the postoperative volume management of cardiac and thoracic surgery patients - Con |
|---|---|
| Original language | German |
| Article number | S607 |
| Number of pages | 1 |
| Journal | Anästhesiologie & Intensivmedizin |
| Volume | 50 |
| Issue number | suppl. 4 |
| Publication status | Published - 17-Sept-2009 |
| Externally published | Yes |
| Event | Der Hauptstadtkongress der DGAI für Anästhesiologie und Intensivtherapie - Berlin, Germany Duration: 17-Sept-2009 → 19-Sept-2009 Conference number: 11 |