Hemodynamic Monitoring by Double-Indicator Dilution Technique in Patients After Orthotopic Heart Transplantation

摘要

Study objectives: A transpulmonary thermal-dye dilution (TDD) technique using cold indocya-nnine green dye was utilized to monitor cardiac index (CI) and preload in patients after heartntransplantation. Preload, determined by intrathoracic blood volume index (ITBVI) and globalnend-diastolic volume index (GEDVI), was compared to central venous pressure (CVP) andnpulmonary artery occlusion pressure (PAOP) and was correlated with stroke volume index (SVI).nDesign: Prospective study.nSetting: Cardiac surgery ICU at a university hospital.nPatients: Forty patients (34 men, 6 women) with a mean (6 SD) age of 54.4 6 8.5 years afternorthotopic heart transplantation.nMeasurements and results: CI and preload measurements were performed with TDD andnpulmonary artery catheters in the ICU at 3, 6, 12, 24, 36, 48, and 72 h postoperatively. Thenfemoral artery CI was compared with the pulmonary artery CI. Changes in the ITBVI, GEDVI,nCVP, and PAOP were correlated with changes in the SVI. No difference was found between thenfemoral and pulmonary arterial CIs (r 5 0.98 [bias, 0.35 L/min/m2n]; p < 0.01). There was nonstatistically significant correlation between changes in the SVI and changes in CVP (r 520.23,)nand PAOP (r 520.06). However, the ITBVI (r 5 0.65; p < 0.01) and the GEDVI (r 5 0.73;np < 0.01) were significantly correlated to changes in the SVI. Changes in the same directionnoccurred between the SVI and the GEDVI as well as between the SVI and the ITBVI in 76.3% andn71.9% of patients, respectively, while CVP and PAOP also changed in the same direction as SVInin only 35.1% and 36.9% of patients, respectively.nConclusion: ITBVI and GEDVI are more reliable preload parameters than CVP and PAOP. Evennin denervated hearts, ITBVI and GEDVI show significant correlations with SVI. The transpul-nmonary indicator dilution technique is promising and should be investigated further.