Assessing fluid responses after coronary surgery: role of mathematical coupling of global end-diastolic volume to cardiac output measured by transpulmonary thermodilution.

摘要

BACKGROUND: Mathematical coupling may explain in part why cardiac filling volumes obtained by transpulmonary thermodilution may better predict and monitor responses of cardiac output to fluid loading than pressures obtained by pulmonary artery catheters (PACs). METHODS: Eleven consecutive patients with hypovolaemia after coronary surgery and a PAC, allowing central venous pressure (CVP) and continuous cardiac index (CCIp) measurements, received a femoral artery catheter for transpulmonary thermodilution measurements of global end-diastolic blood volume index (GEDVI) and cardiac index (CItp). One to five colloid fluid-loading steps of 250 ml were done in each patient (n = 48 total). RESULTS: Fluid responses were predicted and monitored similarly by CItp and CCIp, whereas CItp and CCIp correlated at r = 0.70 (P < 0.001) with a bias of 0.40 l min(-1) m(-2). Changes in volumes (and not in CVP) related to changes in CItp and not in CCIp. Changes in CVP and GEDVI similarly related to changes in CItp, after exclusion of two patients with greatest CItp outliers (as compared to CCIp). Changes in GEDVI correlated better to changes in CItp when derived from the same thermodilution curve than to changes in CItp of unrelated curves and changes in CCIp. CONCLUSIONS: After coronary surgery, fluid responses can be similarly assessed by intermittent transpulmonary and continuous pulmonary thermodilution methods, in spite of overestimation of CCIp by CItp. Filling pressures are poor monitors of fluid responses and superiority of GEDVI can be caused, at least in part, by mathematical coupling when cardiac volume and output are derived from the same thermodilution curve.