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Schuster H, Haller B, Sancak S, Erber J, Schmid RM, Lahmer T, Rasch S. Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:9876-9890. [PMID: 37322915 DOI: 10.3934/mbe.2023433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Transpulmonary thermodilution (TPTD) is usually performed by jugular indicator injection. In clinical practice, femoral venous access is often used instead, resulting in substantial overestimation of global end-diastolic volume index (GEDVI). A correction formula compensates for that. The objective of this study is to first evaluate the efficacy of the currently implemented correction function and then further improve this formula. METHODS The performance of the established correction formula was investigated in our prospectively collected dataset of 98 TPTD measurements from 38 patients with both, jugular and femoral venous access. Subsequently, a new correction formula was developed: cross validation revealed the favourite covariate combination and a general estimating equation provided the final version, which was tested in a retrospective validation on an external dataset. RESULTS Investigating the current correction function revealed a considerable reduction of bias compared to no correction. Concerning the objective of formula development, the covariate combination of GEDVI obtained after femoral indicator injection, age and body surface area is even favoured, when compared to the parameters of the previously published correction formula, as a further reduction of mean absolute error (68 vs. 61 ml/m2), a better correlation (0.90 vs. 0.91) and an increased adjusted R2 (0.72 vs 0.78) is noticed in the cross validation results. Of particular clinical importance is, that more measurements were correctly assigned to the same GEDVI category (decreased / normal / increased) using the revised formula, compared with the gold standard of jugular indicator injection (72.4 vs. 74.5%). In a retrospective validation, the newly developed formula showed a greater reduction of bias (to 2 vs. 6 %) than the currently implemented formula. CONCLUSIONS The currently implemented correction function partly compensates for GEDVI overestimation. Applying the new correction formula on GEDVI measured after femoral indicator administration enhances the informative value and reliability of this preload parameter.
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Affiliation(s)
- Hannah Schuster
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sengül Sancak
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johanna Erber
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Zhao Z, Zhang Z, Lin Q, Shen L, Wang P, Zhang S, Xia Z, Li F, Xing Q, Zhu B. Changes in the Cardiac Index Induced by Unilateral Passive Leg Raising in Spontaneously Breathing Patients: A Novel Way to Assess Fluid Responsiveness. Front Med (Lausanne) 2022; 9:862226. [PMID: 35479952 PMCID: PMC9035785 DOI: 10.3389/fmed.2022.862226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEvaluation of fluid responsiveness in intensive care unit (ICU) patients is crucial. This study was to determine whether changes in the cardiac index (CI) induced by a unilateral passive leg raising (PLR) test in spontaneously breathing patients can estimate fluid responsiveness.MethodsThis was a prospective study, and 40 patients with spontaneous breathing activity who were considered for volume expansion (VE) were included. CI data were obtained in a semirecumbent position, during unilateral PLR, bilateral PLR, and immediately after VE. If the CI increased more than 15% in response to the expansion in volume, patients were defined as responders.ResultsThe results showed that a unilateral PLR-triggered CI increment of ≥7.5% forecasted a fluid-triggered CI increment of ≥15% with 77.3% sensitivity and 83.3% specificity with and an area under the receiver operating characteristic (ROC) curve of 0.82 [P < 0.001]. Compared with that for bilateral PLR, the area under the ROC curve constructed for unilateral PLR-triggered changes in CI (ΔCI) was not significantly different (p = 0.1544).ConclusionΔCI >7.5% induced by unilateral PLR may be able to predict fluid responsiveness in spontaneously breathing patients and is not inferior to that induced by bilateral PLR.Trial RegistrationUnilateral passive leg raising test to assess patient volume responsiveness: Single-Center Clinical Study, ChiCTR2100046762. Registered May 28, 2021.
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Affiliation(s)
- Zhiyong Zhao
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhongwei Zhang
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qionghua Lin
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lihua Shen
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Pengmei Wang
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shan Zhang
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhili Xia
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangfang Li
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qian Xing
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Biao Zhu
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Biao Zhu ; orcid.org/0000-0002-5041-9630
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Zampieri FG, Cavalcanti AB. Slower vs Faster Intravenous Fluid Bolus Rates and Mortality in Critically Ill Patients-Reply. JAMA 2021; 326:2332. [PMID: 34905033 DOI: 10.1001/jama.2021.18545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fernando G Zampieri
- HCor Research Institute, Brazil Research in Intensive Care Medicine Network-BRICNet, São Paulo, Brazil
| | - Alexandre B Cavalcanti
- HCor Research Institute, Brazil Research in Intensive Care Medicine Network-BRICNet, São Paulo, Brazil
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Furtado S, Reis L. Inferior vena cava evaluation in fluid therapy decision making in intensive care: practical implications. Rev Bras Ter Intensiva 2019; 31:240-247. [PMID: 31271627 PMCID: PMC6649212 DOI: 10.5935/0103-507x.20190039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/09/2018] [Indexed: 01/03/2023] Open
Abstract
The fluid resuscitation of patients with acute circulatory failure aims to
increase systolic volume and consequently improve cardiac output for better
tissue oxygenation. However, this effect does not always occur because
approximately half of patients do not respond to fluids. The evaluation of fluid
responsiveness before their administration may help to identify patients who
would benefit from fluid resuscitation and avoid the risk of fluid overload in
the others. The dynamic parameters of fluid responsiveness evaluation are
promising predictive factors. Of these, the echocardiographic measurement of the
respiratory variation in the inferior vena cava diameter is easy to apply and
has been used in the hemodynamic evaluation of intensive care unit patients.
However, the applicability of this technique has many limitations, and the
present studies are heterogeneous and inconsistent across specific groups of
patients. We review the use of the inferior vena cava diameter respiratory
variation, measured via transthoracic echocardiography, to decide whether to
administer fluids to patients with acute circulatory failure in the intensive
care unit. We explore the benefits and limitations of this technique, its
current use, and the existing evidence.
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Affiliation(s)
- Sofia Furtado
- Departamento de Medicina Interna - Unidade 1.2, Hospital São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal.,Unidade de Urgência Médica, Hospital São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Luís Reis
- Unidade de Urgência Médica, Hospital São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
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