Volume 5 Supplement 1

21st International Symposium on Intensive Care and Emergency Medicine

Open Access

Hemodynamics changes induced by volume expansion measured by PiCCO® system: the post-expansion effect

  • P Cougot1,
  • O Puyoo2,
  • O Anglès2,
  • B Georges1,
  • JF Decun1,
  • Ch Roche1,
  • Ch Virenque1,
  • B Cathala2,
  • M Génestal2 and
  • K Samii1, 2
Critical Care20015(Suppl 1):P154

DOI: 10.1186/cc1221

Received: 15 January 2001

Published: 2 March 2001

Aim

Volume expansion is usually guided by central venous pressure (CVP) [1]. PiCCO® system which evaluates intra thoracic blood volume (ITBV) may be a useful guide for volume expansion The aim of this study was, using a PiCCO® system, to measure the changes induced by a volume expansion in cardiac index (CI), systolic index (SI), mean systemic arterial pressure (MSAP), CPV and ITBV.

Materials and methods

Eighteen patients with acute circulatory ditress syndrome were prospectively studied. All the patients were sedated and mechanically ventilated and received 50 or 100 ml (group 1: CVP > 14 and 14 = CVP = 8 respectively) or 200 ml (group2: CVP < 8 cmH2O) of HEAfusine 6%® over a 10 min period. Hemodynamics measurements were performed using a transpulmonary indicator dilution technique (PiCCO® Pulsion, Munich) before (T0), after fluid administration (T10) and 10 min later (T20).

Results

The acute circulatory distress syndrome was due to septic shock (n = 15), cardiogenic shock (n = 2) and hypovolemic shock (n = 1). The Table shows the changes observed from the baseline values at T10 (T0-T10) and from the end of volume expansion to 10 min later (T10-T20) in each group.

Table

 

200 ml group 2 (n = 26)

50 or 100 ml group 1 (n = 42)

Changes

T0

T0-T10

T10-T20

T0

T0-T10

T10-T20

CI (l/min/m2)

3.86 ± 0.9

0.3 ± 0.09

0.11 ± 0.07

3.9 ± 0.9

0.12 ± 0.06

-0.36 ± 0.04*

SI (ml/m2)

42.3 ± 12.2

3.5 ± 0.8

1.9 ± 0.1

42.5 ± 10.4

1.74 ± 0.7

0.09 ± 0.56 *

ITBV (ml/m2)

867 ± 245

12 ± 11

40 ± 15

862 ± 124

61.3 ± 10.7

-18.6 ± 10.8*

MSAP (mmHg)

77.3 ± 11.6

4.9 ± 1

1.6 ± 0,5 *

73.3 ± 8.5

3.6 ± 0.5

-0.3 ± 0.1 *

CVP (cmH2O)

5.8 ± 2.8

1.9 ± 0.2

-0.07 ± 0.2 *

9.95 ± 1.75

1.2 ± 0.2

-0.05 ± 0.13 *

*P < 0.05 changes from T10 to T20 vs changes from T0 to T10.

Discussion

In the 200 ml group, 10 min after the end of volume expansion, the increase in MSAP and CVP disappears, whereas ITBV, CI and SI increases remain unchanged and even shows for ITBV a trend toward increase. This suggest a post-expansion effect which is not observed on CVP values. In group 2 who had a higher baseline CVP and a lower volume expansion, the increases in MSAP, CVP, ITBV and SI observed at the end of volume expansion disappear 10 min later, suggesting the absence of a post-expansion effect when the baseline CVP is high and/or the volume infused is low.

Conclusion

ITBV measurement may be a useful guide for the evaluation of volume expansion and post-volume expansion effect when baseline CVP is low and/or volume expansion is 200 ml.

Authors’ Affiliations

(1)
Réanimation Polyvalente, Hôpital Purpan
(2)
Réanimation Polyvalente, Hôpital Rangueil Toulouse

References

  1. Weil MH, Henning RJ: New concepts in the diagnosis and fluid treatment of circulatory shock. Anaesth Analg 1979, 58: 2.View ArticleGoogle Scholar

Copyright

© The Author(s) 2001

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