Poster presentation | Open | Published:
Comparison of vascular pedicle width and PiCCO-derived haemodynamic measurements in patients in a general intensive care unit
Critical Carevolume 11, Article number: P291 (2007)
Assessing clinically the intravascular volume status of critically ill patients can be exceedingly difficult. Due to concerns about the efficacy and safety (possible increase in mortality) of using invasive haemodynamic monitoring, noninvasive diagnostic testing has gained increasing importance.
To compare the reliability of vascular pedicle width (VPW) as an indicator of overload, in patients of a general ICU, with a method of invasive haemodynamic monitoring that has proved its efficacy in the literature and in everyday practice.
Patients and methods
The VPW, which represents the mediastinal silhouette of the great vessels, was compared with the haemodynamic measurements, which were obtained with the method of transpulmonary thermodilution (PiCCO Plus; Pulsion, Munich, Germany). We measured the VPW in anteroposterior chest X-rays in the supine position, with standard parameters, in 100 patients without prior cardiac surgery, prior mediastinal irradiation, obesity, severe acute respiratory distress syndrome and positive end-expiratory pressure > 7.5 cmH2O. In every patient we performed invasive haemodynamic monitoring with the PiCCO Plus. An intrathoracic blood volume index (ITBI) > 1,000 ml/m2, global end-diastolic index (GEDI) > 800 ml/m2, and extravascular lung water index (ELWI) > 7.0 ml/kg were considered the markers of significant volume overload. After further refinement, 27 patients fulfilled the above criteria and were considered eligible to be included in the study.
The mean VPW in overloaded patients was 75.14 mm compared with a mean of 64.71 mm for the rest. The results were subsequently analyzed using Spearman's nonparametric test and we found correlation (0.785, 0.710, and 0.510) between VPW and the GEDI, ITBI, and ELWI, respectively. The results were considered statistically significant (P < 0.000, P < 0.000, and P < 0.005, respectively).
The VPW, when appropriately assessed at the bedside by the same physician and therefore avoiding the possible bias, using portable chest X-rays, might give very useful information regarding the volume status of the patients, results that are comparable in their efficacy with those obtained with invasive and more expensive methods.