Comparison of pressure-related performance data with data measured by thermodilution in heart failure and sepsis

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Introduction

The performance diagrams evaluate the cardiocirculatory function by means of blood pressure, pulse rate and body surface area (BSA). The basics are represented by Kunig et al. in this symposium. The performance data predict nonsurvival with a sensitivity of 94% and a specificity of 84%.

Aim of study

Comparison of hemodynamic data measured by thermodilution with pressure-related performance diagrams and their use in differentiation of critical cardiocirculatory states.

Method

On-line measured performance data are compared with discontinuously determined thermodilution data in patients with heart failure (CI<2.5 l/min/m²; PCWP>20 mmHg) and sepsis (CI>4.5 l/min/m²; PCWP >16 mmHg).

Results

In 9 patients with cardiac failure (CI 1.94±0.44 l/min/m²; PCWP 23.3±5.5 mmHg) the efficiency (EF[P]) declines to 0.27±0.03, the diastolic blood pressure (DBP) and systolic blood pressure (SBP) range slightly above the basal values (DBP^* 2.64±0.58; SBP^* 3.61±0.73) and the pulse pressure rate (PP^*) below the critical border of 1 (0.93±0.30). In 20 patients with sepsis (CI 5.22±1.32 l/min/m²; PCWP 19.4±4.4 mmHg) the efficiency is normal (0.48±0.07), while SBP^* and DBP^* are remarkably increased (5.16±1.23 and 2.69±0.85). The PP^* ranges is 2.52±0.61. The differences in CI, EF(P), PP^* and SBP^* are strongly significant (P<0.01) in sepsis compared with heart failure.

Conclusions

(1)The pressure-related performance data show changes in case of abnormal deviations of volumetrically determined hemodynamic parameters.(2) A differentiation of hemodynamic parameters between sepsis and severe heart failure succeeds by means of CI, EF(P), PP^* and SBP^*. (3) A remarkable deviation of performance parameters from basal values signals a cardiocirculatory deterioration, which should be analyzed by conventionally measured hemodynamic parameters at present.