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Pre-ejection period is a reliable parameter to estimate cardiac preload in a hemorrhagic shock

Introduction

We have already demonstrated that in mechanically ventilated patients, the respiratory change in the pre-ejection period (ΔPEP) is a reliable dynamic index for the prediction of increase in cardiac output after volume infusion [1]. However, in an animal study, Kubitz and colleagues showed that the pre-ejection period is not sensitive to the changes in intravascular volume status [2].

Methods

This study investigated the influence of changes in intravascular volume status on ΔPEP. In 17 pigs, ECG, arterial pressure and cardiac output derived from a Swan-Ganz catheter were recorded. Measurements were performed during normovolaemic conditions, after haemorrhage (25 ml/kg) and following re-transfusion (25 ml/kg) with constant tidal volume (10 ml/kg) and respiration rate (15/minute).

Results

At baseline, respiratory changes in pulse pressure (PPV) and ΔPEP were both <12%. PPV significantly correlated with ΔPEP (r = 0.96, P < 0.001). Volume loss induced by haemorrhage increased PPV and ΔPEP. Moreover, during this state, PPV correlated with ΔPEP with a significant correlation coefficient (r = 0.88, P < 0.001). Retransfusion significantly decreased PPV and ΔPEP and PPV significantly correlated with ΔPEP (r = 0.94, P < 0.001) (Figure 1).

Figure 1
figure1

Box plot representing pulse pressure variations (PPV) (%) and pre-ejection period variations (ΔPEP) (%) at the three times of the protocol. §P < 0.05, P < 0.05.

Conclusions

Available correlations between PPV and ΔPEP at each time of the study were observed, meaning that ΔPEP is a reliable parameter to estimate the changes in intravascular volume status.

References

  1. 1.

    Bendjelid K, Suter PM, Romand JA: The respiratory change in preejection period: a new method to predict fluid responsiveness. J Appl Physiol. 2004, 96: 337-342. 10.1152/japplphysiol.00435.2003.

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    Kubitz JC, Kemming GI, Schultheib G, Starke J, Podtschaske A, Goetz AE, Reuter DA: The influence of cardiac preload and positive end-expiratory pressure on the pre-ejection period. Physiol Meas. 2005, 26: 1033-1038. 10.1088/0967-3334/26/6/012.

    PubMed  Article  Google Scholar 

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Correspondence to R Giraud.

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Giraud, R., Siegenthaler, N., Romand, J. et al. Pre-ejection period is a reliable parameter to estimate cardiac preload in a hemorrhagic shock. Crit Care 14, P117 (2010). https://doi.org/10.1186/cc8349

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Keywords

  • Catheter
  • Cardiac Output
  • Animal Study
  • Respiration Rate
  • Arterial Pressure