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July 1992

End-Diastolic Volume: A Better Indicator of Preload in the Critically Ill

Author Affiliations

From the Department of Surgery, Wayne State University and Detroit (Mich) Receiving Hospital.

Arch Surg. 1992;127(7):817-822. doi:10.1001/archsurg.1992.01420070081015

• The relative value of pulmonary artery wedge pressure (PAWP) and right ventricular end-diastolic volume index (RVEDVI) as a reflection of the preload status of the critically ill was determined in 29 patients. Regression analysis of 131 hemodynamic studies demonstrated that cardiac index (CI) correlated better with RVEDVI (r=.61) than did PAWP (r =.42). Comparisons of PAWP and RVEDVI showed that possible misleading information concerning filling volume was provided by the PAWP at some time in 15 (52%) of these patients. In 15 patients given 22 fluid challenges, patients with a high PAWP (≥18 mm Hg) "responded" with a rise in CI more frequently than did patients with a low PAWP (<12 mm Hg). However, all eight patients with a RVEDVI less than 90 mL/m2 responded with a rise in CI, but all seven patients with a RVEDVI greater than or equal to 139 mL/m2 failed to respond. Thus, RVEDVI more accurately predicted preload recruitable increases in cardiac output.

(Arch Surg. 1992;127:817-822)

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