To evaluate the utility of the right ventricular end-diastolic volume index (RVEDVI) as a method of preload assessment in trauma patients during large-volume shock resuscitation, and to compare the RVEDVI with the pulmonary artery occlusion pressure (PAOP) as a predictor of preload in this patient population.
Retrospective study of a consecutive series of 46 trauma patients, admitted between June 1, 1992, and June 1, 1993, who received a volumetric oximetry pulmonary artery catheter and greater than 10 L of fluid in 24 hours.
University level I trauma center.
Main Outcome Measures:
Correlations of the RVEDVI and PAOP with the cardiac index (CI) during the defined study period.
Three hundred fourteen measurements of the RVEDVI, PAOP, CI, and other hemodynamic variables were evaluated. Patients received a mean±SD of 22.1± 13.3 L of blood and fluid during the 24 hours. The RVEDVI correlated better (P<.001) with the CI (r=0.39) than did the PAOP (r=0.05). Furthermore, there was a better correlation (P<.04) between the RVEDVI and CI when the RVEDVI was 130 mL/m2 or less (r=0.54) than when it was greater than 130 mL/m2 (r=0.30).
The RVEDVI is a better predictor of preload than the PAOP in trauma patients during large-volume shock resuscitation. When the RVEDVI is 130 mL/m2 or less, volume administration will likely increase the CI.Arch Surg. 1996;131:728-731
Chang MC, Blinman TA, Rutherford EJ, Nelson LD, Morris JA. Preload Assessment in Trauma Patients During Large-Volume Shock Resuscitation. Arch Surg. 1996;131(7):728–731. doi:10.1001/archsurg.1996.01430190050013
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