The accuracy of preload assessment by different transesophageal echocardiographic techniques in patients undergoing cardiac surgery. Export

@article{citeulike:3022053, abstract = {OBJECTIVES: The aim of this study was to compare the following approaches to assess left ventricular preload by transesophageal echocardiography (TEE): left ventricular end-diastolic volume index (LVEDVI) determined by using the method of disc summation (LVEDVI(Md)) and left ventricular end-diastolic area index (LVEDAI) were compared with LVEDVI assessed by the modified Simpson formula (LVEDVI(Si)). Global end-diastolic volume index (GEDVI) and stroke volume index (SVI) measured by the PiCCO(plus) system (Pulsion Medical Systems, Munich, Germany) were used as TEE-independent reference variables. DESIGN: Prospective observational study. SETTING: Community hospital. PARTICIPANTS: Twenty-two patients undergoing elective cardiac surgery. INTERVENTIONS: After the induction of anesthesia, hemodynamic assessment by TEE and the PiCCO(plus) system was made 20 (T(1)) and 10 minutes (T(2)) before and 10 (T(3)) and 20 minutes (T(4)) after a fluid trial. At each time point, LVEDVI(Md), LVEDAI, LVEDVI(Si), GEDVI, and SVI were determined. MEASUREMENTS AND MAIN RESULTS: The fluid trial resulted in a significant increase of all preload variables measured at T(3). At T(4), all preload variables but LVEDVI(Md) showed a significant decrease. The mean bias +/- 2 SD for percent changes (Delta) of LVEDVI(Md) - DeltaLVEDVI(Si) was 1.5\% +/- 59.0\% and for DeltaLVEDAI - Delta LVEDVI(Si) 0.9\% +/- 23.6\%. The correlation between LVEDVI(Md) and LVEDVI(Si) was significantly weaker than between LVEDAI and LVEDVI(Si) (p < 0.001). Comparing TEE measurements with GEDVI and SVI, strong correlations were observed for LVEDAI and LVEDVI(Si) only. CONCLUSION: The method of disc summation cannot be recommended for preload assessment during a fluid challenge in cardiac surgery patients. By contrast, single-plane area measurements provided reliable information when compared with the application of the modified Simpson formula.}, address = {Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Zurich, Switzerland.}, author = {Hofer, C. K. and Ganter, M. T. and Rist, A. and Klaghofer, R. and Matter-Ensner, S. and Zollinger, A.}, citeulike-article-id = {3022053}, citeulike-linkout-0 = {http://dx.doi.org/10.1053/j.jvca.2007.06.007}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18375326}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18375326}, doi = {10.1053/j.jvca.2007.06.007}, issn = {1532-8422}, journal = {Journal of cardiothoracic and vascular anesthesia}, keywords = {echo, pc, volume}, month = {April}, number = {2}, pages = {236--242}, posted-at = {2008-07-20 05:50:26}, priority = {2}, title = {The accuracy of preload assessment by different transesophageal echocardiographic techniques in patients undergoing cardiac surgery.}, url = {http://dx.doi.org/10.1053/j.jvca.2007.06.007}, volume = {22}, year = {2008} }

TY - JOUR ID - citeulike:3022053 L3 - citeulike-article-id:3022053 N2 - OBJECTIVES: The aim of this study was to compare the following approaches to assess left ventricular preload by transesophageal echocardiography (TEE): left ventricular end-diastolic volume index (LVEDVI) determined by using the method of disc summation (LVEDVI(Md)) and left ventricular end-diastolic area index (LVEDAI) were compared with LVEDVI assessed by the modified Simpson formula (LVEDVI(Si)). Global end-diastolic volume index (GEDVI) and stroke volume index (SVI) measured by the PiCCO(plus) system (Pulsion Medical Systems, Munich, Germany) were used as TEE-independent reference variables. DESIGN: Prospective observational study. SETTING: Community hospital. PARTICIPANTS: Twenty-two patients undergoing elective cardiac surgery. INTERVENTIONS: After the induction of anesthesia, hemodynamic assessment by TEE and the PiCCO(plus) system was made 20 (T(1)) and 10 minutes (T(2)) before and 10 (T(3)) and 20 minutes (T(4)) after a fluid trial. At each time point, LVEDVI(Md), LVEDAI, LVEDVI(Si), GEDVI, and SVI were determined. MEASUREMENTS AND MAIN RESULTS: The fluid trial resulted in a significant increase of all preload variables measured at T(3). At T(4), all preload variables but LVEDVI(Md) showed a significant decrease. The mean bias +/- 2 SD for percent changes (Delta) of LVEDVI(Md) - DeltaLVEDVI(Si) was 1.5% +/- 59.0% and for DeltaLVEDAI - Delta LVEDVI(Si) 0.9% +/- 23.6%. The correlation between LVEDVI(Md) and LVEDVI(Si) was significantly weaker than between LVEDAI and LVEDVI(Si) (p < 0.001). Comparing TEE measurements with GEDVI and SVI, strong correlations were observed for LVEDAI and LVEDVI(Si) only. CONCLUSION: The method of disc summation cannot be recommended for preload assessment during a fluid challenge in cardiac surgery patients. By contrast, single-plane area measurements provided reliable information when compared with the application of the modified Simpson formula. IS - 2 JF - Journal of cardiothoracic and vascular anesthesia SN - 1532-8422 AD - Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Zurich, Switzerland. EP - 242 TI - The accuracy of preload assessment by different transesophageal echocardiographic techniques in patients undergoing cardiac surgery. VL - 22 SP - 236 KW - echo KW - pc KW - volume AU - Hofer, CK AU - Ganter, MT AU - Rist, A AU - Klaghofer, R AU - Matter-Ensner, S AU - Zollinger, A PY - 2008/04// UR - http://dx.doi.org/10.1053/j.jvca.2007.06.007 ER -