Cardiac output and pulmonary wedge pressure. Use for evaluation of fluid replacement in trauma patients
D. M. Shah, B. D. Browner, R. E. Dutton, J. C. Newell and S. R. Powers Jr
Cardiac output and pulmonary wedge pressure (PWP) were used to evaluate the
end point of fluid resuscitation in 20 patients suffering from multiple
trauma and shock. Eleven patients received crystalloid resuscitation and
nine patients received colloid resuscitation. Fifteen of 20 patients had an
adequate cardiac output at the termination of resuscitation, but but only
six of these patients had a PWP above 10 mm Hg. There was no significant
correlation between left ventricular stroke work index and PWP in these
patients, either at the completion of resuscitation or during the following
three days. Five patients did not achieve adequate cardiac output and four
of these patients died, suggesting that cardiac output was the most
important criterion for adequate resuscitation. If the goal of fluid
resuscitation is to achieve an adequate cardiac output, then PWP was not a
reliable guide. Furthermore, using both cardiac output and PWP as a guide
to fluid resuscitation of our patients, we found that the type of fluid
(crystalloid or colloid) for resuscitation did not influence the course of
respiratory distress in these patients up to three days following
resuscitation.
