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Preload Assessment in Trauma Patients During Large-Volume Shock Resuscitation
Michael C. Chang, MD;
Thane A. Blinman, MD;
Edmund J. Rutherford, MD;
Loren D. Nelson, MD;
John A. Morris, Jr, MD
Arch Surg. 1996;131(7):728-731.
Abstract
Objectives
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.
Design
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.
Setting
University level I trauma center.
Main Outcome Measures
Correlations of the RVEDVI and PAOP with the cardiac index (CI) during the defined study period.
Results
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).
Conclusions
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
Author Affiliations
From the Division of Surgical Sciences, the Bowman Gray School of Medicine, Winston-Salem, NC (Dr Chang), and the Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tenn (Drs Blinman, Rutherford, Nelson, and Morris).
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