• L Diebel, R F Wilson, J Heins, H Larky, K Warsow, and S Wilson.
• Department of Surgery, Wayne State University, Detroit, MI 48201.
• J Trauma. 1994 Dec 1;37(6):950-5.

ObjectiveTo evaluate the relative accuracy of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery wedge pressure (PAWP) for determining cardiac preload.MethodsA modified pulmonary artery catheter was used to determine RVEDVI, PAWP, and CI 238 times in 32 trauma patients.ResultsThe initial mean values included cardiac index (CI) = 3.4 +/- 1.3 L/min/m2, PAWP = 14.8 +/- 6.6 mm Hg, and RVEDVI = 99 +/- 40 mL/m2. Cardiac index correlated better with RVEDVI (r = 0.6440; p < 0.001) than with PAWP (r = 0.1068) or CVP (r = 0.1604). In 84 studies in 19 patients, the PAWP was high (19+ mm Hg) in spite of an RVEDVI that was low (< 90 mL/m2) in 22 (26%) or mid-range (90-140 mL/m2) in 49 (58%) of these. In addition, in 12 studies a high RVEDVI (> 140 mL/m2) existed with a relatively low PAWP (< 12 mm Hg). Thus, in 83 (35%) of the studies, PAWP provided information different from the RVEDVI. Of 65 instances in which preload was increased, CI "responded" (> or = 20%) in 26 (40%). The incidence of a response was not affected by the PAWP; however, responses with a RVEDVI of < 90, 90-140, or > 140 mL/m2 were 64%, 27%, and 0 (p < 0.001).ConclusionThe RVEDVI more accurately predicted preload recruitable increases in CI than did the PAWP.

23 keywords...

hide…