Deja Maria, Hildebrandt Bert, Ahlers Olaf, Riess Hanno, Wust Peter, Gerlach Herwig, Kerner Thoralf
Department of Anesthesiology and Critical Care Medicine, Charité Medical Center, Campus Virchow-Clinic, Augustenburger Platz 1, 13353 Berlin, Germany.
Chest. 2005 Aug;128(2):580-6. doi: 10.1378/chest.128.2.580.
To optimize volume therapy during induced whole-body hyperthermia (WBH) < or = 42.2 degrees C, pulmonary capillary wedge pressure (PCWP) and intrathoracic blood volume index (ITBVI) were compared as goal parameters.
Prospective clinical study.
ICU at university hospital.
Twenty-three patients with metastatic cancers.
Radiant WBH in combination with induced hyperglycemia, hyperoxemia, and chemotherapy was applied. Volume therapy was directed to the PCWP (group A, 8 to 12 mm Hg [20 treatments]), or to ITBVI (group B, 800 to 1,100 mL/m2 [19 treatments]) following a standardized protocol. Goals other than PCWP and ITBVI were cardiac index of > 3.5 L/min/m2 and mean arterial pressure of > 55 mm Hg.
In addition to the primary goals PCWP and ITBVI, at defined temperatures, central venous pressure (CVP), extravascular lung water index, the number of infusions, and packed RBCs, as well as serum lactate level, norepinephrine dosage, and levels of liver enzymes, bilirubin, creatinine, and urea were measured. Patients in group A received a significantly greater mean (+/- SD) amount of crystalloids compared to those in group B (6,175 +/- 656 vs 3,947 +/- 375 mL, respectively) and required significantly lower dosages of vasoconstrictors compared with patients in group B. Except for the lower values of CVP in patients in group A during hyperthermia, all of the other hemodynamic and laboratory parameters showed no significant differences between the groups or stayed in a normal range.
PCWP and ITBVI are useful parameters to assess preload in induced WBH. Differences in crystalloids and vasopressor dosages may suggest an appropriate ITBVI of > 1,100 mL/m2 for patients with good cardiopulmonary health under such extremely hypercirculatory conditions.
在诱导性全身热疗（WBH）体温≤42.2℃期间优化容量治疗，比较肺毛细血管楔压（PCWP）和胸腔内血容量指数（ITBVI）作为目标参数。
前瞻性临床研究。
大学医院重症监护病房。
23例转移性癌症患者。
采用辐射性WBH联合诱导性高血糖、高氧血症及化疗。按照标准化方案，容量治疗以PCWP为目标（A组，8至12 mmHg[20次治疗]）或ITBVI为目标（B组，800至1100 mL/m²[19次治疗]）。除PCWP和ITBVI外的目标为心脏指数>3.5 L/min/m²及平均动脉压>55 mmHg。
除主要目标PCWP和ITBVI外，在特定温度下，测量中心静脉压（CVP）、血管外肺水指数、输液次数、红细胞压积，以及血清乳酸水平、去甲肾上腺素剂量、肝酶、胆红素、肌酐和尿素水平。与B组患者相比，A组患者接受的晶体液平均（±标准差）量显著更多（分别为6175±656 vs 3947±375 mL），且所需血管收缩剂剂量显著更低。除热疗期间A组患者CVP值较低外，所有其他血流动力学和实验室参数在两组之间无显著差异或均保持在正常范围内。
PCWP和ITBVI是评估诱导性WBH期间前负荷的有用参数。晶体液和血管升压药剂量的差异可能表明，在这种极度高循环状态下，心肺功能良好的患者适宜的ITBVI>1100 mL/m²。
