Department of Neurosurgery, Klinikum Bogenhausen, Akademisches Lehrkrankenhaus der Technischen Universität München, München 81925, Germany.
Crit Care. 2009;13(6):R202. doi: 10.1186/cc8209. Epub 2009 Dec 14.
Volumetric parameters acquired by transpulmonary thermodilution had been repeatedly proven superior to filling pressures for estimation of cardiac preload. Up to now, the proposed normal ranges were never studied in detail. We investigated the relationship of the global end-diastolic volume (GEDV) acquired by transpulmonary thermodilution with age and gender in awake and spontaneously breathing patients.
Patients requiring brain tumor surgery were equipped prospectively with a transpulmonary thermodilution device. On postoperative day one, thermodilution measurements were performed in 101 patients ready for discharge from the ICU. All subjects were awake, spontaneously breathing, hemodynamically stable and free of catecholamines.
Main finding was a dependence of GEDV on age and gender, height and weight of the patient. Age was a highly significant non-linear coefficient for GEDV with large inter-individual variance (p < 0.001). On average, GEDV was 131.1 ml higher in males (p = 0.027). Each cm body height accounted for 13.0 ml additional GEDV (p < 0.001). GEDV increased by 2.90 ml per kg actual body weight (p = 0.043). Each cofactor, including height and weight, remained significant after indexing GEDV to body surface area using predicted body weight.
The volumetric parameter GEDV shows a large inter-individual variance and is dependent on age and gender. These dependencies persist after indexing GEDV to body surface area calculated with predicted body weight. Targeting resuscitation using fixed ranges of preload volumes acquired by transpulmonary thermodilution without concern to an individual patient's age and gender seems not to be appropriate.
经肺温度稀释法获得的容积参数已被反复证明优于充盈压，可用于估计心脏前负荷。到目前为止，这些建议的正常范围从未被详细研究过。我们研究了经肺温度稀释法获得的全心舒张末期容积（GEDV）与清醒和自主呼吸患者的年龄和性别之间的关系。
前瞻性地为需要脑瘤手术的患者配备经肺温度稀释设备。术后第一天，对 101 名准备从 ICU 出院的患者进行了热稀释测量。所有患者均清醒、自主呼吸、血流动力学稳定且无儿茶酚胺。
主要发现是 GEDV 取决于患者的年龄、性别、身高和体重。年龄是 GEDV 的一个高度显著的非线性系数，个体间差异很大（p < 0.001）。男性的 GEDV 平均高出 131.1ml（p = 0.027）。身高每增加 1cm，GEDV 增加 13.0ml（p < 0.001）。实际体重每增加 1kg，GEDV 增加 2.90ml（p = 0.043）。包括身高和体重在内的每个协变量，在根据预测体重计算的体表面积对 GEDV 进行指数化后，仍然具有统计学意义。
容积参数 GEDV 个体间差异较大，且依赖于年龄和性别。这些依赖性在将 GEDV 与根据预测体重计算的体表面积指数化后仍然存在。使用经肺温度稀释法获得的固定前负荷体积范围进行复苏，而不考虑个体患者的年龄和性别，似乎并不合适。
