II. Medizinische Klinik Und Poliklinik, Klinikum Rechts Der Isar Der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
Sci Rep. 2020 Nov 27;10(1):20773. doi: 10.1038/s41598-020-76286-w.
Transpulmonary thermodilution (TPTD)-derived global end-diastolic volume index (GEDVI) is a static marker of preload which better predicted volume responsiveness compared to filling pressures in several studies. GEDVI can be generated with at least two devices: PiCCO and EV-1000. Several studies showed that uncorrected indicator injection into a femoral central venous catheter (CVC) results in a significant overestimation of GEDVI by the PiCCO-device. Therefore, the most recent PiCCO-algorithm corrects for femoral indicator injection. However, there are no systematic data on the impact of femoral indicator injection for the EV-1000 device. Furthermore, the correction algorithm of the PiCCO is poorly validated. Therefore, we prospectively analyzed 14 datasets from 10 patients with TPTD-monitoring undergoing central venous catheter (CVC)- and arterial line exchange. PiCCO was replaced by EV-1000, femoral CVCs were replaced by jugular/subclavian CVCs and vice-versa. For PiCCO, jugular and femoral indicator injection derived GEDVI was comparable when the correct information about femoral catheter site was given (p = 0.251). By contrast, GEDVI derived from femoral indicator injection using the EV-1000 was obviously not corrected and was substantially higher than jugular GEDVI measured by the EV-1000 (846 ± 250 vs. 712 ± 227 ml/m; p = 0.001). Furthermore, measurements of GEDVI were not comparable between PiCCO and EV-1000 even in case of jugular indicator injection (p = 0.003). This is most probably due to different indexations of the raw value GEDV. EV-1000 could not be recommended to measure GEDVI in case of a femoral CVC. Furthermore, different indexations used by EV-1000 and PiCCO should be considered even in case of a jugular CVC when comparing GEDVI derived from PiCCO and EV-1000.
经肺温度稀释（TPTD）衍生的全心舒张末期容积指数（GEDVI）是前负荷的静态标志物，与几项研究中的充盈压相比，它能更好地预测容量反应性。GEDVI 可以用至少两种设备生成：PiCCO 和 EV-1000。几项研究表明，未校正的指示剂注入股中央静脉导管（CVC）会导致 PiCCO 设备显著高估 GEDVI。因此，最新的 PiCCO 算法对股动脉指示剂注射进行了校正。然而，对于 EV-1000 设备，没有关于股动脉指示剂注射的系统数据。此外，PiCCO 的校正算法验证不足。因此，我们前瞻性地分析了 10 例接受中心静脉导管（CVC）和动脉置管更换的 TPTD 监测患者的 14 组数据集。PiCCO 被 EV-1000 取代，股 CVC 被颈内/锁骨下 CVC 取代，反之亦然。对于 PiCCO，当提供股导管位置的正确信息时，颈内和股动脉指示剂注射衍生的 GEDVI 是可比的（p=0.251）。相比之下，使用 EV-1000 从股动脉指示剂注射衍生的 GEDVI 没有得到明显校正，明显高于 EV-1000 测量的颈内 GEDVI（846±250 比 712±227 ml/m；p=0.001）。此外，即使在颈内指示剂注射的情况下，PiCCO 和 EV-1000 之间的 GEDVI 测量也不可比（p=0.003）。这很可能是由于 GEDV 原始值的不同指标化所致。在股 CVC 的情况下，不建议使用 EV-1000 测量 GEDVI。此外，即使在颈内 CVC 的情况下，当比较 PiCCO 和 EV-1000 衍生的 GEDVI 时，也应考虑 EV-1000 和 PiCCO 使用的不同指标化。
