plasma expander in chirurgia toracica - Area-c54

CORSO TEORICO-PRATICO
NAPOLI 9-10 GIUGNO 2005
La Termodiluizione Transpolmonare ed I
Volumi in Anestesia e Rianimaizone
Prof Giorgio Della Rocca
Clinica di Anestesia e Rianimazione
APUGD (Azienda Policlinico Universitario a Gestione Diretta)
University of Udine. Udine, Italy
Iced Versus Room Temperature Injectate for Assessment of
Cardiac Output, Intrathoracic Blood Volume, and Extravascular
lung Water by Single Transpulmonary Thermodilution
P Faybik, H Hetz, A Baker, E Yankovskaya, CG Krenn andf H Steltzer
Septic shock
8
15 critically ill pts
Pancreatitis
2
Acute liver failure
2
Surgical Intensive Care Unit
OLTx
1
PiCCO System
Triplicate STPD with a 20 mL of Room Temperature and
iced saline solution
J Crit Care 2004; 19(2):103-7
CI r=0.95 bias -0.2 2SD 0.7 L min-1 m-2
144 data pairs
ITBVI r=0.91 bias -4.9 2SD 194 mL m-2
EVLWI r=0.97 bias -0.535 2SD 1.5 mL kg-1
J Crit Care 2004; 19(2):103-7
Reliability of a new algorithm for continuous cardiac output
determination by pulse-contour analysis during hemodynamic
instability
O Godje, K Hoke, AE Goetz, TW Felbinger, DA Reuter, B Reichart, R Frield, A Hannekum, UJ Pfeiffer
Wesseling Algorithm
CO
= HR ·
PCnew
New Algorithm
Asys/Zao
Where Zao = SVpc/SVtd
Crit Care Med 2002; 30(1): 52-8
Wesseling Algorithm
New Algorithm
Crit Care Med 2002; 30(1): 52-8
Reliability of a new algorithm for continuous cardiac output
determination by pulse-contour analysis during hemodynamic
instability
O Godje, K Hoke, AE Goetz, TW Felbinger, DA Reuter, B Reichart, R Frield, A Hannekum, UJ Pfeiffer
CONCLUSIONS
Pulse contour cardiac output measurements provides an
easy and reliable method for the continuous monitoring of
cardiac output in critically ill patients.
Crit Care Med 2002; 30(1): 52-8
Intra Thoracic Blood Volume:
preload?
ITBV
ITBV
=
TBV
3
ITBV = 1.25*GEDV
Clinical application-Preload
Preload index: PAOP versus intrathoracic blood volume
monitoring during lung transplantation
G Della Rocca, MG Costa, C Coccia, L Pompei, P Di Marco, P Pietropaoli
r2= 0.41 p<0.0001
r2= - 0.01 ns
40
PAOP (mmHg)
ITBVI (mL m -2)
1500
1000
500
30
20
10
0
0
0
10
20
30
40
50
SVIpa (mL m -2)
60
70
80
0
10
20
30
40
50
60
70
80
SVIpa (mL m -2)
Anesth Analg 2002; 95: 835-43
ITBVI: misinterpretations
• Huge aneurismatic lesions strongly increase
ITBVI
• ITBV indicates the amount of “central blood” and
you have to give a clinical meaning in “that”
patient
(i. e. ITBVI = 1600 ml/m2:
hyperdinamic state or cardiac failure?)
Prognostic Values of Extravascular Lung Water
in Critically Ill patients
SG Sakka, M Klein, K Reinhart, A Meier-Hellman
EVLW was significantly higher in NS than in S
15.6±7.8ml/kg [median, 14.3] vs 12.2±6.4ml/kg [median 10.2]
Chest 2002; 122:2080-2086
Extravascular lung water in patients with severe sepsis:
a prospective cohort study
GS Martin, S Eaton, M Mealer, M Moss
1. The majority of severe sepsis pts have increased amounts
of EVLW including those who do not meet clinical criteria
definig ARDS
2. Increased EVLW is associated with worse survival in
patients with severe sepsis and viceversa
3. Chronic
alcohol
quantities
of
abuse
EVLW
is
associated
with
increased
(alveolar-capillary
barrier
dysfunction?)
Critical Care 2005; 9(2):R74-R82
SVV:
The percentage of variations among the
max and the min Stroke Volumes on the mean of
the min and the max during 12 sec of measure
AP
Stroke volume variation
t
Pulse pressure variation
(PPV)
∆PP(%)=100*[(PPmax-PPmin)/(PPmax+PPmin)]:2
PP= APsyst - APdiast
PP
Assessing fluid-responsiveness by a standardized ventilatory
maneuver: The respiratory systolic variation test
A Perel, L Minkovich, S Preisman, M Abiad, E Segal, P Coriat
Schematic representation of the
respiratory Systolic Variation Test
(RSVT) maneuver.
The smallest 4 systolic pressure
values (identified by the x) are
plotted against their respective
airway pressures to obtain the slope
of the RSVT (mmHg/cmH20).
Anesth Analg 2005; 100: 942-5
Assessing fluid-responsiveness by a standardized ventilatory
maneuver: The respiratory systolic variation test
A Perel, L Minkovich, S Preisman, M Abiad, E Segal, P Coriat
1. The AUC (ROC) for a ≥15 change of CI: PAOP = 0.771
(95% CI, 0.486-1.055), EDAI = 0.875 (95% CI, 0.6831.067), and RSVT = 0.896 (95% CI, 0.726-1.065)
2. RSVT value ≥ 0.24 mmHg/cmH2O predicted a change
≥15% in CI with a sensitivity of 87.5% and a
specificity of 83%.
3. EDAI value≤10.2 cm2/m2 predicted a change ≥15% in
CI with a sensitivity of 87.5% and a specificity of 67%.
Anesth Analg 2005; 100: 942-5