Issn Print: 1079-6061

Publication Date: 1998/12/01


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RIGHT VENTRICULAR END DIASTOLIC VOLUME INDEX IS NOT AFFECTED BY INCREASES IN POSITIVE END EXPIRATORY PRESSURE

Jeffrey S. Guy; Edmund J. Rutherford; Toan Huynh; Christopher C. Baker; Anthony A. Meyer

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Excerpt

Objective: The pulmonary artery occlusive pressure (PAOP) is commonly used to estimate volume status and cardiac preload. Measurement of PAOP is artificially elevated by the application of positive end expiratory pressure (PEEP). Right ventricular end diastolic volume index (RVEDVI) is an assessment of preload that does not rely on the measurement pressure. The hypothesis of this investigation is that RVEDVI provides a better method of preload determination in patients exposed to various levels of PEEP.
Methods: 400 observations were made in 22 patients admitted to a surgical intensive care unit of a university hospital. Patients with PA catheters had simultaneous recording of PAOP, and RVEDVI.
Results: PAOP was well correlated with increasing PEEP, R2 = 0.58 (p<0.0001). EDVI was not correlated with PEEP (R2 = 0.01, p=NS) Subgroup analyses are present in the following Table 1.
Conclusion: Increasing levels of PEEP are significantly correlated with increases in PAOP but not RVEDVI. PAOP poorly predicts CI, however, RVEDVI correlated with CI at all levels of PEEP. Therefore, RVEDVI provides a better assessment of intravascular volume status and cardiac preload in patients at various levels of PEEP.
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