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1 Medical and 2 Surgical Intensive Care Unit and 3 Department of Clinical Physics, Institute for Cardiovascular Research, Free University Hospital, 1081 HV Amsterdam, The Netherlands
The purpose of this
study was to evaluate right ventricular (RV) loading and cardiac output
changes, by using the thermodilution technique, during the mechanical
ventilatory cycle. Fifteen critically ill patients on mechanical
ventilation, with 5 cmH2O of positive end-expiratory
pressure, mean respiratory frequency of 18 breaths/min, and mean tidal
volume of 708 ml, were studied with help of a rapid-response thermistor
RV ejection fraction pulmonary artery catheter, allowing 5-ml
room-temperature 5% isotonic dextrose thermodilution measurements of
cardiac index (CI), stroke volume (SV) index, RV ejection fraction (RVEF), RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) indexes at 10% intervals of the mechanical ventilatory cycle. The ventilatory modulation of CI and RV volumes varied from patient to patient, and the interindividual variability was greater for the latter variables. Within patients also, RV
volumes were modulated more by the ventilatory cycle than CI and SV
index. Around a mean value of 3.95 ± 1.18 l · min
1 · m
2 (= 100%), CI varied from
87.3 ± 5.2 (minimum) to 114.3 ± 5.1% (maximum), and RVESV
index varied between 61.5 ± 17.8 and 149.3 ± 34.1% of mean
55.1 ± 17.9 ml/m2 during the ventilatory cycle. The
variations in the cycle exceeded the measurement error even though the
latter was greater for RVEF and volumes than for CI and SV index. For
mean values, there was an inspiratory decrease in RVEF and increase in
RVESV, whereas a rise in RVEDV largely prevented a fall in SV index. We
conclude that cyclic RV afterloading necessitates multiple
thermodilution measurements equally spaced in the ventilatory cycle for
reliable assessment of RV performance during mechanical ventilation of patients.
right ventricular performance; ejection fraction catheter; critically ill; reliability of thermodilution
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