Left ventricular end-diastolic area is a measure of cardiac preload in patients with early septic shock

Scheuren, Karolinea,1; Wente, Moritz Nb,1; Hainer, Christiana; Scheffler, Matthiasc; Lichtenstern, Christophc; Martin, Eikea; Schmidt, Janb; Bopp, Christiana,2; Weigand, Markus Ac,2

European Journal of Anaesthesiology: September 2009 - Volume 26 - Issue 9 - p 759–765
doi: 10.1097/EJA.0b013e32832a3a9c
Original Articles - ICU

Background and objective: Central venous pressure, intrathoracic blood volume, and left ventricular end-diastolic area are reliable measures of cardiac preload under stable clinical conditions. The purpose of this study was to compare different preload parameters over 24 h under conditions of multiple, frequently changing treatments in early septic shock.

Methods: In 28 mechanically ventilated patients within 6 h of the onset of septic shock, left ventricular end-diastolic area was measured using transoesophageal echocardiography. Intrathoracic blood volume, stroke volume variation, and central venous pressure were analysed as preload parameters. The relation between parameter changes and changes in therapy was examined with respect to cardiac index and stroke volume index.

Results: Regarding preload variables, linear regression analyses revealed a significant correlation between left ventricular end-diastolic area and stroke volume index (r2 = 0.59, P < 0.001) and cardiac index (r2 = 0.41, P < 0.001), respectively. Changes in left ventricular end-diastolic index and intrathoracic blood volume index reflected changes in the stroke volume index, whereas central venous pressure did not. Myocardial responsiveness also failed to predict changes in the stroke volume index.

Conclusion: Only the left ventricular end-diastolic area index may help predict preload in ventilated patients with early septic shock.

aDepartment of Anaesthesiology, Germany

bDepartment of Surgery, University of Heidelberg, Heidelberg, Germany

cDepartment of Anaesthesiology, University of Giessen–Marburg, Giessen, Germany

1Karoline Scheuren and Moritz N. Wente contributed equally to the writing of this article.

2Christian Bopp and Markus A. Weigand contributed equally as senior authors of this article.

Received 2 December, 2008

Revised 2 December, 2008

Accepted 9 February, 2009

Correspondence to Markus A. Weigand, MD, Department of Anaesthesiology, University of Giessen–Marburg, Rudolf-Buchheim Street 7, 35392 Giessen, Germany Tel: +49 641 9944401; fax: +49 641 9944409; e-mail: markus.weigand@chiru.med.uni-giessen.de

Supported by a grant from Else Kröner-Fresenius-Stiftung to M.A. Weigand.

© 2009 European Society of Anaesthesiology