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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-4497

Hofer, C K; Ganter, M T; Rist, A; Klaghofer, R; Matter-Ensner, S; Zollinger, A (2008). The accuracy of preload assessment by different transesophageal echocardiographic techniques in patients undergoing cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 22(2):236-242.

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OBJECTIVES: The aim of this study was to compare the following approaches to assess left ventricular preload by transesophageal echocardiography (TEE): left ventricular end-diastolic volume index (LVEDVI) determined by using the method of disc summation (LVEDVI(Md)) and left ventricular end-diastolic area index (LVEDAI) were compared with LVEDVI assessed by the modified Simpson formula (LVEDVI(Si)). Global end-diastolic volume index (GEDVI) and stroke volume index (SVI) measured by the PiCCO(plus) system (Pulsion Medical Systems, Munich, Germany) were used as TEE-independent reference variables. DESIGN: Prospective observational study. SETTING: Community hospital. PARTICIPANTS: Twenty-two patients undergoing elective cardiac surgery. INTERVENTIONS: After the induction of anesthesia, hemodynamic assessment by TEE and the PiCCO(plus) system was made 20 (T(1)) and 10 minutes (T(2)) before and 10 (T(3)) and 20 minutes (T(4)) after a fluid trial. At each time point, LVEDVI(Md), LVEDAI, LVEDVI(Si), GEDVI, and SVI were determined. MEASUREMENTS AND MAIN RESULTS: The fluid trial resulted in a significant increase of all preload variables measured at T(3). At T(4), all preload variables but LVEDVI(Md) showed a significant decrease. The mean bias +/- 2 SD for percent changes (Delta) of LVEDVI(Md) - DeltaLVEDVI(Si) was 1.5% +/- 59.0% and for DeltaLVEDAI - Delta LVEDVI(Si) 0.9% +/- 23.6%. The correlation between LVEDVI(Md) and LVEDVI(Si) was significantly weaker than between LVEDAI and LVEDVI(Si) (p < 0.001). Comparing TEE measurements with GEDVI and SVI, strong correlations were observed for LVEDAI and LVEDVI(Si) only. CONCLUSION: The method of disc summation cannot be recommended for preload assessment during a fluid challenge in cardiac surgery patients. By contrast, single-plane area measurements provided reliable information when compared with the application of the modified Simpson formula.


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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Division of Psychosocial Medicine (former)
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Date:April 2008
Deposited On:10 Nov 2008 13:18
Last Modified:05 Apr 2016 12:30
Publisher DOI:10.1053/j.jvca.2007.06.007
PubMed ID:18375326

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