Advertisement

Critical Care

, 11:P283 | Cite as

The role of clinical examination, chest X-ray and central venous pressure in volume assessment in critically ill patients: a comparison with PiCCO-derived data

  • W Huber
  • S Ringmaier
  • A Umgelter
  • K Holzapfel
  • W Reindl
  • M Franzen
  • J Gaa
  • R Schmid
Poster presentation

Keywords

Pancreatitis Clinical Examination Pleural Effusion Central Venous Pressure Experienced Radiologist 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Background

Assessment of preload and goal-directed resuscitation are crucial parts of ICU therapy. To assess preload, clinical parameters such as filling of the jugular veins, edema and pleural effusions as well as X-ray are used. In addition, haemodynamic parameters such as the central venous pressure (CVP), pulmonary arterial wedge pressure and PiCCO-derived global end-diastolic volume index (GEDVI) are determined. The GEDVI has been shown to be superior to pressure-based parameters with regard to volume responsiveness in several studies. However, PiCCO data are not available in all patients, and frequently clinical examination, CVP and chest X-ray are the first tools for preload assessment. It was the aim of our study to evaluate clinical assessment, X-ray and CVP with regard to the GEDVI and extravascular lung water index (ELWI).

Methods

In 86 patients of an internal ICU, clinical examination was independently determined by a physician and investigator not working in the ICU. Subsequently, chest X-ray (analysed by an experienced radiologist), CVP and PiCCO (Pulsion Company, Munich, Germany) measurements were performed and these data were correlated to clinical findings.

Results

Patients (n = 86; 34 females, 52 males) included 25 patients with cirrhosis, 18 patients with pancreatitis, 19 patients with sepsis; age 63.0 ± 15.5 years; APACHE II score 23.3 ± 8.4. Leg edema significantly correlated to CVP (r = 0.247; P = 0.038) and (negatively) to GEDVI (r = -0.258; P = 0.032). CVP and GEDVI were not associated: r = 0.035; P = 0.784. The ELWI significantly correlated to the degree of rales (r = 0.258; P = 0.016) and GEDVI (r = 0.557; P < 0.001). The ELWI and CVP did not correlate (r = 0.030; P = 0.785). Global clinical preload assessment (scale 1–10) was not predictive for GEDVI. Radiological assessment significantly overestimated the GEDVI (901.41 ± 139.76 vs 782.56 ± 183.80 ml/m2; P < 0.001) and underestimated the ELWI (7.22 ± 1.38 vs 9.77 ± 4.51 ml/kg; P < 0.001).

Conclusion

(1) Leg edema and increased CVP do not exclude preload deficiency determined by the GEDVI, which was overestimated by X-ray. (2) CVP and leg edema are poor predictors of the ELWI, which was significantly associated with audible rales but underestimated by X-ray.

Copyright information

© BioMed Central Ltd. 2007

Authors and Affiliations

  • W Huber
    • 1
  • S Ringmaier
    • 1
  • A Umgelter
    • 1
  • K Holzapfel
    • 1
  • W Reindl
    • 1
  • M Franzen
    • 1
  • J Gaa
    • 1
  • R Schmid
    • 1
  1. 1.Klinikum Rechts der IsarTechnical University of MunichGermany

Personalised recommendations