Intrathoracic Blood Volume Accurately Reflects Circulating Volume Status in Critically Ill Patients
In general, central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) are used for control and management of circulating blood volume. It has been demonstrated that there is a good correlation between left atrial pressure and PCWP during spontaneous breathing and intermittent positive pressure ventilation [1, 2, 7]. However, the introduction of continuous pressure ventilation (CPPV) has complicated the use of, e.g., PCWP as the indicator of left ventricle (LV) preload greatly; more than 10 years ago it was shown that PCWP poorly reflects circulating volume status during CPPV in subjects with normal lungs [13, 16]. In an investigation by Shippy et al.  of over 1500 occasions of clinical indication or suspicion of either hypovolemia or hypervolemia during periods of critical illness in patients admitted to the surgical ICU or during early resuscitation from hypotensive shock with administration of a fluid load, blood volume and values of the commonly monitored variables, including CVP, PCWP, and cardiac output (CO.), improved appropriately. However, the correlation coefficients, in general, were not good. The authors concluded that the commonly monitored variables in and of themselves do not reflect adequately the blood volume status in critically ill patients.
KeywordsCatheter Depression Pneumonia Norepinephrine Dextran
Unable to display preview. Download preview PDF.
- 8.Pfeiffer H-G, Pfeiffer UJ, Aschenbrenner G, Kolb E, Blümel G (1990) Intrathoracic blood volume is a useful guide for volume substitution in intensive care patients. In: Lewis FR, Pfeiffer UJ (eds) Practical applications of fiberoptics in critical care monitoring. Springer, Berlin Heidelberg New York, pp 42–44CrossRefGoogle Scholar
- 9.Pfeiffer UJ, Zimmermann G (1984) Fehlermöglichkeiten und Grenzen der Lungenwasserbestim-mung mit der Thermo-Dye Technik. Beitr Anaesthesiol Intensivmed 6:81–104Google Scholar
- 10.Pfeiffer UJ, Perker M, Zeravik J, Zimmermann G (1990) Sensitivity of central venous pressure, pulmonary capillary wedge pressure, and intrathoracic blood volume as indicators of acute and chronic hypovolemia. In: Lewis FR, Pfeiffer UJ (eds) Practical applications of fiberoptics in critical care monitoring. Springer, Berlin Heidelberg New York, pp 25–31CrossRefGoogle Scholar
- 11.Sampliner JE, Piluk HC (1986) Hämodynamische und respiratorische Überwachung. In: Berk JL, Sampliner JE (eds) Handbuch der Intensivmedizin. Karger, Basel, pp 61–92Google Scholar
- 14.Wellhöfer H, Zeravik J, Perker M, Blümel G, Zimmermann G, Pfeiffer UJ (1990) PEEP-induced changes of pulmonary capillary wedge pressure, prepulmonary and total intrathoracic blood volume in anesthetized dogs. In: Lewis FR, Pfeiffer UJ (eds) Practical applications of fiber-optics in critical care monitoring. Springer, Berlin Heidelberg New York, pp 32–41CrossRefGoogle Scholar