Document Detail


Increasing cardiac output by fluid loading: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation.
MedLine Citation:
PMID:  16146464     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Sufficient cardiac pre-load for maintaining adequate cardiac output is a major goal in the treatment of critically ill patients. We studied the effects of increasing cardiac output by fluid loading on the indocyanine green plasma disappearance rate (ICG-PDR) and gastric mucosal regional CO2 tension (PRco2) as an indicator of splanchnic microcirculation. METHODS: With approval by our ethics committee and written consent, we studied post-operatively 12 patients (1 female, 11 males; 66 +/- 13 years) with elective coronary artery bypass grafting (n = 10) or aortic valve replacement (n = 2). All patients had received pulmonary artery and left atrial catheterization previously for clinical indications. Cardiac output and filling pressures were measured immediately after intensive care unit (ICU) admission and 1 h after the beginning of fluid loading. RESULTS: Overall, 630 +/- 130 ml of 6% hydroxyethylstarch (130 kDa) was infused with the splanchnic perfusion pressure remaining constant. Norepinephrine and epinephrine dosages were unchanged. The cardiac index increased significantly from 2.8 +/- 0.7 to 3.5 +/- 0.6 l/min/m2 and the stroke volume index from 30 +/- 7 to 38 +/- 8 ml/m2. ICG-PDR showed no significant change, i.e. from 21.2 +/- 6.5 to 21.6 +/- 6.5%/min. Gastric mucosal PRco2 and the Pco2 gap (difference between regional and end-tidal CO2 tension) were constant, i.e. changed from 5.1 +/- 0.8 to 5.5 +/- 1.1 kPa and from 0.9 +/- 0.5 to 1.0 +/- 0.7 kPa, respectively. CONCLUSION: Increasing cardiac output to supranormal values by fluid loading is not associated with a significant change in ICG-PDR or gastric mucosal PRco2.
Authors:
D Hofmann; O Thuemer; C Schelenz; N van Hout; S G Sakka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  49     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-08     Completed Date:  2005-12-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  1280-6     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Aged
Aged, 80 and over
Carbon Dioxide / blood
Cardiac Output / physiology*
Cardiopulmonary Bypass
Coloring Agents / diagnostic use
Epinephrine / blood
Female
Heart Valve Prosthesis Implantation
Hetastarch / pharmacology
Humans
Indocyanine Green / diagnostic use*
Liver Function Tests
Male
Microcirculation / physiology*
Middle Aged
Norepinephrine / blood
Plasma Substitutes / pharmacology
Respiration, Artificial
Splanchnic Circulation / physiology*
Chemical
Reg. No./Substance:
0/Coloring Agents; 0/Plasma Substitutes; 124-38-9/Carbon Dioxide; 3599-32-4/Indocyanine Green; 51-41-2/Norepinephrine; 51-43-4/Epinephrine; 9005-27-0/Hetastarch

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