nach oben

Journal of Clinical Monitoring and Computing

Erschienen in:

05.11.2019 | Original Research

Transpulmonary thermodilution before and during veno-venous extra-corporeal membrane oxygenation ECMO: an observational study on a potential loss of indicator into the extra-corporeal circuit

verfasst von: Alexander Herner, Tobias Lahmer, Ulrich Mayr, Sebastian Rasch, Jochen Schneider, Roland M. Schmid, Wolfgang Huber

Erschienen in: Journal of Clinical Monitoring and Computing | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Haemodynamic monitoring before extra-corporeal membrane oxygenation (ECMO) might help to optimize the effectiveness of ECMO. However, there are concerns that pulmonary arterial and trans-pulmonary thermodilution (TPTD) might be confounded by a loss of indicator into the ECMO-circuit, resulting in an overestimation of volumetric parameters. Since there is a lack of data on indicator dilution techniques during ECMO, we compared TPTD-measurements before and during ECMO. TPTD-derived parameters before and after initiation of ECMO were compared in 14 intensive care unit-patients with veno-venous ECMO and TPTD-monitoring (PiCCO^®). Eight patients had a jugular and six patients a femoral central venous catheter (CVC). Cardiac index, global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI) before ECMO as well as the ECMO-flow were comparable in patients with jugular and femoral CVC. Pre-ECMO, cardiac index (CI) was not significantly different compared to values during ECMO (4.5 ± 1.7 vs. 4.4 ± 2.1 L/min/m²; p = 0.43). By contrast, GEDVI (791 ± 179 vs. 974 ± 384 mL/m²; p = 0.04) and EVLWI (21 ± 9 vs. 28 ± 11 mL/kg; p < 0.01) were higher during ECMO than before. Increases in GEDVI (36 ± 210 vs. 378 ± 247 mL/m²; p = 0.02) and EVLWI (3 ± 2 vs. 11 ± 8 mL/kg; p = 0.06) were substantially more pronounced in patients with femoral compared to jugular indicator injection. In multivariate analysis, femoral indicator injection was independently associated with larger increases in GEDVI (p < 0.01) and EVLWI (p = 0.04) during ECMO. However, CI and haemodynamic parameters not derived from TPTD, but from pulse contour analysis (systolic and diastolic arterial pressure, stroke volume variation and pulse pressure variation) were not affected by the start of ECMO. Our study demonstrates marked increases in GEDVI and EVLWI after the onset of ECMO. These increases were more pronounced for femoral compared to jugular indicator injection. CI and haemodynamic parameters not derived from TPTD were not affected by the extra-corporeal circuit.

Nur mit Berechtigung zugänglich

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–63. https://doi.org/10.1016/s0140-6736(09)61069-2.CrossRefPubMed

Combes A, Hajage D, Capellier G, Demoule A, Lavoue S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–75. https://doi.org/10.1056/nejmoa1800385.CrossRefPubMed

Romagnoli S, Zagli G, Ricci Z, Villa G, Barbani F, Pinelli F, De Gaudio R, Chelazzi C. Cardiac output: a central issue in patients with respiratory extracorporeal support. Perfusion. 2017;32(1):44–9. https://doi.org/10.1177/0267659116658112.CrossRefPubMed

Huber W, Hollthaler J, Schuster T, Umgelter A, Franzen M, Saugel B, Cordemans C, Schmid RM, Malbrain ML. Association between different indexations of extravascular lung water (EVLW) and PaO₂/FiO₂: a two-center study in 231 patients. PLoS ONE. 2014;9(8):e103854. https://doi.org/10.1371/journal.pone.0103854.CrossRefPubMedPubMedCentral

Jozwiak M, Silva S, Persichini R, Anguel N, Osman D, Richard C, Teboul JL, Monnet X. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome. Crit Care Med. 2013;41(2):472–80. https://doi.org/10.1097/ccm.0b013e31826ab377.CrossRefPubMed

Cordemans C, De Laet I, Van Regenmortel N, Schoonheydt K, Dits H, Huber W, Malbrain ML. Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care. 2012;2(Suppl 1):S1. https://doi.org/10.1186/2110-5820-2-s1-s1.CrossRefPubMedPubMedCentral

Cordemans C, De Laet I, Van Regenmortel N, Schoonheydt K, Dits H, Martin G, Huber W, Malbrain ML. Aiming for a negative fluid balance in patients with acute lung injury and increased intra-abdominal pressure: a pilot study looking at the effects of PAL-treatment. Ann Intensive Care. 2012;2(Suppl 1):S15. https://doi.org/10.1186/2110-5820-2-s1-s15.CrossRefPubMedPubMedCentral

Haller M, Zollner C, Manert W, Briegel J, Kilger E, Polasek J, Hummel T, Forst H, Peter K. Thermodilution cardiac output may be incorrect in patients on venovenous extracorporeal lung assist. Am J Respir Crit Care Med. 1995;152(6 Pt 1):1812–7. https://doi.org/10.1164/ajrccm.152.6.8520741.CrossRefPubMed

Huber W, Fuchs S, Minning A, Kuchle C, Braun M, Beitz A, Schultheiss C, Mair S, Phillip V, Schmid S, Schmid RM, Lahmer T. Transpulmonary thermodilution (TPTD) before, during and after sustained low efficiency dialysis (SLED). A prospective study on feasibility of TPTD and prediction of successful fluid removal. PLoS ONE. 2016;11(4):e0153430. https://doi.org/10.1371/journal.pone.0153430.CrossRefPubMedPubMedCentral

10.

Sakka SG. Influence of an extracorporeal lung assist system on transpulmonary thermodilution-derived variables. Br J Anaesth. 2010;104(5):664–5. https://doi.org/10.1093/bja/aeq078.CrossRefPubMed

11.

Van Craenenbroeck A, Van Ingelgem A, Palmers PJ, Cordemans C, Van Hootegem A, Van Regenmortel N, De Laet I, Schoonheydt K, Dits H, Malbrain ML. Influence of continuous venovenous hemofiltration (CVVH) and catheter position on transpulmonary thermodilution derived parameters. Intensive Care Med. 2010;36(Supplem 2):S294.

12.

Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–33. https://doi.org/10.1001/jama.2012.5669.CrossRefPubMed

13.

Saugel B, Umgelter A, Schuster T, Phillip V, Schmid RM, Huber W. Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheter. Crit Care. 2010;14(3):R95. https://doi.org/10.1186/cc9030.CrossRefPubMedPubMedCentral

14.

Hofkens PJ, Verrijcken A, Merveille K, Neirynck S, Van Regenmortel N, De Laet I, Schoonheydt K, Dits H, Bein B, Huber W, Malbrain ML. Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review. Anaesthesiol Intensive Ther. 2015;47(2):89–116. https://doi.org/10.5603/ait.a2014.0068.CrossRefPubMed

15.

Malbrain ML, De Potter TJ, Dits H, Reuter DA. Global and right ventricular end-diastolic volumes correlate better with preload after correction for ejection fraction. Acta Anaesthesiol Scand. 2010;54(5):622–31. https://doi.org/10.1111/j.1399-6576.2009.02202.x.CrossRefPubMed

16.

Combes A, Brodie D, Bartlett R, Brochard L, Brower R, Conrad S, De Backer D, Fan E, Ferguson N, Fortenberry J, Fraser J, Gattinoni L, Lynch W, MacLaren G, Mercat A, Mueller T, Ogino M, Peek G, Pellegrino V, Pesenti A, Ranieri M, Slutsky A, Vuylsteke A. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014;190(5):488–96. https://doi.org/10.1164/rccm.201404-0630cp.CrossRefPubMed

17.

Tagami T, Nakamura T, Kushimoto S, Tosa R, Watanabe A, Kaneko T, Fukushima H, Rinka H, Kudo D, Uzu H, Murai A, Takatori M, Izumino H, Kase Y, Seo R, Takahashi H, Kitazawa Y, Yamaguchi J, Sugita M, Kuroki Y, Kanemura T, Morisawa K, Saito N, Irahara T, Yokota H. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care. 2014;4:27. https://doi.org/10.1186/s13613-014-0027-7.CrossRefPubMedPubMedCentral

18.

Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest. 2002;122(6):2080–6. https://doi.org/10.1378/chest.122.6.2080.CrossRefPubMed

19.

Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, McAuley DF. Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med. 2010;38(1):114–20. https://doi.org/10.1097/ccm.0b013e3181b43050.CrossRefPubMed

20.

Phillips CR, Chesnutt MS, Smith SM. Extravascular lung water in sepsis-associated acute respiratory distress syndrome: indexing with predicted body weight improves correlation with severity of illness and survival. Crit Care Med. 2008;36(1):69–73. https://doi.org/10.1097/01.ccm.0000295314.01232.be.CrossRefPubMed

21.

Berkowitz DM, Martin G. Extravascular lung water measurement in acute respiratory distress syndrome. Crit Care Med. 2009;37(1):378. https://doi.org/10.1097/ccm.0b013e31818f292f.CrossRefPubMed

22.

Groeneveld AB, Verheij J. Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS. Intensive Care Med. 2006;32(9):1315–21. https://doi.org/10.1007/s00134-006-0212-8.CrossRefPubMed

23.

Lahmer T, Mayr U, Rasch S, Batres Baires G, Schmid RM, Huber W. In-parallel connected intermittent hemodialysis through ECMO does not affect hemodynamic parameters derived from transpulmonary thermodilution. Perfusion. 2017;32(8):702–5. https://doi.org/10.1177/0267659117707816.CrossRefPubMed

24.

Pathil A, Stremmel W, Schwenger V, Eisenbach C. The influence of haemodialysis on haemodynamic measurements using transpulmonary thermodilution in patients with septic shock: an observational study. Eur J Anaesthesiol. 2013;30(1):16–20. https://doi.org/10.1097/eja.0b013e328358543a.CrossRefPubMed

25.

Compton F, Hoffmann C, Zidek W, Schmidt S, Schaefer JH. Volumetric hemodynamic parameters to guide fluid removal on hemodialysis in the intensive care unit. Hemodial Int. 2007;11(2):231–7. https://doi.org/10.1111/j.1542-4758.2007.00174.x.CrossRefPubMed

26.

Compton F, Vogel M, Zidek W, van der Giet M, Westhoff T. Changes in volumetric hemodynamic parameters induced by fluid removal on hemodialysis in critically ill patients. Ther Apher Dial. 2015;19(1):23–9. https://doi.org/10.1111/1744-9987.12193.CrossRefPubMed

27.

Kuhn C, Kuhn A, Rykow K, Osten B. Extravascular lung water index: a new method to determine dry weight in chronic hemodialysis patients. Hemodial Int. 2006;10(1):68–72. https://doi.org/10.1111/j.1542-4758.2006.01177.x.CrossRefPubMed

28.

De Laet I, Deeren D, Schoonheydt K, Van Regenmortel N, Dits H, Malbrain ML. Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients. Ann Intensive Care. 2012;2(Suppl 1):S20. https://doi.org/10.1186/2110-5820-2-s1-s20.CrossRefPubMed

29.

Redwan B, Ziegeler S, Freermann S, Meemann T, Semik M, Dickgerber N, Fischer S. Single-site low-flow veno-venous extracorporeal lung support does not influence hemodynamic monitoring by transpulmonary thermodilution. ASAIO J. 2016;62(4):454–7. https://doi.org/10.1097/mat.0000000000000379.CrossRefPubMed

30.

Haller M, Zollner C, Briegel J, Forst H. Evaluation of a new continuous thermodilution cardiac output monitor in critically ill patients: a prospective criterion standard study. Crit Care Med. 1995;23(5):860–6.CrossRefPubMed

31.

Sakka SG, Ruhl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000;26(2):180–7.CrossRefPubMed

32.

Linton RA, Band DM, Haire KM. A new method of measuring cardiac output in man using lithium dilution. Br J Anaesth. 1993;71(2):262–6. https://doi.org/10.1093/bja/71.2.262.CrossRefPubMed

33.

Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J. 2016;37(27):2097–104. https://doi.org/10.1093/eurheartj/ehw164.CrossRefPubMedPubMedCentral

Titel: Transpulmonary thermodilution before and during veno-venous extra-corporeal membrane oxygenation ECMO: an observational study on a potential loss of indicator into the extra-corporeal circuit
verfasst von: Alexander Herner
Tobias Lahmer
Ulrich Mayr
Sebastian Rasch
Jochen Schneider
Roland M. Schmid
Wolfgang Huber
Publikationsdatum: 05.11.2019
Verlag: Springer Netherlands
Erschienen in: Journal of Clinical Monitoring and Computing / Ausgabe 5/2020
Print ISSN: 1387-1307
Elektronische ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-019-00398-6

Neu im Fachgebiet AINS

24.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Transpulmonary thermodilution before and during veno-venous extra-corporeal membrane oxygenation ECMO: an observational study on a potential loss of indicator into the extra-corporeal circuit

Abstract

Neu im Fachgebiet AINS

Magen-Darm-Blutungen werden präklinisch oft falsch eingeschätzt

Sepsis-Verdacht: Eine Stunde, fünf essenzielle Maßnahmen

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Update AINS

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2020

Automated echocardiography for measuring and tracking cardiac output after cardiac surgery: a validation study

Impact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery

Non-invasive monitoring is coming the full circle, making our patients safer!

The incidence and interpretation of large differences in EIT-based measures for PEEP titration in ARDS patients

Continuous respiratory rate monitoring during an acute hypoxic challenge using a depth sensing camera

Quantitative sensory testing to evaluate and compare the results after epidural injection and simple discectomy, in patients with radiculopathy secondary to lumbar disc herniation

Neu im Fachgebiet AINS

Magen-Darm-Blutungen werden präklinisch oft falsch eingeschätzt

Sepsis-Verdacht: Eine Stunde, fünf essenzielle Maßnahmen

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Update AINS