Unusually High Global End Diastolic Index Associated with Optimal Cardiac Index in Two Critically Ill Patients

DOI

10.2991/icres.k.210406.002How to use a DOI?

Keywords

Cardiopulmonary physiological disorders; hemodynamic monitoring; pulse indicator continuous cardiac output (PiCCO); global end diastolic index (GEDI)

Abstract

The optimal management of hemodynamic disorders among critically ill patients requires an accurate assessment of hemodynamic status. Global End Diastolic Index (GEDI) is taken for a more reliable indicator of preload in critically ill patients than central venous pressure and doctors tend to arrange it among the normal ranges (680–800 ml/m²). Here we report a case with a relatively extremely high GEDI that initially erroneously led to a fluid restrictive treatment. An 83-year-old man was admitted to the intensive care unit (ICU) for dyspnea and severe hypoxemia following inefficient antibiotics treatment of bilateral pneumonia in emergency room. Failed with non-invasive positive pressure ventilation (NPPV), he was intubated and Pulse Indicator Continuous Cardiac Output (PiCCO) system was installed. Result shows extremely high GEDI 1620 ml/m², therefore continuous renal replacement therapy was initiated for negative fluid balance. When GEDI was reduced below 1300 ml/m², cardiac index (CI) decreased simultaneously. According to the Frank–Starling curve, GEDI of 1300 ml/m² was seemed as being associated with a maximal CI for the patient. Next chest roentgenogram and abdomen computer tomography (CT) scan showed three aneurysms which were responsible for the extremely high GEDI values due to special calculated methods in Newman model of the PiCCO principle. In such cases, ventricular function curve will be useful and recommended to assess the individually most appropriate GEDI.

Chinese Abstract

危重患者血流动力学紊乱的精准管理需要对血流动力学状态进行精确评估。与中心静脉压相比，全心舒张末期容积指数(Global End Diastolic Index，GEDI)被认为是评估危重患者前负荷更可靠的指标，临床医生常将其正常范围设为680-800 ml/m²。本文报道一例GEDI极高，并在初始治疗进行了错误地限制性液体治疗的病例。该病例是一位83岁老年男性，因双肺肺炎在急诊室进行抗生素治疗无效，后因呼吸困难、低氧血症收入ICU。给与无创正压通气(NPPV)治疗失败后，改为有创机械通气，并通过PiCCO系统监测血流动力学状态。PiCCO监测结果显示GEDI非常高，为1620 ml/m²，因此给予CRRT治疗，纠正液体负平衡。当GEDI低于1300 ml/m²时，同时伴有心脏指数(cardiac index，CI)的降低。根据Frank-Starling曲线，GEDI为1300 ml/m²时CI最大。胸部x线片和腹部CT结果显示机体存在3个动脉瘤，这是导致GEDI值极高的原因，该值是PiCCO系统基于Newman模型的计算方法，在这种情况下，建议采用心室功能曲线获得准确的GEDI值。

Copyright

© 2021 First Affiliated Hospital of Zhengzhou University. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Download article (PDF)
View full text (HTML)

TY  - JOUR
AU  - Xiaoqing Wu
AU  - Desheng Chen
AU  - Chen Li
AU  - Jun Duan
PY  - 2021
DA  - 2021/04/10
TI  - Unusually High Global End Diastolic Index Associated with Optimal Cardiac Index in Two Critically Ill Patients
JO  - Intensive Care Research
SP  - 31
EP  - 33
VL  - 1
IS  - 1-2
SN  - 2666-9862
UR  - https://doi.org/10.2991/icres.k.210406.002
DO  - 10.2991/icres.k.210406.002
ID  - Wu2021
ER  -