Critical Care Medicine

Adult Critical Care

Pre-Ejection Period to Estimate Cardiac Preload Dependency in Mechanically Ventilated Pigs Submitted to Severe Hemorrhagic Shock

Giraud R, Siegenthaler N, Morel DR, et al (Intensive Care Unit, Geneva University Hospitals, CH-1211 Geneva 14; Division d’Investigations Anesthésiologiques, Geneva Medical School, Geneva) J Trauma 71:702-707, 2011^§

Abstract

Background

Respiratory change in pre-ejection period (ΔPEP) has been described as a potential parameter for monitoring cardiac preload dependency in critically ill patients. This study was designed to describe the relationship between ΔPEP and pulse pressure variation (PPV) in pigs submitted to severe hemorrhagic shock.

Methods

In 17 paralyzed, anesthetized mechanically ventilated pigs, electrocardiography, arterial pressure, and cardiac output derived from pulmonary artery catheter were recorded. Hemorrhagic shock was induced by removal of blood volume followed by restoration. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the invasive radial arterial pressure curve.

Results

At baseline, ΔPEP and PPVs were both <12% with PPV significantly correlated with ΔPEP (r = 0.96, p < 0.001). Volume loss induced by hemorrhage significantly increased PPV and ΔPEP values (p < 0.05). During severe hemorrhage, PPV correlated well with ΔPEP (r = 0.88, p < 0.001) with PPV values significantly higher than ΔPEP (p < 0.05). However, the reproducibility of ΔPEP measurements was significantly better than PPV during this step (p < 0.05). Retransfusion significantly decreased PPV and ΔPEP (p < 0.05) with PPV significantly correlated to ΔPEP (r = 0.94, p < 0.001).

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