Preload Assessment in Trauma Patients During Large-Volume Shock Resuscitation

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Abstract
Objectives: To evaluate the utility of the right ventricular end-diastolic volume index (RVEDVI) as a method of preload assessment in trauma patients during large-volume shock resuscitation, and to compare the RVEDVI with the pulmonary artery occlusion pressure (PAOP) as a predictor of preload in this patient population. Design: Retrospective study of a consecutive series of 46 trauma patients, admitted between June 1, 1992, and June 1, 1993, who received a volumetric oximetry pulmonary artery catheter and greater than 10 L of fluid in 24 hours. Setting: University level I trauma center. Main Outcome Measures: Correlations of the RVEDVI and PAOP with the cardiac index (CI) during the defined study period. Results: Three hundred fourteen measurements of the RVEDVI, PAOP, CI, and other hemodynamic variables were evaluated. Patients received a mean±SD of 22.1± 13.3 L of blood and fluid during the 24 hours. The RVEDVI correlated better (P<.001) with the CI (r=0.39) than did the PAOP (r=0.05). Furthermore, there was a better correlation (P<.04) between the RVEDVI and CI when the RVEDVI was 130 mL/m2or less (r=0.54) than when it was greater than 130 mL/m2(r=0.30). Conclusions: The RVEDVI is a better predictor of preload than the PAOP in trauma patients during large-volume shock resuscitation. When the RVEDVI is 130 mL/m2or less, volume administration will likely increase the CI. Arch Surg. 1996;131:728-731