Determining Optimal Cardiac Preload during Resuscitation Using Measurements of Ventricular Compliance

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Abstract
While the right ventricular end-diastolic volume index (RVEDVI) has been shown to be a better indicator of preload than cardiac filling pressures, optimal values during resuscitation from trauma are unknown. This study examines right ventricular stiffness as a guide to optimal values of RVEDVI. Prospective study of 19 critically injured patients monitored with a volumetric pulmonary artery catheter during resuscitation. Per resuscitation protocol, the target RVEDVI was ≥ 120 mL/m2. Sequential fluid boluses of 500 to 1000 mL were administered to obtain at least four values of RVEDVI and right ventricular end-diastolic pressure (estimated by central venous pressure [CVP]). For each patient, nonlinear regression was used to construct the ventricular compliance curve based on the equation, CVP =a ek (RVEDVI), where k is the coefficient of chamber stiffness. Overall, the derived compliance curves had excellent fit with the theoretical equation (mean R 2, 0.95 ± 0.04). Mean k was 0.043 ± 0.012 (range, 0.029–0.067). For each patient, mean RVEDVI during resuscitation was significantly correlated with k (R 2 = 0.75, p < 10− 5) indicating that chamber stiffness, measured during initial fluid administration, may be used to determine RVEDVI during the ensuing resuscitation. In critically injured patients, bedside assessment of right ventricular compliance is possible and may help determine optimal values of RVEDVI during resuscitation.