3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 1

P17: Differences between room-temperature vs iced saline indicator injection for transpulmonary thermodilution

De Vos Jelke, ICU ZNA Stuivenberg, BelgiumHofkens P-J1, Verburgh P1, Van De Kerkhove C1, Philipse

E1, Huygh J1, Van Regenmortel N1, De laet I1, Schoonheydt K1, Dits H1, Saugel B2, Huber W2, Malbrain MLNG1

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 2

Introduction

• Cardiac index is a cornerstone of goal-directed therapy.

• Ice-cold injectate is assumed to provide best accuracy of transpulmonary thermodilution (TPTD)-derived CI, GEDVI and EVLWI.

• Room-temperature injectate might facilitate TPTDs outside the ICU, e.g. in the operating room.

• This substantiated by few data.

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 3

Methods• 26 adult mixed ICU-patients with PiCCO-

monitoring (Pulsion Medical Systems, Munich, Germany)

• 6x 20ml TPTDs (3 times with room temperature 22°C and 3 times with ice-cold 4°C saline).

• Means of the 3 room-temperature TPTDs were compared with the means of the 3 cold TPTDs (primary endpoint)

• Bland-Altman • Means of 1st warm and 1st cold measurements

were compared to means of the 2nd measurements.

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 4

Mean ValuesTPTDRoom TPTDIced

Injectate Temp (°C)

23.4 ±1.6 4.5 ±2.6

Cardiac IndexL/min*m²

4.0 ±1.0 3.8 ±1.0

GEDVImL/m²

804 ±190

766 ±198

EVWLImL/kg

10.5 ±3.4 9.5 ±3.6

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 5

Correlations

1.0 2.0 3.0 4.0 5.0 6.0 7.00.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

f(x) = 0.924965254502722 x + 0.0689300294732016R² = 0.929158289980161

400.0 600.0 800.0 1000.0 1200.0 1400.0400.0

500.0

600.0

700.0

800.0

900.0

1000.0

1100.0

1200.0

1300.0

f(x) = 0.998293229513765 x − 37.1649489305001R² = 0.921710731184244

4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 22.00.0

5.0

10.0

15.0

20.0

25.0

f(x) = 0.96661717860386 x − 0.163156857940423R² = 0.960885765321496

GEDVI

EVLWI

CI

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 6

Bland and Altman

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

1.5

2.0Bland-Altman

(CIroom+CIcold)/2 (L/min.m2)

CIc

old

- C

Iro

om

(L

/min

.m2

)

mean 3,9 -0,2 SD 1,0 0,28 min/LLA 1,5 -0,8 max/ULA 5,6 0,3

PE 14%

CI

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 7

Bland and Altman (volumes)

0.0 250.0 500.0 750.0 1000.0 1250.0 1500.0

-500.0

-400.0

-300.0

-200.0

-100.0

0.0

100.0

200.0

300.0

400.0

500.0Bland-Altman

(GEDVIroom + GEDVIcold)/2 (ml/m2)

GE

DV

Ico

ld-G

ED

VIr

oo

m (

ml/m

2)

0.0 5.0 10.0 15.0 20.0 25.0

-5.0

-4.0

-3.0

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

Bland-Altman

(TDCI + PULSECI)/2 [l/min]

TDC

I-PU

LSE

CI

[l/m

in]

GEDVI EVLWI

PE 18%

PE 13%

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 8

1st measurement2nd measurement3th measurement

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 9

Effect 1st measurement• Means of first warm and first cold

measurement exceeded means of second measurements for CI, GEDVI, EVLWIMeasurement 1st 2ndCardiac IndexL/min*m²

3,9 ±1.0 3.8 ±1.0

GEDVImL/m²

799 ±194 778 ±191

EVWLImL/kg

10.3 ±3.5 10,2 ±3.4

3rd iFAD 29/11/2013 Room vs Ice Temperature in TPTD 10

Conclusions

• TPTDRoom results in slight, but significant overestimation of CI, GEDVI and EVLWI.

• In routine, bias and PE values are acceptable for CI and EVLWI.

• Loss of indicator within the catheter may result in significant (albeit clinically irrelevant) overestimation of 1st measurements of CI and GEDVI.