Assessment of Cardiac Index in Anemic Patients

During isovolemic hemodilution, healthy individuals maintain oxygen consumption( V˙o2) by identical increases in cardiacindex (CI) and oxygen extraction ratio (O2ER). Incritically ill patients, the relationship between CI and , O2ER may be different. Patients with an altered cardiacfunction may have...

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Veröffentlicht in:Chest 2000-09, Vol.118 (3), p.782-787
Hauptverfasser: Yalavatti, Gangadhar S., De Backer, Daniel, Vincent, Jean-Louis
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Sprache:eng
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Zusammenfassung:During isovolemic hemodilution, healthy individuals maintain oxygen consumption( V˙o2) by identical increases in cardiacindex (CI) and oxygen extraction ratio (O2ER). Incritically ill patients, the relationship between CI and , O2ER may be different. Patients with an altered cardiacfunction may have a decreased CI/O2ER ratio, whereaspatients with sepsis may have an increased CI/O2ER ratio. We hypothesized that the analysis of the CI-O2ERrelationship could help us to assess the adequacy of cardiac functionin critically ill patients with anemia. Prospective, observational study. Thirty-one-bed medicosurgical ICU of a university hospital. Sixty patients equipped with arterial and , Swan-Ganz catheters presenting with anemia, which was defined as ahemoglobin level ≤ 10 g/dL in the absence of active bleeding. Patients were classified into those with compromised cardiac function(group 1; n = 40), and those with normal cardiac function(group 2; n = 20). Inaddition to the pertinent clinical data, initial hemodynamicmeasurements, including pulmonary artery occlusion pressure (PAOP), CI,and O2ER, were collected in all patients at the onset ofanemia. As anticipated, group 1 patients (n = 40) had lower CIs, higher O2ER levels, and lower CI/O2ER ratiosthan group 2 patients. However, there was no significant difference in, PAOP values between the groups. The CI/O2ER ratio was< 10 in 27 of 40 group 1 patients but only in 4 of 20 group 2patients. Of these latter four patients, three were found to behypovolemic, and one patient with sepsis had severe myocardialdepression. There was no statistically significant difference in PAOPin group 2 patients with or without hypovolemia ([mean ± SD]12.3 ± 2.1 mm Hg) vs 13.7 ± 4.3 mm Hg; p = 0.21). In group 1,survivors had a higher CI and CI/O2ER ratio thannonsurvivors. In group 2, however, such a relationship did not reachstatistical significance. Therelationship between CI and O2ER level can help interpretthe CI in anemic patients. In anemic patients with no cardiac history, a low CI/O2ER ratio (< 10) suggests hypovolemia even when, CI is not depressed.
ISSN:0012-3692
1931-3543
DOI:10.1378/chest.118.3.782