Limitations of global end-diastolic volume index as a parameter of cardiac preload in the early phase of severe XXXX : a subgroup analysis of a multicenter, prospective observational study.

@entity1 @entity64 @entity295 @entity308 @entity296 @entity6355 @entity649 @entity3257 @entity647
BACKGROUND: In @entity1 with severe @entity295 , @entity308 of cardiac performance is common and is often associated with left ventricular (LV) dilatation to maintain @entity64 volume. Although it is essential to optimize cardiac preload to maintain tissue perfusion in @entity1 with severe @entity295 , the optimal preload remains unknown. This study aimed to evaluate the reliability of global end-diastolic volume index (GEDI) as a parameter of cardiac preload in the early phase of severe @entity295 . METHODS: Ninety-three mechanically ventilated @entity1 with @entity647 /acute @entity649 syndrome secondary to @entity295 were enrolled for subgroup analysis in a multicenter, prospective, observational study. @entity1 were divided into two groups-with @entity295 -induced @entity296 ( @entity3257 ) and without @entity3257 ( @entity3257 )-according to a threshold LV ejection fraction (LVEF) of 50% on the day of enrollment. Both groups were further subdivided according to a threshold @entity64 volume variation ( @entity6355 ) of 13% as a parameter of fluid responsiveness. RESULTS: On the day of enrollment, there was a positive correlation (r   =   0.421, p   =   0.045) between GEDI and @entity6355 in the @entity3257 group, whereas this paradoxical correlation was not found in the @entity3257 group and both groups on day 2. To evaluate the relationship between attainment of cardiac preload optimization and GEDI value, GEDI with @entity6355  <=13% and @entity6355 >13% was compared in both the @entity3257 and @entity3257 groups. @entity6355  <=13% implies the attainment of cardiac preload optimization. Among @entity1 with @entity3257 , GEDI was higher in @entity1 with @entity6355 >13% than in @entity1 with @entity6355  <=13% on the day of enrollment (872 [785-996] mL/m(2) vs. 640 [597-696] mL/m(2); p   <   0.001); this finding differed from the generally recognized relationship between GEDI and @entity6355 . However, GEDI was not significantly different between @entity1 with @entity6355  <=13% and @entity6355 >13% in the @entity3257 group on the day of enrollment and both groups on day 2. CONCLUSIONS: In the early phase of severe @entity295 in mechanically ventilated @entity1 , there was no constant relationship between GEDI and fluid reserve responsiveness, irrespective of the presence of @entity3257 . GEDI should be used as a cardiac preload parameter with awareness of its limitations.
