Introduction
Estimation of cardiac preload is an important prerequisite for adequate volume resuscitation. The global end-diastolic volume (GEDV) and the global end-diastolic volume index (GEDVI) are surrogate parameters for preload and have been hypothesized to be age dependent [1]. The current study was performed to assess the influence of age on the preload parameters GEDV and GEDVI prospectively.
Methods
One hundred and one patients (41 male, 60 female) scheduled for brain tumour surgery were investigated using the PiCCOplus device (Pulsion Medical Systems AG, Munich, Germany). On postoperative day 1, the cardiac output, GEDV and GEDVI were determined by transpulmonary thermodilution before discharge from the ICU. The influence of predefined age groups (21 to 40 years old, n = 12; 41 to 50 years old, n = 24; 51 to 60 years old, n = 20; 61 to 70 years old, n = 26; 71 to 83 years old, n = 19) was tested using a Kruskal–Wallis test. The level of significance was 5%.
Results
Age significantly influenced the GEDV (P = 0.0024) as well as the GEDVI (P = 0.0007). Cardiac output (P = 0.3555), mean arterial pressure (P = 0.0764) and systemic vascular resistance (P = 0.1446) were not dependent on age.
Conclusion
The volumetric parameter GEDV is dependent on age in haemodynamically healthy and spontaneously breathing patients. Indexing to body surface area does not remove age dependence. Targeting volume resuscitation using fixed ranges of the GEDVI acquired by transpulmonary thermodilution without reference to the patient's age seems not to be appropriate.
Table 1.
GEDV in age groups
| 21 to 40 years old | 41 to 50 years old | 51 to 60 years old | 61 to 70 years old | 71 to 83 years old | |
|---|---|---|---|---|---|
| GEDV (ml) | 1,154 (1,442 to 980) | 1,156 (1,295 to 975) | 1,183 (1,352 to 1,074) | 1,462 (1,630 to 1,182) | 1,337 (1,567 to 1,157) |
| GEDVI (ml/m2) | 612 (674 to 548) | 598 (680 to 557) | 652 (752 to 597) | 756 (875 to 655) | 734 (781 to 634) |
Data presented as median (75th to 25th quartile).
References
- Wolf S. et al. ITBV and GEDV but not EVLW acquired by transpulmonary thermodilution is age dependent in a series of neurosurgical patients [poster] Intensive Care Med. 2007;13(S2):P0273. [Google Scholar]