Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection
Purpose: Transpulmonary thermodilution (TPTD) is usually performed by jugular indicator injection. In clinical practice, femoral venous access is often used instead, resulting in substantial overestimation of global end-diastolic volume index (GEDVI). A correction formula compensates for that. The...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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AIMS Press
2023-03-01
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| Series: | Mathematical Biosciences and Engineering |
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| Online Access: | https://www.aimspress.com/article/doi/10.3934/mbe.2023433?viewType=HTML |
| _version_ | 1797844378860912640 |
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| author | Hannah Schuster Bernhard Haller Sengül Sancak Johanna Erber Roland M. Schmid Tobias Lahmer Sebastian Rasch |
| author_facet | Hannah Schuster Bernhard Haller Sengül Sancak Johanna Erber Roland M. Schmid Tobias Lahmer Sebastian Rasch |
| author_sort | Hannah Schuster |
| collection | DOAJ |
| description | Purpose:
Transpulmonary thermodilution (TPTD) is usually performed by jugular indicator injection. In clinical practice, femoral venous access is often used instead, resulting in substantial overestimation of global end-diastolic volume index (GEDVI). A correction formula compensates for that. The objective of this study is to first evaluate the efficacy of the currently implemented correction function and then further improve this formula.
Methods:
The performance of the established correction formula was investigated in our prospectively collected dataset of 98 TPTD measurements from 38 patients with both, jugular and femoral venous access. Subsequently, a new correction formula was developed: cross validation revealed the favourite covariate combination and a general estimating equation provided the final version, which was tested in a retrospective validation on an external dataset.
Results:
Investigating the current correction function revealed a considerable reduction of bias compared to no correction. Concerning the objective of formula development, the covariate combination of GEDVI obtained after femoral indicator injection, age and body surface area is even favoured, when compared to the parameters of the previously published correction formula, as a further reduction of mean absolute error (68 vs. 61 ml/m2), a better correlation (0.90 vs. 0.91) and an increased adjusted R2 (0.72 vs 0.78) is noticed in the cross validation results. Of particular clinical importance is, that more measurements were correctly assigned to the same GEDVI category (decreased / normal / increased) using the revised formula, compared with the gold standard of jugular indicator injection (72.4 vs. 74.5%). In a retrospective validation, the newly developed formula showed a greater reduction of bias (to 2 vs. 6 %) than the currently implemented formula.
Conclusions:
The currently implemented correction function partly compensates for GEDVI overestimation. Applying the new correction formula on GEDVI measured after femoral indicator administration enhances the informative value and reliability of this preload parameter. |
| first_indexed | 2024-04-09T17:21:30Z |
| format | Article |
| id | doaj.art-64dd9002b8da4ab390ca8513f79d6549 |
| institution | Directory Open Access Journal |
| issn | 1551-0018 |
| language | English |
| last_indexed | 2024-04-09T17:21:30Z |
| publishDate | 2023-03-01 |
| publisher | AIMS Press |
| record_format | Article |
| series | Mathematical Biosciences and Engineering |
| spelling | doaj.art-64dd9002b8da4ab390ca8513f79d65492023-04-19T01:17:36ZengAIMS PressMathematical Biosciences and Engineering1551-00182023-03-012069876989010.3934/mbe.2023433Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injectionHannah Schuster 0Bernhard Haller1Sengül Sancak2Johanna Erber 3Roland M. Schmid4Tobias Lahmer5Sebastian Rasch61. Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany2. Institute of AI and Informatics in Medicine, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany1. Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany1. Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany1. Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany1. Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany1. Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, GermanyPurpose: Transpulmonary thermodilution (TPTD) is usually performed by jugular indicator injection. In clinical practice, femoral venous access is often used instead, resulting in substantial overestimation of global end-diastolic volume index (GEDVI). A correction formula compensates for that. The objective of this study is to first evaluate the efficacy of the currently implemented correction function and then further improve this formula. Methods: The performance of the established correction formula was investigated in our prospectively collected dataset of 98 TPTD measurements from 38 patients with both, jugular and femoral venous access. Subsequently, a new correction formula was developed: cross validation revealed the favourite covariate combination and a general estimating equation provided the final version, which was tested in a retrospective validation on an external dataset. Results: Investigating the current correction function revealed a considerable reduction of bias compared to no correction. Concerning the objective of formula development, the covariate combination of GEDVI obtained after femoral indicator injection, age and body surface area is even favoured, when compared to the parameters of the previously published correction formula, as a further reduction of mean absolute error (68 vs. 61 ml/m2), a better correlation (0.90 vs. 0.91) and an increased adjusted R2 (0.72 vs 0.78) is noticed in the cross validation results. Of particular clinical importance is, that more measurements were correctly assigned to the same GEDVI category (decreased / normal / increased) using the revised formula, compared with the gold standard of jugular indicator injection (72.4 vs. 74.5%). In a retrospective validation, the newly developed formula showed a greater reduction of bias (to 2 vs. 6 %) than the currently implemented formula. Conclusions: The currently implemented correction function partly compensates for GEDVI overestimation. Applying the new correction formula on GEDVI measured after femoral indicator administration enhances the informative value and reliability of this preload parameter.https://www.aimspress.com/article/doi/10.3934/mbe.2023433?viewType=HTMLintensive carehemodynamic monitoringtranspulmonary thermodilutionglobal end-diastolic volume indexvenous catheter siteoverestimationcorrectionpreload |
| spellingShingle | Hannah Schuster Bernhard Haller Sengül Sancak Johanna Erber Roland M. Schmid Tobias Lahmer Sebastian Rasch Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection Mathematical Biosciences and Engineering intensive care hemodynamic monitoring transpulmonary thermodilution global end-diastolic volume index venous catheter site overestimation correction preload |
| title | Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection |
| title_full | Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection |
| title_fullStr | Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection |
| title_full_unstemmed | Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection |
| title_short | Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection |
| title_sort | transpulmonary thermodilution a revised correction formula for global end diastolic volume index derived after femoral indicator injection |
| topic | intensive care hemodynamic monitoring transpulmonary thermodilution global end-diastolic volume index venous catheter site overestimation correction preload |
| url | https://www.aimspress.com/article/doi/10.3934/mbe.2023433?viewType=HTML |
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