Unusually High Global End Diastolic Index Associated with Optimal Cardiac Index in Two Critically Ill Patients

Abstract

Abstract The optimal management of hemodynamic disorders among critically ill patients requires an accurate assessment of hemodynamic status. Global End Diastolic Index (GEDI) is taken for a more reliable indicator of preload in critically ill patients than central venous pressure and doctors tend to arrange it among the normal ranges (680–800 ml/m2). Here we report a case with a relatively extremely high GEDI that initially erroneously led to a fluid restrictive treatment. An 83-year-old man was admitted to the intensive care unit (ICU) for dyspnea and severe hypoxemia following inefficient antibiotics treatment of bilateral pneumonia in emergency room. Failed with non-invasive positive pressure ventilation (NPPV), he was intubated and Pulse Indicator Continuous Cardiac Output (PiCCO) system was installed. Result shows extremely high GEDI 1620 ml/m2, therefore continuous renal replacement therapy was initiated for negative fluid balance. When GEDI was reduced below 1300 ml/m2, cardiac index (CI) decreased simultaneously. According to the Frank-Starling curve, GEDI of 1300 ml/m2 was seemed as being associated with a maximal CI for the patient. Next chest roentgenogram and abdomen computer tomography (CT) scan showed three aneurysms which were responsible for the extremely high GEDI values due to special calculated methods in Newman model of the PiCCO principle. In such cases, ventricular function curve will be useful and recommended to assess the individually most appropriate GEDI.

Keywords

• Cardiopulmonary physiological disorders
• hemodynamic monitoring
• pulse indicator continuous cardiac output (PiCCO)
• global end diastolic index (GEDI)