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TECHNOLOGY, COMPUTING, AND SIMULATION

An Evaluation of the Initial Distribution Volume of Glucose to Assess Plasma Volume During a Fluid Challenge

Surgical Intensive Care Unit, University Hospital, 1011 Lausanne, Switzerland

Address correspondence and reprint requests to Jean-Pierre Revelly, MD, Surgical Intensive Care Unit, Room 08. 652, Lausanne University Hospital, CH-1011 Lausanne, Switzerland. Address e-mail to jrevelly{at}chuv.hospvd.ch.

Circulation blood volume can be estimated with the initial distribution volume of glucose (IDVG) method. In a prospective, observational study, we evaluated the effect of a fluid challenge on IDVG in individual patients. In 13 patients after cardiac surgery, IDVG was determined before and after the infusion of 7 mL/kg hydroxyethyl starch over 30 min. Eleven patients not requiring a fluid challenge served as control. IDVG was computed with a one-compartment exponential model, using plasma glucose concentrations at baseline and 3, 4, 5, 6, and 7 min after 5 g of glucose IV bolus. IDVG was repeated 3 times in the control group. IDVG did not change after a fluid challenge (85 ± 14 versus 93 ± 14 mL/kg, P = 0.08), and the power of the comparison was 0.25 for a P value of 0.05. The regression coefficient of the exponential fit of glucose versus time was 0.96 ± 0.03 before, and 0.95 ± 0.04 after starch infusion (not significant). In the control group, IDVG was 90 ± 18 mL/kg, and the average individual coefficient of variation was 0.15 ± 0.08. IDVG seems inadequate to assess individual response to fluid therapy. This limitation may be related to the weak reproducibility of IDVG.

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