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Lutz J, Levenbrown Y, Hossain MJ, Hesek A, Massa KE, Keith JP, Shaffer TH. Impact of intravenous fluid administration on cardiac output and oxygenation during cardiopulmonary resuscitation. Intensive Care Med Exp 2023; 11:13. [PMID: 36959337 PMCID: PMC10036707 DOI: 10.1186/s40635-023-00497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The effect of intravenous fluid (IVF) administration during cardiopulmonary resuscitation (CPR) is an unexplored factor that may improve cardiac output (CO) during CPR. The aim of this study was to determine the effect of IVF administration on CO and oxygenation during CPR. METHODS This experimental animal study was performed in a critical care animal laboratory. Twenty-two Landrace-Yorkshire female piglets weighing 27-37 kg were anesthetized, intubated, and placed on positive pressure ventilation. Irreversible cardiac arrest was induced with bupivacaine. CPR was performed with a LUCAS 3 mechanical compression device. Pigs were randomized into IVF or no-IVF groups. Pigs in the IVF group were given 20 mL/kg of Plasma-Lyte (Baxter International, Deerfield, IL USA), infused from 15 to 35 min of CPR. CPR was maintained for 50 min with serial measurements of CO obtained using ultrasound dilution technology and partial pressure of oxygen (PaO2). RESULTS A mixed-effects repeated measures analysis of variance was used to compare within-group, and between-group mean changes in CO and PaO2 over time. CO and PaO2 for the piglets were measured at 10-min intervals during the 50 min of CPR. CO was greater in the IVF compared with the control group at all time points during and after the infusion of the IVF. Mean PaO2 decreased with time; however, at no time was there a significant difference in PaO2 between the IVF and control groups. CONCLUSIONS Administration of IVF during CPR resulted in a significant increase in CO during CPR both during and after the IVF infusion. There was no statistically significant decrease in PaO2 between the IVF and control groups.
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Affiliation(s)
- Jennifer Lutz
- Division of Pediatric Critical Care, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
| | - Yosef Levenbrown
- Division of Pediatric Critical Care, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
- Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Md Jobayer Hossain
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
- Department of Applied Economics and Statistics, University of Delaware, Newark, DE, USA
| | - Anne Hesek
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Kelly E Massa
- Department of Respiratory Care, Nemours Children's Health, Wilmington, DE, USA
| | - James P Keith
- Department of Respiratory Care, Nemours Children's Health, Wilmington, DE, USA
| | - Thomas H Shaffer
- Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Biomedical Research/Research Lung Center, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation. Intensive Care Med Exp 2020; 8:36. [PMID: 32712733 PMCID: PMC7382317 DOI: 10.1186/s40635-020-00330-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background Positive end-expiratory pressure (PEEP) is used to optimize oxygenation by preventing alveolar collapse. However, PEEP can potentially decrease cardiac output through cardiopulmonary interactions. The effect of PEEP on cardiac output during cardiopulmonary resuscitation (CPR) is not known. Methods This was a preclinical randomized, controlled, animal study conducted in an animal research facility on 25 Landrace-Yorkshire pigs. After inducing cardiac arrest, CPR was performed with LUCAS 3. During CPR, pigs were ventilated at a PEEP of 0, 5, 10, 15, 20 cmH2O (randomly determined via lottery) for 9 min. Cardiac output, obtained via ultrasound dilution, and PaO2 were measured, and oxygen delivery calculated for each PEEP. Results A mixed-effects repeated-measures analysis of variance was used to compare the baseline value adjusted mean cardiac output, PaO2, and oxygen delivery between PEEP groups. Least significant difference test was used to conduct pairwise comparisons between PEEP groups. To determine optimum PEEP, Gaussian mixture model was applied to the adjusted means of cardiac output and oxygen delivery. Increasing PEEP to 10 and higher resulted in significant declines in cardiac output. A PEEP of 15 and higher resulted in significant declines in oxygen delivery. As PEEP was increased from 0 to 20, PaO2 increased significantly. Gaussian mixture model identified the 0–5 PEEP group as providing optimal cardiac output and oxygen delivery, with PEEP of 5 providing the highest oxygen delivery. Conclusions A PEEP of 0–5 resulted in the optimal oxygen delivery and cardiac output during CPR, with PEEP of 5 resulting in higher oxygen delivery, and a slightly lower, statistically insignificant cardiac output than PEEP of 0.
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Feasibility and Accuracy of Cardiac Right-to-Left-Shunt Detection in Children by New Transpulmonary Ultrasound Dilution Method. Pediatr Cardiol 2017; 38:135-148. [PMID: 27826705 DOI: 10.1007/s00246-016-1494-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
Transpulmonary ultrasound dilution (TPUD) method, a novel indicator dilution (ID) technique for cardiac output measurement, detects and quantifies shunts, both in children and adults. However, its accuracy and reproducibility in cardiac right-to-left-shunt (RLS) detection have not been investigated. In a prospective observational study, we assessed the validity of TPUD algorithm for RLS detection in children with congenital heart disease (CHD) and proven RLS in comparison with controls without shunts between February 2010 and October 2011. As TPUD algorithm was unknown, we tested ID curve morphology, appearance time (AT) and central blood volume index (CBVI) as diagnostic criteria. TPUD identified RLS correctly in all 16 RLS subjects [median age (range): 18 months (1 month-15 years 6 months)] and excluded RLS in all 26 controls [74 months (8 months to 17 years 4 months)]. AT was significantly shorter in RLS (P < 0.05). Applying only AT (93.8 % sensitivity, 92.3 % specificity), RLS can be detected by shortening of ≥1.69 s of normally expected AT. RLS ID curves were subdivided into four morphological categories: (I) hump-on-upslope (n = 5); (II) double-hump (n = 3); (III) pseudonormal (n = 3); (IV) abnormal width (n = 5). No correlation was found between specific type of CHD and RLS categories. CBVI measurements were significantly smaller in RLS categories I-III than in controls (P < 0.05). TPUD appears to be a valid method for cardiac RLS detection. Shortened AT and low CBVI are reliable parameters for RLS identification. RLS categories have specific implications for cardiac output, blood volume and RLS fraction measurements. TPUD is valuable to monitor shunt direction and magnitude to optimise haemodynamic and respiratory therapy.
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Vrancken SL, van Heijst AF, Hopman JC, Liem KD, van der Hoeven JG, de Boode WP. Detection and quantification of left-to-right shunting using transpulmonary ultrasound dilution (TPUD): a validation study in neonatal lambs. J Perinat Med 2016; 44:925-932. [PMID: 27159914 DOI: 10.1515/jpm-2015-0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 03/31/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We investigated the accuracy of left-to-right shunt detection using transpulmonary ultrasound dilution (TPUD) and compared the agreement between pulmonary over systemic blood flow (Qp/Qs) ratio measured by TPUD [Qp/Qs(tpud)] and ultrasonic flow probes [Qp/Qs(ufp)]. METHODS Seven newborn lambs under general anesthesia were connected to the TPUD monitor (COstatus™) after insertion of arterial and central venous catheters. A Gore-Tex® shunt, inserted between the descending aorta and left pulmonary artery, was intermittently opened and closed while cardiac output was varied by blood withdrawals. Flow probes were placed around the main pulmonary artery (Qufp) and the descending aorta proximal (Qpre) and distal (Qpost) to the shunt insertion. Qp/Qs(ufp) was calculated as (Qufp+Qpre-Qpost)/Qufp. RESULTS Seventy-two paired measurement sessions were analyzed. Shunts were detected by TPUD with a positive predictive value of 86%, a negative predictive value of 100%, a sensitivity of 100% and a specificity of 83%. The Bland-Altman analysis comparing Qp/Qs(tpud) and Qp/Qs(ufp) showed an overall mean bias (SD) of 0.1 (0.3), limits of agreement (LOA) of ±0.6 and a percentage error of 34.8%. CONCLUSIONS The qualitative diagnostic accuracy of TPUD for shunt detection is high. Modification of the algorithm seems required as shunt quantification by TPUD is accurate, but not yet very precise.
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Linden K, Ladage D, Dewald O, Gatzweiler E, Pieper A, Seehase M, Duerr GD, Breuer J, Herberg U. Comparison of stroke volumes assessed by three-dimensional echocardiography and transpulmonary thermodilution in a pediatric animal model. J Clin Monit Comput 2016; 31:353-360. [PMID: 26886899 DOI: 10.1007/s10877-016-9843-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/14/2016] [Indexed: 02/02/2023]
Abstract
To compare stroke volumes (SV) in small hearts assessed by real-time three-dimensional echocardiography (3DE) with SV measured by transpulmonary thermodilution (TPTD) and continuous pulse contour analysis (PC) under various hemodynamic conditions. In thirteen anesthetized piglets (range 3.6-7.1 kg) SV were measured by 3DE, TPTD and PC at baseline and during phenylephrine and esmolol administration. 3DE and TPTD measurements were done successively while SV calculated by PC was documented at the time of 3DE. 3DE and TPTD showed a good correlation (r2 = 0.74) and a bias of -1.3 ml (limits of agreement -4.1 to 1.5 ml). While TPTD measured higher SV than 3DE, both methods tracked SV changes with a concordance rate of 91 %. PC and 3DE showed a lower correlation coefficient of r2 = 0.57 and a bias of -2.1 ml (limits of agreement -5.9 to 1.8 ml). Inter- and intra-observer variability of SV measured by 3DE was good with a mean bias <5 %. SV3DE showed a small variance and tracked acute small changes in SV in acceptable concordance with TPTD. PC measured SV with a higher variance and mean difference compared to 3DE. In an experimental setting 3DE has the possibility to offer non-invasive assessments of ventricular volumes volume changes. To determine whether 3DE could be used for SV assessment in a clinical routine our results need confirmation in a clinical setting.
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Affiliation(s)
- Katharina Linden
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
| | - Dennis Ladage
- Department of Internal Medicine III, Heart Center, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, Pediatric Heart Center, University Clinical Center Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Eva Gatzweiler
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Andrea Pieper
- House of Experimental Therapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Matthias Seehase
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiac Surgery, Pediatric Heart Center, University Clinical Center Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
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Hemodynamic volumetry using transpulmonary ultrasound dilution (TPUD) technology in a neonatal animal model. J Clin Monit Comput 2014; 29:643-52. [PMID: 25500953 DOI: 10.1007/s10877-014-9647-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
To analyze changes in cardiac output and hemodynamic volumes using transpulmonary ultrasound dilution (TPUD) in a neonatal animal model under different hemodynamic conditions. 7 lambs (3.5-8.3 kg) under general anesthesia received arterial and central venous catheters. A Gore-Tex(®) shunt was surgically inserted between the descending aorta and the left pulmonary artery to mimic a patent ductus arteriosus. After shunt opening and closure, induced hemorrhagic hypotension (by repetitive blood withdrawals) and repetitive volume challenges, the following parameters were assessed using TPUD: cardiac output, active circulating volume index (ACVI), central blood volume index (CBVI) and total end-diastolic volume index (TEDVI). 27 measurement sessions were analyzed. After shunt opening, there was a significant increase in TEDVI and a significant decrease in cardiac output with minimal change in CBVI and ACVI. With shunt closure, these results reversed. After progressive hemorrhage, cardiac output and all volumes decreased significantly, except for ACVI. Following repetitive volume resuscitation, cardiac output increased and all hemodynamic volumes increased significantly. Correlations between changes in COufp and changes in hemodynamic volumes (ACVI 0.83; CBVI 0.84 and TEDVI 0.78 respectively) were (slightly) better than between changes in COufp and changes in heart rate (0.44) and central venous pressure (0.7). Changes in hemodynamic volumes using TPUD were as expected under different conditions. Hemodynamic volumetry using TPUD might be a promising technique that has the potential to improve the assessment and interpretation of the hemodynamic status in critically ill newborns and children.
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Boehne M, Baustert M, Paetzel V, Köditz H, Schoof S, Happel CM, Bertram H. Determination of cardiac output by ultrasound dilution technique in infants and children: a validation study against direct Fick principle. Br J Anaesth 2013; 112:469-76. [PMID: 24335550 DOI: 10.1093/bja/aet382] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In critically ill children, monitoring of cardiac output (CO) is essential to guide haemodynamic management and facilitate cardiovascular therapy. The ultrasound dilution technique (UDT), a novel minimally invasive indicator method, was recently introduced to determine CO. We validated UDT against the 'gold standard' reference technique, the direct Fick principle, in infants and children. METHODS Twenty-six children (median age: 6 yr 2 months; median weight: 19.2 kg) underwent diagnostic heart catheterization. In each child, CO was determined by the Fick principle using direct measurement of oxygen consumption and invasive oximetry. Consecutively, haemodynamically stable conditions provided; three independent measurements of CO were conducted with UDT. CO values were compared using bias and limits of agreement calculated using the Bland-Altman approach and linear regression analysis for the complete study group and for a subgroup with body weight <20 kg (n=14). RESULTS The mean (standard deviation) CO values were 3.76 (1.73) litre min(-1) (range 1.38-6.97) for the direct Fick principle and 3.49 (1.72) litre min(-1) (range 1.31-7.00) for UDT. An excellent correlation (r=0.96) was found between both methods (P<0.0001). The Bland-Altman analysis demonstrated good clinical agreement with a mean bias of 0.26 litre min(-1), limits of agreement of -0.66 and 1.19 litre min(-1), and percentage error of 25.9%. Comparable results were obtained for patients <20 kg (mean bias=0.19 litre min(-1), percentage error=25.5%). CONCLUSIONS CO measurements by UDT agree favourably with Fick-derived CO data and both techniques were found to be equivalent and interchangeable. UDT represents a valid and applicable method for repetitive CO determinations in infants and children.
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Affiliation(s)
- M Boehne
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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