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Kim YH, Lee JH. Prediction of fluid responsiveness in spontaneously breathing patients with hemodynamic stability: a prospective repeated-measures study. Sci Rep 2024; 14:14451. [PMID: 38914634 PMCID: PMC11196262 DOI: 10.1038/s41598-024-65554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/20/2024] [Indexed: 06/26/2024] Open
Abstract
Evaluating fluid responsiveness with dynamic parameters is recommended for fluid management. However, in hemodynamically stable patients who are breathing spontaneously, accurately measuring stroke volume variation via echocardiography and passive leg raising is challenging due to subtle SV changes. This study aimed to identify normal SV changes in healthy volunteers and evaluate the precision of hemodynamic parameters in screening mild hypovolemia in patients. This prospective, repeated-measures, cross-sectional study screened 269 subjects via echocardiography. Initially, 45 healthy volunteers underwent a fluid challenge test, the outcomes of which served as criteria to screen 215 ICU patients. Among these patients, 53 underwent additional fluid challenge testing. Hemodynamic parameters, including medians of maximum velocity time integrals (VTImaxs), peak velocity of VTImax (PV), internal jugular vein diameters (IJVD), and area (IJVA) were repeatedly measured first at a 60° upper body elevation (UBE), second in a supine position, third at UBE, fourth in a supine position, and lastly in a supine position after fluid loading. The hemodynamic responses to the position changes were compared between 83 fluid non-responders and 15 fluid responders. Fluid responsiveness was defined as fluid-induced medians' change of VTImaxs (fluid-induced median VTImax change) ≥ 10%. None of the healthy volunteers showed the mean value of repeatedly measured medians of VTImaxs ≥ 7%, following either UBE position (UBE-induced median VTImax change) or fluid loading (fluid-induced median VTImax change). UBE-induced median VTImax and PV changes were significantly correlated with fluid responsiveness (p < 0.001, AUC 0.959; p < 0.001, AUC 0.804). The significant correlations were demonstrated via multivariable analysis using binary logistic regression (p = 0.001, OR 90.1) and the correlation coefficient (R2 = 0.793) using linear regression analysis. UBE-induced median VTImax changes (≥ 11.8% and 7.98%) predicted fluid-induced median VTImax changes ≥ 10% and 7% (AUC 0.959 and 0.939). The collapsibility and variation of IJVD and IJVA showed no significant correlation. An increase in the mean value of medians of repeatedly measured VTImaxs transitioning from an UBE to a supine position, effectively screened mild hypovolemia and demonstrated a significant correlation with fluid responsiveness in spontaneously breathing patients maintaining hemodynamic stability.
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Affiliation(s)
- Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Palyong-ro, Masanhoiwon-gu, Changwon-si, Gyeongsangnam-do, 51353, South Korea
| | - Jae Hoon Lee
- Department of Emergency Medicine, Dong-A University College of Medicine, 26 Daesin Gonwon-Ro, Seo-Gu, Busan, 49201, South Korea.
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2
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Accuracy of a noninvasive estimated continuous cardiac output measurement under different respiratory conditions: a prospective observational study. J Anesth 2023; 37:394-400. [PMID: 36905408 DOI: 10.1007/s00540-023-03176-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE The estimated continuous cardiac output (esCCO) system was recently developed as a noninvasive hemodynamic monitoring alternative to the thermodilution cardiac output (TDCO). However, the accuracy of continuous cardiac output measurements by the esCCO system compared to TDCO under different respiratory conditions remains unclear. This prospective study aimed to assess the clinical accuracy of the esCCO system by continuously measuring the esCCO and TDCO. METHODS Forty patients who had undergone cardiac surgery with a pulmonary artery catheter were enrolled. We compared the esCCO with TDCO from mechanical ventilation to spontaneous respiration through extubation. Patients undergoing cardiac pacing during esCCO measurement, those receiving treatment with an intra-aortic balloon pump, and those with measurement errors or missing data were excluded. In total, 23 patients were included. Agreement between the esCCO and TDCO measurements was evaluated using Bland-Altman analysis with a 20 min moving average of the esCCO. RESULTS The paired esCCO and TDCO measurements (939 points before extubation and 1112 points after extubation) were compared. The respective bias and standard deviation (SD) values were 0.13 L/min and 0.60 L/min before extubation, and - 0.48 L/min and 0.78 L/min after extubation. There was a significant difference in bias before and after extubation (P < 0.001); the SD before and after extubation was not significant (P = 0.315). The percentage errors were 25.1% before extubation and 29.6% after extubation, which is the criterion for acceptance of a new technique. CONCLUSION The accuracy of the esCCO system is clinically acceptable to that of TDCO under mechanical ventilation and spontaneous respiration.
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3
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Grønlykke L, Korshin A, Gustafsson F, Nilsson JC, Ravn HB. The Effect of Common Interventions in the Intensive Care Unit on Right Ventricular Function After Cardiac Surgery—An Intervention Study. J Cardiothorac Vasc Anesth 2020; 34:1211-1219. [DOI: 10.1053/j.jvca.2019.11.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/21/2019] [Accepted: 11/27/2019] [Indexed: 11/11/2022]
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4
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Fischer MO, Joosten A, Desebbe O, Boutros M, Debroczi S, Broch O, Malbrain ML, Ameloot K, Hofer CK, Bubenek-Turconi ŞI, Monnet X, Diouf M, Lorne E. Interchangeability of cardiac output measurements between non-invasive photoplethysmography and bolus thermodilution: A systematic review and individual patient data meta-analysis. Anaesth Crit Care Pain Med 2020; 39:75-85. [DOI: 10.1016/j.accpm.2019.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/29/2019] [Accepted: 05/27/2019] [Indexed: 01/30/2023]
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5
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Grønlykke L, Korshin A, Holmgaard F, Kjøller SM, Gustafsson F, Nilsson JC, Ravn HB. Severe loss of right ventricular longitudinal contraction occurs after cardiopulmonary bypass in patients with preserved right ventricular output. Int J Cardiovasc Imaging 2019; 35:1661-1670. [DOI: 10.1007/s10554-019-01616-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022]
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Tannvik TD, Rimehaug AE, Skjærvold NK, Kirkeby‐Garstad I. Post cardiac surgery stunning reduces stroke work, but leaves cardiac power output unchanged in patients with normal ejection fraction. Physiol Rep 2018; 6:e13781. [PMID: 29998610 PMCID: PMC6041697 DOI: 10.14814/phy2.13781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/25/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022] Open
Abstract
This study assesses positional changes in cardiac power output and stroke work compared with classic hemodynamic variables, measured before and after elective coronary artery bypass graft surgery. The hypothesis was that cardiac power output was altered in relation to cardiac stunning. The study is a retrospective analysis of data from two previous studies performed in a tertiary care university hospital. Thirty-six patients scheduled for elective coronary artery bypass graft surgery, with relatively preserved left ventricular function, were included. A pulmonary artery catheter and a radial artery catheter were placed preoperatively. Cardiac power output and stroke work were calculated through thermodilution both supine and standing prior to induction of anesthesia and again day one postoperatively. Virtually all systemic hemodynamic parameters changed significantly from pre- to postoperatively, and from supine to standing. Cardiac power output was maintained at 0.9-1.0 (±0.3) W both pre- and postoperatively and from supine to standing on both days. Stroke work fell from pre- to postoperatively from 1.1 to 0.8 J (P < 0.001), there was a significant fall in stroke work with positional change preoperatively from 1.1 to 0.9 J (P < 0.001). Postoperatively the stroke work remained at 0.8 J despite positional change. Cardiac power output was the only systemic hemodynamic variable which remained unaltered during all changes. Stroke work appears to be a more sensitive marker for temporary cardiovascular dysfunction than cardiac power output. Further studies should explore the relationship between stroke work and cardiac performance and whether cardiac power output is an autoregulated intrinsic physiological parameter.
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Affiliation(s)
- Tomas D. Tannvik
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
- Faculty of Medicine and Health SciencesInstitute of Circulation and Medical ImagingNorges Teknisk‐Naturvitenskapelige UniversitetTrondheimNorway
| | - Audun E. Rimehaug
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
| | - Nils K. Skjærvold
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
- Faculty of Medicine and Health SciencesInstitute of Circulation and Medical ImagingNorges Teknisk‐Naturvitenskapelige UniversitetTrondheimNorway
| | - Idar Kirkeby‐Garstad
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
- Faculty of Medicine and Health SciencesInstitute of Circulation and Medical ImagingNorges Teknisk‐Naturvitenskapelige UniversitetTrondheimNorway
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7
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Sigmundsson TS, Öhman T, Hallbäck M, Redondo E, Sipmann FS, Wallin M, Oldner A, Hällsjö Sander C, Björne H. Performance of a capnodynamic method estimating effective pulmonary blood flow during transient and sustained hypercapnia. J Clin Monit Comput 2017; 32:311-319. [PMID: 28497180 PMCID: PMC5838142 DOI: 10.1007/s10877-017-0021-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/22/2017] [Indexed: 01/04/2023]
Abstract
The capnodynamic method is a minimally invasive method continuously calculating effective pulmonary blood flow (COEPBF), equivalent to cardiac output when intra pulmonary shunt flow is low. The capnodynamic equation joined with a ventilator pattern containing cyclic reoccurring expiratory holds, provides breath to breath hemodynamic monitoring in the anesthetized patient. Its performance however, might be affected by changes in the mixed venous content of carbon dioxide (CvCO2). The aim of the current study was to evaluate COEPBF during rapid measurable changes in mixed venous carbon dioxide partial pressure (PvCO2) following ischemia–reperfusion and during sustained hypercapnia in a porcine model. Sixteen pigs were submitted to either ischemia–reperfusion (n = 8) after the release of an aortic balloon inflated during 30 min or to prolonged hypercapnia (n = 8) induced by adding an instrumental dead space. Reference cardiac output (CO) was measured by an ultrasonic flow probe placed around the pulmonary artery trunk (COTS). Hemodynamic measurements were obtained at baseline, end of ischemia and during the first 5 min of reperfusion as well as during prolonged hypercapnia at high and low CO states. Ischemia–reperfusion resulted in large changes in PvCO2, hemodynamics and lactate. Bias (limits of agreement) was 0.7 (−0.4 to 1.8) L/min with a mean error of 28% at baseline. COEPBF was impaired during reperfusion but agreement was restored within 5 min. During prolonged hypercapnia, agreement remained good during changes in CO. The mean polar angle was −4.19° (−8.8° to 0.42°). Capnodynamic COEPBF is affected but recovers rapidly after transient large changes in PvCO2 and preserves good agreement and trending ability during states of prolonged hypercapnia at different levels of CO.
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Affiliation(s)
- Thorir Svavar Sigmundsson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Tomas Öhman
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Eider Redondo
- Department of Intensive Care Medicine, Hospital de Navarra, Pamplona, Spain
| | - Fernando Suarez Sipmann
- Hedenstierna's laboratory, Section of Anaesthesiology and Critical Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Mats Wallin
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Maquet Critical Care AB, Solna, Sweden
| | - Anders Oldner
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Hällsjö Sander
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Björne
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Høiseth LØ, Hagemo JS. Predicting fluid responsiveness in whom? A simulated example of patient spectrum influencing the receiver operating characteristics curve. J Clin Monit Comput 2017; 32:215-219. [PMID: 28432561 DOI: 10.1007/s10877-017-0019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/17/2017] [Indexed: 11/26/2022]
Abstract
The influence of patient spectrum on the sensitivities and specificities of diagnostic methods has been termed spectrum bias or spectrum effect. Receiver operating characteristics curves are often used to assess the ability of diagnostic methods to predict fluid responsiveness. As a receiver operating characteristics curve is a presentation of sensitivity and specificity, the purpose of the present manuscript was to explore if patient spectrum could affect areas under receiver operating characteristics curves and their gray zones. Relationships between stroke volume variation and change in stroke volume in two different patient populations using simulated data. Simulated patient populations with stroke volume variation values between 5 and 15 or 3 and 25% had median (2.5th-97.5th percentiles) areas under receiver operating characteristics curves of 0.79 (0.65-0.90) and 0.93 (0.85-0.99), respectively. The gray zones indicating range of diagnostic uncertainty were also affected. The patient spectrum can affect common statistics from receiver operating characteristics curves, indicating the need for considering patient spectrum when evaluating the abilities of different methods to predict fluid responsiveness.
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Affiliation(s)
- Lars Øivind Høiseth
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Kirkeveien 166, 0368, Oslo, Norway.
- Section of Vascular Investigations, Division of Cardiovascular and Pulmonary Diseases, Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway.
| | - Jostein S Hagemo
- Norwegian Air Ambulance Foundation, Drøbak, Norway
- Division of Prehospital Care, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
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9
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10
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Comparing measurement methods using linear least squares regression. J Clin Monit Comput 2016; 32:373-374. [PMID: 27837298 DOI: 10.1007/s10877-016-9955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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11
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Fischer MO, Diouf M, de Wilde RB, Dupont H, Hanouz JL, Lorne E. Evaluation of cardiac output by 5 arterial pulse contour techniques using trend interchangeability method. Medicine (Baltimore) 2016; 95:e3530. [PMID: 27336861 PMCID: PMC4998299 DOI: 10.1097/md.0000000000003530] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiac output measurement with pulse contour analysis is a continuous, mini-invasive, operator-independent, widely used, and cost-effective technique, which could be helpful to assess changes in cardiac output. The 4-quadrant plot and the polar plot have been described to compare the changes between 2 measurements performed under different conditions, and the direction of change by using different methods of measurements. However, the 4-quadrant plot and the polar plot present a number of limitations, with a risk of misinterpretation in routine clinical practice. We describe a new trend interchangeability method designed to objectively define the interchangeability of each change of a variable. Using the repeatability of the reference method, we classified each change as either uninterpretable or interpretable and then as either noninterchangeable, in the gray zone or interchangeable. An interchangeability rate can then be calculated by the number of interchangeable changes divided by the total number of interpretable changes. In this observational study, we used this objective method to assess cardiac output changes with 5 arterial pulse contour techniques (Wesseling's method, LiDCO, PiCCO, Hemac method, and Modelflow) in comparison with bolus thermodilution technique as reference method in 24 cardiac surgery patients. A total of 172 cardiac output variations were available from the 199 data points: 88 (51%) were uninterpretable, according to the first step of the method. The second step of the method, based on the 84 (49%) interpretable variations, showed that only 18 (21%) to 30 (36%) variations were interchangeable regardless of the technique used. None of pulse contour cardiac output technique could be interchangeable with bolus thermodilution to assess changes in cardiac output using the trend interchangeability method in cardiac surgery patients. Future studies may consider using this method to assess interchangeability of changes between different methods of measurements.
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Affiliation(s)
- Marc-Olivier Fischer
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen
- EA 4650, Université de Caen Normandie, Esplanade de la Paix, Caen
| | - Momar Diouf
- Department of Biostatistics and Clinical Research, Amiens University Hospital, Place Victor Pauchet, Amiens, France
| | - Robert B.P. de Wilde
- Department of Intensive Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - Hervé Dupont
- Anesthesiology and Critical Care Department, Amiens University Hospital, Amiens
- INSERM U 1088, Jules Vernes University of Picardy, Centre Universitaire de Recherche en Santé (CURS). Chemin du Thil, Amiens Cedex, France
| | - Jean-Luc Hanouz
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen
- EA 4650, Université de Caen Normandie, Esplanade de la Paix, Caen
| | - Emmanuel Lorne
- Anesthesiology and Critical Care Department, Amiens University Hospital, Amiens
- INSERM U 1088, Jules Vernes University of Picardy, Centre Universitaire de Recherche en Santé (CURS). Chemin du Thil, Amiens Cedex, France
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12
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Sander CH, Sigmundsson T, Hallbäck M, Sipmann FS, Wallin M, Oldner A, Björne H. A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow. J Clin Monit Comput 2016; 31:717-725. [PMID: 27251701 DOI: 10.1007/s10877-016-9891-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/25/2016] [Indexed: 12/15/2022]
Abstract
In a previous study a new capnodynamic method for estimation of effective pulmonary blood flow (COEPBF) presented a good trending ability but a poor agreement with a reference cardiac output (CO) measurement at high levels of PEEP. In this study we aimed at evaluating the agreement and trending ability of a modified COEPBF algorithm that uses expiratory instead of inspiratory holds during CO and ventilatory manipulations. COEPBF was evaluated in a porcine model at different PEEP levels, tidal volumes and CO manipulations (N = 8). An ultrasonic flow probe placed around the pulmonary trunk was used for CO measurement. We tested the COEPBF algorithm using a modified breathing pattern that introduces cyclic end-expiratory time pauses. The subsequent changes in mean alveolar fraction of carbon dioxide were integrated into a capnodynamic equation and effective pulmonary blood flow, i.e. non-shunted CO, was calculated continuously breath by breath. The overall agreement between COEPBF and the reference method during all interventions was good with bias (limits of agreement) 0.05 (-1.1 to 1.2) L/min and percentage error of 36 %. The overall trending ability as assessed by the four-quadrant and the polar plot methodology was high with a concordance rate of 93 and 94 % respectively. The mean polar angle was 0.4 (95 % CI -3.7 to 4.5)°. A ventilatory pattern recurrently introducing end-expiratory pauses maintains a good agreement between COEPBF and the reference CO method while preserving its trending ability during CO and ventilatory alterations.
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Affiliation(s)
- Caroline Hällsjö Sander
- Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Thorir Sigmundsson
- Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Fernando Suarez Sipmann
- Hedenstierna's Laboratory, Department of Surgical Sciences, Section of Anaesthesiology and Critical Care, Uppsala University, Uppsala, Sweden.,CIBER de enfermedades respiratorias (CIBERES), Instituto Carlos III, Madrid, Spain
| | - Mats Wallin
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Maquet Critical Care AB, Solna, Sweden
| | - Anders Oldner
- Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Björne
- Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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13
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Kjetså E, Skjaervold NK, Skogvoll E, Kirkeby-Garstad I. Synchronizing thermodilution cardiac output measurements with spontaneous breathing does not improve precision. Acta Anaesthesiol Scand 2016; 60:354-9. [PMID: 26497869 DOI: 10.1111/aas.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Measuring cardiac output (CO) with the pulmonary artery catheter intermittent bolus thermodilution technique (PAC-IBTD) is less precise with spontaneous breathing compared to controlled ventilation. We aimed to test if precision could be improved in spontaneous breathing by synchronizing the measurement with respiration or using instructed respiration in 18 post-operative cardiac surgery patients. METHODS We performed eight CO measurements with PAC-IBTD using cold saline in three different situations; in random order: 1) random compared to respiration, 2) timed to the start of expiration, and 3) synchronized with a slow exhalation through a PEP-flute. We calculated the standard deviation (SD), coefficient of variation (CV), and precision in the total material and in the three situations using a linear mixed effects model. RESULTS A total of 408 CO measurements were performed in 17 included patients. There were no differences between the three study situations regarding mean or precision. The overall CO was 6.0 ± 1.4 l/min (mean ± SD), CV 6.2% and precision 12.2% for single measurements. Averaging three measurements increased the precision to 7.0%. CONCLUSION We could not improve the precision of PAC-IBTD in spontaneously breathing patients by synchronizing the measurements with respiration.
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Affiliation(s)
- E. Kjetså
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
- Department of Anaesthesia and Intensive Care Medicine; Trondheim University Hospital; Trondheim Norway
| | - N. K. Skjaervold
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
- Department of Anaesthesia and Intensive Care Medicine; Trondheim University Hospital; Trondheim Norway
| | - E. Skogvoll
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
- Department of Anaesthesia and Intensive Care Medicine; Trondheim University Hospital; Trondheim Norway
| | - I. Kirkeby-Garstad
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
- Department of Anaesthesia and Intensive Care Medicine; Trondheim University Hospital; Trondheim Norway
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