1
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Svedmyr A, Steiner K, Andersson A, Sjöberg G, Hallbäck M, Wallin M, Lönnqvist PA, Karlsson J. Validation of a Novel Method for Noninvasive Mixed Venous Oxygen Saturation Monitoring in Anesthetized Children. Anesth Analg 2024:00000539-990000000-00891. [PMID: 39093817 DOI: 10.1213/ane.0000000000007083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Mixed venous oxygen saturation (SvO 2 ) is a critical variable in the assessment of oxygen supply and demand but is rarely used in children due to the invasive nature of pulmonary artery catheters. The aim of this prospective, observational study was to investigate the accuracy of noninvasively measured SvO 2 acquired by the novel capnodynamic method, based on differential Fick equation (Capno-SvO 2 ), against gold standard CO-oximetry. METHODS Capno-SvO 2 was compared to SvO 2 measured by pulmonary artery blood gas CO-oximetry in children undergoing cardiac catheter interventions and subjected to moderate hemodynamic challenges. Bland-Altman analysis was used to describe the agreement of absolute values between CO-oximetry and Capno-SvO 2 , and a concordance rate was calculated to evaluate the ability of Capno-SvO 2 to track change. RESULTS Twenty-five procedures were included in the study. Capno-SvO 2 showed a bias toward CO-oximetry of +3 percentage points; upper and lower limits of agreement were +11 percentage points (95% confidence interval [CI], 9-14) and -5 percentage points (95% CI, -8 to -3), respectively. The concordance rate was 92% (95% CI, 89-96). CONCLUSIONS In conclusion, this first clinical application of a novel concept for noninvasive SvO 2 monitoring without the need for a pulmonary artery catheter indicates that Capno-SvO 2 generates absolute values and trending capacity in close agreement with the gold standard reference method.
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Affiliation(s)
- Anders Svedmyr
- From the Department of Physiology and Pharmacology (FYFA), C3, Eriksson I Lars, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Karolinska Institute, Stockholm, Sweden
- Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Kristoffer Steiner
- Department of Pediatric Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Andreas Andersson
- From the Department of Physiology and Pharmacology (FYFA), C3, Eriksson I Lars, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Karolinska Institute, Stockholm, Sweden
- Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Sjöberg
- Department of Pediatric Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | | | - Mats Wallin
- From the Department of Physiology and Pharmacology (FYFA), C3, Eriksson I Lars, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Per-Arne Lönnqvist
- From the Department of Physiology and Pharmacology (FYFA), C3, Eriksson I Lars, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Karolinska Institute, Stockholm, Sweden
- Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Karlsson
- From the Department of Physiology and Pharmacology (FYFA), C3, Eriksson I Lars, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Karolinska Institute, Stockholm, Sweden
- Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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2
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Gómez Fernández L, Potter J, Hughes JML, Fernandez Perez C, Brama PAJ, Niimura Del Barrio MC. Effects of two alveolar recruitment manoeuvres (sustained inflation and stepwise) followed by positive end-expiratory pressure on cardiac output (measured with lithium dilution), invasive blood pressure and arterial oxygen tension in isoflurane-anaesthetised goats. Res Vet Sci 2022; 150:195-203. [PMID: 35842951 DOI: 10.1016/j.rvsc.2022.07.004] [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: 07/16/2021] [Revised: 04/03/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Alveolar recruitment manoeuvres (ARM) performed during general anaesthesia improve oxygenation; however cardiovascular depression may be observed. The aim of the study was to compare the effects of sustained inflation (SI) and stepwise ARMs on cardiac output (CO), mean arterial blood pressure and arterial oxygen tension (PaO2) in ten mechanically ventilated goats anaesthetised with isoflurane. In the SI ARM, peak inspiratory presure (PIP) was increased to 30 cmH2O and sustained for 20 s. In the stepwise ARM, the PIP was increased by 5 cmH2O each minute for three minutes from 10 to 25 cmH2O. Both ARMs were followed by positive end-expiratory pressure of 5 cmH2O. Paired lithium dilution CO measurements and arterial blood samples were obtained before and after each ARM. The order of the ARM was randomised and each goat was subjected to both techniques. Data was reported as median and interquartile range (IQR). Significance was set at 0.05. The median change in CO (measured by subtracting values after and before ARM) was -0.15 L min-1 (IQR -0.51; 0.03) and - 0.90 L min-1 (IQR -1.69; -0.58) for SI and stepwise ARM respectively (p = 0.04). The median change in PaO2 was 3 kPa (IQR -2.7; 7.6) and 0.4 kPa (IQR -3.4; 5.5) for SI and stepwise ARM respectively (p = 0.03). In conclusion, SI ARM causes less impact on CO and provides a better improvement in PaO2 compared to stepwise ARM in goats.
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Affiliation(s)
- L Gómez Fernández
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland; Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada.
| | - J Potter
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - J M L Hughes
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - C Fernandez Perez
- Servicio de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación Sanitaria de Santiago de Compostela, A Coruña, Spain
| | - P A J Brama
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - M C Niimura Del Barrio
- Lumbry Park Veterinary Specialists, Selborne Road, Alton, Hampshire GU34 3HL, United Kingdom
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3
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Chang K, Barletta M, Messenger KM, Sakai DM, Reed RA, Quandt JE. The effect of a ketamine constant rate infusion on cardiovascular variables in sheep anesthetized at the minimum alveolar concentration of sevoflurane that blunts adrenergic responses. Am J Vet Res 2022; 83:205-211. [DOI: 10.2460/ajvr.21.08.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To evaluate the effect of a constant rate infusion of ketamine on cardiac index (CI) in sheep, as estimated using noninvasive cardiac output (NICO) monitoring by partial carbon dioxide rebreathing, when anesthetized with sevoflurane at the previously determined minimum alveolar concentration that blunts adrenergic responses (MACBAR).
ANIMALS
12 healthy Dorset-crossbred adult sheep.
PROCEDURES
Sheep were anesthetized 2 times in a balanced placebo-controlled crossover design. Anesthesia was induced with sevoflurane delivered via a tight-fitting face mask and maintained at MACBAR. Following induction, sheep received either ketamine (1.5 mg/kg IV, followed by a constant rate infusion of 1.5 mg/kg/h) or an equivalent volume of saline (0.9% NaCl) solution (placebo). After an 8-day washout period, each sheep received the alternate treatment. NICO measurements were performed in triplicate 20 minutes after treatment administration and were converted to CI. Blood samples were collected prior to the start of NICO measurements for analysis of ketamine plasma concentrations. The paired t test was used to compare CI values between groups and the ketamine plasma concentrations with those achieved during the previous study.
RESULTS
Mean ± SD CI of the ketamine and placebo treatments were 2.69 ± 0.65 and 2.57 ± 0.53 L/min/m2, respectively. No significant difference was found between the 2 treatments. Mean ketamine plasma concentration achieved prior to the NICO measurement was 1.37 ± 0.58 µg/mL, with no significant difference observed between the current and prior study.
CLINICAL RELEVANCE
Ketamine, at the dose administered, did not significantly increase the CI in sheep when determined by partial carbon dioxide rebreathing.
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Affiliation(s)
- Kevin Chang
- 1Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Michele Barletta
- 2Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Kristen M. Messenger
- 3Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Daniel M. Sakai
- 1Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Rachel A. Reed
- 2Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Jane E. Quandt
- 1Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
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4
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Gómez Fernández L, Niimura Del Barrio MC, Huuskonen V, Fernandez Perez C, Brama P, Hughes L. Lithium dilution cardiac output measurements in isoflurane-anaesthetised goats: Jugular versus cephalic lithium chloride administration. Res Vet Sci 2021; 141:95-102. [PMID: 34706305 DOI: 10.1016/j.rvsc.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 12/26/2022]
Abstract
The administration of lithium chloride (LiCl) for cardiac output (CO) measurement via a peripheral instead of a central vein has been described previously as a valid alternative route in pigs and dogs. The aim of the study was to compare CO measurements after administration of LiCl using two peripheral veins, cephalic or jugular, in goats. Ten adult, female, experimental goats undergoing bilateral stifle arthrotomy were recruited for the study. Paired CO measurements were taken two minutes apart during stable conditions in isoflurane-anaesthetised goats. Forty-two paired CO measurements were taken in total, and the median (range) of paired CO measurement per goat were 4.5 (3-6). The mean (SD) CO using the cephalic and jugular vein for injection of LiCl was 5.28 (1.29) L min-1 and 5.20 (1.24) L min-1 respectively. The Bland-Altman analysis showed an acceptable agreement with a mean bias of 1.33% with limits of agreement (LoA) of -18.43 to 21.09%. The percentage of error was 25%. The four-quadrant plot analysis showed a poor agreement (71%) between the two routes. The polar plot showed a poor trending ability. An 86% inclusion rate (18/21 points) was reached with a ± 35° radial sector size. The findings revealed that the agreement between the two routes is not as precise as the authors expected, however the results are comparable with studies published previously.
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Affiliation(s)
- Laura Gómez Fernández
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland.
| | | | - Vilhelmiina Huuskonen
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - Cristina Fernandez Perez
- Servicio de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, A Coruña, Spain
| | - Pieter Brama
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - Lynne Hughes
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
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5
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Karlsson J, Svedmyr A, Wiegele M, Lönnqvist PA, Wallin M, Hallbäck M. Cardiac Output Assessments in Anesthetized Children: Dynamic Capnography Versus Esophageal Doppler. Anesth Analg 2021; 134:644-652. [PMID: 34304235 DOI: 10.1213/ane.0000000000005679] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this study was to compare esophageal Doppler cardiac output (COEDM) against the reference method effective pulmonary blood flow cardiac output (COEPBF), for agreement of absolute values and ability to detect change in cardiac output (CO) in pediatric surgical patients. Furthermore, the relationship between these 2 methods and noninvasive blood pressure (NIBP) parameters was evaluated. METHODS Fifteen children American Society of Anesthesiology (ASA) I and II (median age, 8 months; median weight, 9 kg) scheduled for surgery were investigated in this prospective observational cohort study. Baseline COEPBF/COEDM/NIBP measurements were made at positive end-expiratory pressure (PEEP) 3 cm H2O. PEEP was increased to 10 cm H2O and COEPBF/COEDM/NIBP was recorded after 1 and 3 minutes. PEEP was then lowered to 3 cm H2O, and all measurements were repeated after 3 minutes. Finally, 20-µg kg-1 intravenous atropine was given with the intent to increase CO, and all measurements were recorded again after 5 minutes. Paired recordings of COEDM and COEPBF were examined for agreement and trending ability, and all parameters were analyzed for their responses to the hemodynamic challenges. RESULTS Bias between COEDM and COEPBF (COEDM - COEPBF) was -17 mL kg-1 min-1 (limits of agreement, -67 to +33 mL kg-1 min-1) with a mean percentage error of 32% (95% confidence interval [CI], 25-37) and a concordance rate of 71% (95% CI, 63-80). The hemodynamic interventions caused by PEEP manipulations resulted in significant decrease in COEPBF absolute numbers (155 mL kg-1 min-1 [95% CI, 151-159] to 127 mL kg-1 min-1 [95% CI, 113-141]) and a corresponding relative decrease of 18% (95% CI, 14-22) 3 minutes after application of PEEP 10. No corresponding decreases were detected by COEDM. Mean arterial pressure showed a relative decrease with 5 (95% CI, 2-8) and 6% (95% CI, 2-10) 1 and 3 minutes after the application of PEEP 10, respectively. Systolic arterial pressure showed a relative decrease of 5% (95% CI, 2-10) 3 minutes after application of PEEP 10. None of the recorded parameters responded to atropine administration except for heart rate that showed a 4% relative increase (95% CI, 1-7, P = .02) 5 minutes after atropine. CONCLUSIONS COEDM was unable to detect the reduction of CO cause by increased PEEP, whereas COEPBF and to a minimal extent NIBP detected these changes in CO. The ability of COEPBF to react to minor reductions in CO, before noticeable changes in NIBP are seen, suggests that COEPBF may be a potentially useful tool for hemodynamic monitoring in mechanically ventilated children.
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Affiliation(s)
- Jacob Karlsson
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm Sweden
| | - Anders Svedmyr
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm Sweden
| | - Marion Wiegele
- Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Per-Arne Lönnqvist
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm Sweden
| | - Mats Wallin
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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6
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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 cardiac output during respiratory failure - before and after lung recruitment. J Clin Monit Comput 2019; 34:1199-1207. [PMID: 31745763 PMCID: PMC7548027 DOI: 10.1007/s10877-019-00421-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/12/2019] [Indexed: 01/06/2023]
Abstract
Respiratory failure may cause hemodynamic instability with strain on the right ventricle. The capnodynamic method continuously calculates cardiac output (CO) based on effective pulmonary blood flow (COEPBF) and could provide CO monitoring complementary to mechanical ventilation during surgery and intensive care. The aim of the current study was to evaluate the ability of a revised capnodynamic method, based on short expiratory holds (COEPBFexp), to estimate CO during acute respiratory failure (LI) with high shunt fractions before and after compliance-based lung recruitment. Ten pigs were submitted to lung lavage and subsequent ventilator-induced lung injury. COEPBFexp, without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk (COTS) at (1) baseline in healthy lungs with PEEP 5 cmH2O (HLP5), (2) LI with PEEP 5 cmH2O (LIP5) and (3) LI after lung recruitment and PEEP adjustment (LIPadj). CO changes were enforced during LIP5 and LIPadj to estimate trending. LI resulted in changes in shunt fraction from 0.1 (0.03) to 0.36 (0.1) and restored to 0.09 (0.04) after recruitment manoeuvre. Bias (levels of agreement) and percentage error between COEPBFexp and COTS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HLP5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LIP5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LIPadj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. COEPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre.
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Affiliation(s)
- Thorir Svavar Sigmundsson
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Tomas Öhman
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Eider Redondo
- Department of Intensive Care Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fernando Suarez Sipmann
- Department of Surgical Sciences, Section of Anaesthesiology and Critical Care, Hedenstierna's Laboratory, 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
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Hällsjö-Sander
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Björne
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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7
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Karlsson J, Winberg P, Scarr B, Lönnqvist PA, Neovius E, Wallin M, Hallbäck M. Validation of capnodynamic determination of cardiac output by measuring effective pulmonary blood flow: a study in anaesthetised children and piglets. Br J Anaesth 2018; 121:550-558. [PMID: 30115252 DOI: 10.1016/j.bja.2018.02.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/27/2018] [Accepted: 03/03/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Effective pulmonary blood flow (COEPBF) has recently been validated as a technique for determining cardiac output (CO) in animals of varying sizes. The primary aim of our study was to investigate this new technique in paediatric surgical patients, compared with suprasternal two-dimensional Doppler (COSSD). METHODS A total of 15 children undergoing cleft lip/palate surgery were investigated. Before the start of surgery, manoeuvres that were anticipated to reduce (increase in PEEP from 3 to 10 cm H2O) and increase (atropine) CO were undertaken. A study in mechanically ventilated piglets was also undertaken under general anaesthesia, measuring COEPBF and pulmonary artery (COTS) flow by ultrasonic probe as the comparator. Bias (Bland-Altman plots) and limits of agreement were assessed for effective pulmonary blood flow and COSSD or COTS. RESULTS In paediatric patients (median age 8.5 months), overall bias was -8.1 (limits of agreement -82 to +66) ml kg-1 min-1, with a mean percentage error of 48% and a concordance rate of 64%. In the piglet model, overall bias was -1 (-36 to +38) ml kg-1 min-1, with a mean percentage error of 31% and a concordance rate of 95%. CONCLUSIONS Under controlled experimental conditions, COEPBF is associated with excellent agreement and good trending ability when compared with the gold standard COTS. In the paediatric clinical setting, COEPBF performs well; by contrast, COSSD, an operator- and anatomy-dependent technology, appears less reliable than COEPBF.
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Affiliation(s)
- J Karlsson
- Karolinska Institute Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Stockholm, Sweden; Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| | - P Winberg
- Department of Pediatric Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - B Scarr
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - P A Lönnqvist
- Karolinska Institute Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Stockholm, Sweden; Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - E Neovius
- Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Wallin
- Karolinska Institute Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Stockholm, Sweden; Maquet Critical Care, Solna, Sweden
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8
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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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9
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Masmoudi H, Persichini R, Cecchini J, Delemazure J, Dres M, Mayaux J, Demoule A, Assouad J, Similowski T. Corrective effect of diaphragm pacing on the decrease in cardiac output induced by positive pressure mechanical ventilation in anesthetized sheep. Respir Physiol Neurobiol 2016; 236:23-28. [PMID: 27836647 DOI: 10.1016/j.resp.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/17/2016] [Accepted: 10/25/2016] [Indexed: 01/13/2023]
Abstract
Positive pressure ventilation (PPV) is a fundamental life support measure, but it decreases cardiac output (CO). Diaphragmatic contractions produce negative intrathoracic and positive abdominal pressures, promoting splanchnic venous return. We hypothesized that: 1) diaphragm pacing alone could produce adequate ventilation without decreasing CO; 2) diaphragm pacing on top of PPV could improve CO. Of 11 anesthetized and mechanically ventilated ewes (39.6±5.9kg), 3 were discarded from analysis because of hemodynamic instability during the experiment, and 8 retained for analysis. Phrenic stimulation electrodes were inserted in the diaphragm (implanted phrenic nerve stimulation, iPS). CO was measured by the thermodilution technique (pulmonary artery catheter). CO during end-expiratory apnea served as reference. Median CO was 9.77 [6.25-11.25] lmin-1 during end-expiratory apnea, 8.25 [5.06-9.25] lmin-1 during "PPV" (-15%) (p<0.05), 9.19 [5.60-10.19] lmin-1 during "PPV-iPS" (NS vs apnea) and 9.37 [6.12-10.48] lmin-1 during "iPS" (NS vs. apnea). iPS-driven ventilation was comparable to its PPV counterpart (median 92% [74-97], NS). Diaphragm pacing alone can produce adequate ventilation without reducing CO. Superimposed onto PPV, diaphragm pacing can reduce the PPV-induced decrease in CO.
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Affiliation(s)
- Hicham Masmoudi
- AP-HP, Groupe Hospitalier Saint-Antoine Tenon Trousseau, Service de Chirurgie Thoracique, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France
| | - Romain Persichini
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Jérôme Cecchini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Julie Delemazure
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Martin Dres
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Julien Mayaux
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Alexandre Demoule
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Jalal Assouad
- AP-HP, Groupe Hospitalier Saint-Antoine Tenon Trousseau, Service de Chirurgie Thoracique, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France.
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10
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Emerging Methodology of Intraoperative Hemodynamic Monitoring Research. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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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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12
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Capnodynamic assessment of effective lung volume during cardiac output manipulations in a porcine model. J Clin Monit Comput 2015; 30:761-769. [PMID: 26377022 DOI: 10.1007/s10877-015-9767-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
A capnodynamic calculation of effective pulmonary blood flow includes a lung volume factor (ELV) that has to be estimated to solve the mathematical equation. In previous studies ELV correlated to reference methods for functional residual capacity (FRC). The aim was to evaluate the stability of ELV during significant manipulations of cardiac output (CO) and assess the agreement for absolute values and trending capacity during PEEP changes at different lung conditions. Ten pigs were included. Alterations of alveolar carbon dioxide were induced by cyclic reoccurring inspiratory holds. The Sulphur hexafluoride technique for FRC measurements was used as reference. Cardiac output was altered by preload reduction and inotropic stimulation at PEEP 5 and 12 cmH2O both in normal lung conditions and after repeated lung lavages. ELV at baseline PEEP 5 was [mean (SD)], 810 (163) mL and decreased to 400 (42) mL after lavage. ELV was not significantly affected by CO alterations within the same PEEP level. In relation to FRC the overall bias (limits of agreement) was -35 (-271 to 201) mL, and percentage error 36 %. A small difference between ELV and FRC was seen at PEEP 5 cmH2O before lavage and at PEEP 12 cmH2O after lavage. ELV trending capability between PEEP steps, showed a concordance rate of 100 %. ELV was closely related to FRC and remained stable during significant changes in CO. The trending capability was excellent both before and after surfactant depletion.
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13
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Hällsjö Sander C, Hallbäck M, Suarez Sipmann F, Wallin M, Oldner A, Björne H. A novel continuous capnodynamic method for cardiac output assessment in a porcine model of lung lavage. Acta Anaesthesiol Scand 2015; 59:1022-31. [PMID: 26041115 DOI: 10.1111/aas.12559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/04/2015] [Accepted: 04/20/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND We have evaluated a new method for continuous monitoring of effective pulmonary blood flow (COEPBF ), i.e. cardiac output (CO) minus intra-pulmonary shunt, during mechanical ventilation. The method has shown good trending ability during severe hemodynamic challenges in a porcine model with intact lungs. In this study, we further evaluate the COEPBF method in a model of lung lavage. METHODS COEPBF was compared to a reference method for CO during hemodynamic and PEEP alterations, 5 and 12 cmH2 O, before and after repeated lung lavages in 10 anaesthetised pigs. Bland-Altman, four-quadrant and polar plot methodologies were used to determine agreement and trending ability. RESULTS After lung lavage at PEEP 5 cmH2 O, the ratio of arterial oxygen partial pressure related to inspired fraction of oxygen significantly decreased. The mean difference (limits of agreement) between methods changed from 0.2 (-1.1 to 1.5) to -0.9 (-3.6 to 1.9) l/min and percentage error increased from 34% to 70%. Trending ability remained good according to the four-quadrant plot (concordance rate 94%), whereas mean angular bias increased from 4° to -16° when using the polar plot methodology. CONCLUSION Both agreement and precision of COEPBF were impaired in relation to CO when the shunt fraction was increased after lavage at PEEP 5 cmH2 O. However, trending ability remained good as assessed by the four-quadrant plot, whereas the mean polar angle, calculated by the polar plot, was wide.
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Affiliation(s)
- C. Hällsjö Sander
- Department of Anaesthesiology, Surgical Services and Intensive Care Medicine; Karolinska University Hospital; Solna Sweden
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| | | | - F. Suarez Sipmann
- Department of Surgical Sciences; Section of Anaesthesiology and Critical Care; Hedenstierna's Laboratory; Uppsala University; Uppsala Sweden
- CIBERES; CIBER de enfermedades respiratorias; Instituto Carlos III; Madrid Spain
| | - M. Wallin
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
- Maquet Critical Care AB; Solna Sweden
| | - A. Oldner
- Department of Anaesthesiology, Surgical Services and Intensive Care Medicine; Karolinska University Hospital; Solna Sweden
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| | - H. Björne
- Department of Anaesthesiology, Surgical Services and Intensive Care Medicine; Karolinska University Hospital; Solna Sweden
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
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14
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Li H, Critchley LAH, Zhang J. Does using two Doppler cardiac output monitors in tandem provide a reliable trend line of changes for validation studies? J Clin Monit Comput 2015; 30:559-67. [PMID: 26315476 DOI: 10.1007/s10877-015-9753-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Abstract
The demise of the pulmonary artery catheter as a gold standard in cardiac output measurement has created the need for new standard. Doppler cardiac output can be measured suprasternally (USCOM) and via the oesophagus (CardioQ). Use in tandem they may provide a reliable trend line of cardiac output changes against which new technologies can be assessed. Data from three similar clinical studies was pooled. Simultaneous USCOM and CardioQ readings, 13 (7-27), were performed every 15-30 min intraoperatively. Within individual patient regression analysis was performed. Data was normalized, CardioQ against USCOM, to eliminate the systematic error component following calibration. Bland-Altman and trend, concordance and polar analysis, were performed on the grouped data. Cardiac output was indexed (CI) to BSA. Data from 53 patients, aged 59 (26-81) years, scheduled for major surgery were included. Within-individual mean (SD) CI was 3.4 (0.6) L min(-1) m(-2). Correlation was good to excellent in 83 % of cases, R(2) > 0.80, and reasonable in 96 %, R(2) > 0.60. Percentage error was 38 %, and decreased to 14 % with normalization. The estimated 95 % precision for a single Doppler reading was ±10 %. Concordance rate was 96.6 % (confidence intervals 94.7-99.5 %) and above the >92 % threshold for good trending ability. Polar analysis also confirmed good trending ability. The regression line between Doppler methods was offset with a slope of 0.9, thus CardioQ CI readings increased relative to USCOM. Both Doppler methods trended cardiac output reliably. Used in tandem they provide a new standard to assess cardiac output trending.
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Affiliation(s)
- Huang Li
- Department of Anaesthesia and Surgical Intensive Care, Peking University First Hospital, Beijing, China
| | - Lester A H Critchley
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Jie Zhang
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR.
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15
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Kutter APN, Mosing M, Hartnack S, Raszplewicz J, Renggli M, Mauch JY, Hofer CK. The influence of acute pulmonary hypertension on cardiac output measurements: calibrated pulse contour analysis, transpulmonary and pulmonary artery thermodilution against a modified Fick method in an animal model. Anesth Analg 2015; 121:99-107. [PMID: 25742632 DOI: 10.1213/ane.0000000000000655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In critically ill patients with significant pulmonary hypertension (PH), close perioperative cardiovascular monitoring is mandatory, considering the increased morbidity and mortality in this patient group. Although the pulmonary artery catheter is still the standard for the diagnosis of PH, its use to monitor cardiac output (CO) in patients with PH is decreasing as a result of increased morbidity and possible influence of tricuspid regurgitation on the measurements. However, continuous CO measurement methods have never been evaluated under PH regarding their agreement and trending ability. In this study, we evaluated the influence of acute PH and different CO states on transpulmonary thermodilution (TPTD) and calibrated pulse contour analysis (PiCCO; both assessed with PiCCO plus™), intermittent pulmonary artery thermodilution (PATD), and continuous thermodilution (CCO) compared with a modified Fick method (FICK) in an animal model. METHODS Nine healthy pigs were studied under anesthesia. PH of 25 and 40 mm Hg (by administration of the thromboxane analog U46619), CO decreases, and CO increases were induced to test the different CO measurement techniques over a broad range of hemodynamic situations. Before each step, a new baseline data set was collected. CO values were compared using Bland-Altman analysis; trending abilities were assessed via concordance and polar plot analysis. The influence of pulmonary pressure on CO measurements was analyzed using linear mixed models. RESULTS A mean bias of -0.26 L/min with prediction intervals of -0.88 to 1.4 L/min was measured between TPTD and FICK. Their concordance rate was 100% (94%-100% confidence interval), and the mean polar angle -3° with radial limits of agreement of ±28° indicated good trending abilities. PATD compared with FICK also showed good trending ability. Comparisons of PiCCO and CCO versus FICK revealed low agreement and poor trending results with concordance rates of 84% (71%-93%) and 88% (74%-95%), mean polar angles from -17° and -19°, and radial limits of agreement of ±45° and 40°. Pulmonary pressures influenced only the difference between FICK and PiCCO, as assessed by linear mixed models. CONCLUSIONS TPTD compared with FICK was able to track all changes induced during the study period, including those by PH. It yielded better agreement than PATD both compared with FICK. PiCCO and CCO were not mapping all changes correctly, and when used clinically in unstable patients, regular controls with intermittent techniques are required. Acute pharmacologically induced PH did influence the difference between FICK and PiCCO.
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Affiliation(s)
- Annette P N Kutter
- From the Section of Anesthesiology, Equine Department and Section of Epidemiology, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Kantonsspital Luzern, Luzern, Switzerland; and Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland
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16
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Critchley LAH, Huang L, Zhang J. Continuous Cardiac Output Monitoring: What Do Validation Studies Tell Us? CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0062-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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