We describe a new indicator dilution method of measuring cardiac output in man. A bolus injection of lithium chloride 0.6 mmol was given via a central venous catheter and arterial plasma [L/+] recorded using a specially developed sensor incorporating an LP-selective electrode. Cardiac output was derived from the lithium dilution curve, with a correction for packed cell volume. Lithium dilution cardiac output (LiDCO) was compared with thermodilution cardiac output (TD) using 22 lithium sensors in nine patients. For each sensor, one LiDCO was measured immediately before and one immediately after three TD estimations and mean values of LiDCO and TD derived. The correlation coefficient, r, was 0.89; slope of the regression 0.84; y intercept 0.72; bias 0.3 (0.5) litre min' 1 (mean (TD-LiDCO) (1 SD). LiDCO appeared to be a safe, simple and accurate technique which does not require insertion of a pulmonary artery catheter.

These results suggest that the LiDCO method can be used to provide safe and accurate measurement of cardiac output in paediatric patients. The method is simple and quick to perform, requiring only arterial and venous catheters, which will already have been inserted for other reasons in these patients.

We have monitored oscillations in arterial pH (of respiratory frequency) in normal man at rest and during exercise. The pH oscillations are known to reflect respiratory oscillations in arterial carbon dioxide tension generated at the lungs. We have found that the pH oscillations increase in their upslope and downslope during exercise. This means that oscillations in arterial carbon dioxide tension can be considered as a control signal.

SUMMARY1. An in vivo pH monitoring technique was used to assess changes in pH, and by inference changes in PCO., in the carotid artery of anaesthetized cats. The changes in carotid artery pH and respiration following abrupt injections of various acids into the carotid artery or aorta were investigated.2. Injections of saline equilibrated with 100% C02, timed to produce changes at the carotid body chemoreceptors during early inspiration caused an increase in the tidal volume of that breath. The amplitude and rate of change of the pH changes so produced were comparable with those of the oscillations in pH produced by respiration itself.3. The respiratory responses to injection of saline equilibrated with 100 % C02 occurred whether the animal was breathing air or 100 % 02.4. Injections of lactic or hydrochloric acid were without an effect on respiration, except when pH changes larger than 0.1 pH unit were produced. A NaHCO3 solution equilibrated with 30 % C02 stimulated respiration, even though the solution was alkaline to the cat's arterial blood and induced an alkaline change in arterial pH.5. Infiltration of the carotid sinus nerve area with procaine temporarily abolished the respiratory response to injections of saline equilibrated with 100 % C02.

Close agreement between arterialized venous and arterial pH, PCO2, and lactate has previously been demonstrated during steady-state exercise. The purpose of the present study was to compare arterialized venous and arterial pH, PCO2, K+, lactate, pyruvate, and epinephrine during the constantly changing circumstances of an incremental exercise test. Eight normal subjects undertook an incremental exercise test (increasing by 20 W/min) to exhaustion on a cycle ergometer during which simultaneous arterial and arterialized venous samples were drawn over the last 20 s of each work load. Linear regression of arterialized venous on arterial values showed that r varied from 0.97 to 0.99 for the variables examined and, therefore, showed that accurate estimates of arterial values could be made from the arterialized venous results during incremental testing. For many purposes it could be assumed that arterialized venous values equaled arterial values without serious error.