Intermittent pneumatic calf compression increased lower limb venous return, causing acute but transient decreases in pulmonary artery blood temperature. This did not affect the accuracy of thermodilution cardiac output measurements that were made using 10 mL of either cold or room temperature injectate.
Women have significantly lower interface pressures when compared with men. BMI >or= 25 also increases interface pressures. The use of the kidney rest is associated with markedly increased pressure; use of a half-flexed position is preferable to a full-flexed position. These data have implications for patient positioning and identification of persons at risk for rhabdomyolysis during laparoscopic renal surgery.
Using the arterial occlusion method, we compared five literature-based estimates of pulmonary capillary pressure (Ppc) with the corresponding double occlusion pressures (Pdo) in anesthetized dogs whose chests had been closed after sternotomy for instrumentation. Arterial occlusions were performed with a balloon-tipped pulmonary artery catheter that housed pressure transducers immediately proximal and distal to the balloon. Separation of the proximal and distal pressure waveforms during balloon inflation allowed us to precisely define the moment of occlusion. We fit a monoexponential curve to pressure data beginning 200 ms after the onset of occlusion and a biexponential curve to data beginning at the instant of occlusion, with data obtained over a range of vascular states (control, serotonin infusion, histamine infusion). In addition, we investigated the use of sampling of the raw data to estimate capillary pressure. Three of the five literature-based estimates of Ppc yielded values similar to Pdo. The optimal (least average difference from Pdo) interpolation/extrapolation time points of the curve fits varied, depending on the type of curve fitting and the state of the pulmonary vasculature. We also determined that a close approximation of Pdo may be derived from the raw data, as an alternative to exponential curve fitting.
A totally self-contained instrument for the measurement of cardiac output is described. The microcomputer controlled instrument is based upon the principles of thermodilution and is capable of making cardiac output determinations on a minute by minute basis. A bolus of heat is delivered to the blood via a resistive heating element wound on the surface of a conventional thermodilution catheter, and the resulting transient pulmonary artery blood temperature increases is monitored with the thermistor located near the tip of the catheter. The performance of the instrument was tested in a mock circulatory loop and in dogs for periods of up to 13 hours. The accuracy and reproducibility of flow determinations made with the system compare favorably with those made with a conventional cardiac output monitor. This study demonstrates the feasibility of a stand-alone cardiac output computer that can provide virtually continuous measurements of blood flow without the intervention of a technician.
Oleic acid lung injury increases pulmonary capillary pressure independent of pulmonary artery occlusion pressure. The gradient between the two pressures was not significantly affected by volume loading or dobutamine infusion.
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