Carbon dioxide rebreathing method of cardiac output measurement during acute respiratory failure in patients with chronic obstructive pulmonary disease

Nevière, Rémi; Mathieu, Daniel; Yvon, Riou; Guimez, Philippe; Renaud, Nathalie; Chagnon, Jean-Luc; Wattel, F

doi:10.1097/00003246-199401000-00017

Cited by 10 publications

(6 citation statements)

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“…∆PCO 2 was calculated as the difference between the hindlimb venous carbon dioxide tension (PvCO 2 ) and hindlimb arterial PCO 2 (PaCO 2 ). In the original study, the hindlimb difference between venous-to-arterial CO 2 content (CvCO 2 − CaCO 2 ) was calculated with the McHardy equation (as proposed by Neviere et al 12 ): ΔCCO 2 = 11.02 × [(PvCO 2 ) 0.396 − (PaCO 2 ) 0.396 ] − (15 − Hb) × 0.015 × (PvCO 2 − PaCO 2 ) − (95 − SaO 2 ) × 0.064. However, the most used equation to calculate the blood CO 2 content is the Douglas equation 13 , which includes pH: where plasma CCO 2 = 2.226 × S × plasma PCO 2 × (1 + 10 pH−pK ′ ) , CCO 2 is CO 2 content, SO 2 is oxygen saturation, S is the plasma CO 2 solubility coefficient, and pK′ is the apparent pK.…”

Section: Methodsmentioning

confidence: 99%

Ratio of venous-to-arterial PCO2 to arteriovenous oxygen content difference during regional ischemic or hypoxic hypoxia

Mallat

Vallet

2021

Sci Rep

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The purpose of the study was to evaluate the behavior of the venous-to-arterial CO2 tension difference (ΔPCO2) over the arterial-to-venous oxygen content difference (ΔO2) ratio (ΔPCO2/ΔO2) and the difference between venous-to-arterial CO2 content calculated with the Douglas’ equation (ΔCCO2D) over ΔO2 ratio (ΔCCO2D/ΔO2) and their abilities to reflect the occurrence of anaerobic metabolism in two experimental models of tissue hypoxia: ischemic hypoxia (IH) and hypoxic hypoxia (HH). We also aimed to assess the influence of metabolic acidosis and Haldane effects on the PCO2/CO2 content relationship. In a vascularly isolated, innervated dog hindlimb perfused with a pump-membrane oxygenator system, the oxygen delivery (DO2) was lowered in a stepwise manner to decrease it beyond critical DO2 (DO2crit) by lowering either arterial PO2 (HH-model) or flow (IH-model). Twelve anesthetized and mechanically ventilated dogs were studied, 6 in each model. Limb DO2, oxygen consumption ($${\dot{\text{V}}\text{O}}_{2}$$ V ˙ O 2 ), ΔPCO2/ΔO2, and ΔCCO2D/ΔO2 were obtained every 15 min. Beyond DO2crit, $${\dot{\text{V}}\text{O}}_{2}$$ V ˙ O 2 decreased, indicating dysoxia. ΔPCO2/ΔO2, and ΔCCO2D/ΔO2 increased significantly only after reaching DO2crit in both models. At DO2crit, ΔPCO2/ΔO2 was significantly higher in the HH-model than in the IH-model (1.82 ± 0.09 vs. 1.39 ± 0.06, p = 0.002). At DO2crit, ΔCCO2D/ΔO2 was not significantly different between the two groups (0.87 ± 0.05 for IH vs. 1.01 ± 0.06 for HH, p = 0.09). Below DO2crit, we observed a discrepancy between the behavior of the two indices. In both models, ΔPCO2/ΔO2 continued to increase significantly (higher in the HH-model), whereas ΔCCO2D/ΔO2 tended to decrease to become not significantly different from its baseline in the IH-model. Metabolic acidosis significantly influenced the PCO2/CO2 content relationship, but not the Haldane effect. ΔPCO2/ΔO2 was able to depict the occurrence of anaerobic metabolism in both tissue hypoxia models. However, at very low DO2 values, ΔPCO2/ΔO2 did not only reflect the ongoing anaerobic metabolism; it was confounded by the effects of metabolic acidosis on the CO2–hemoglobin dissociation curve, and then it should be interpreted with caution.

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Section: Methodsmentioning

confidence: 99%

Ratio of venous-to-arterial PCO2 to arteriovenous oxygen content difference during regional ischemic or hypoxic hypoxia

Mallat

Vallet

2021

Sci Rep

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“…Collier (1956) originally concluded that mixed venous CO 2 tension could be determined with great accuracy, but that this method was not adequate for estimation of cardiac output in patients with certain cardiac and pulmonary disorders. Scientists and clinicians have continued to assess the validity and reliability of equilibrium and exponential rebreathing methods as non-invasive estimates of cardiac output in healthy and diseased populations over the past decades (Cowley et al 1986;Ferguson et al 1968;Franciosa 1977;Muiesan et al 1968;Neviere et al 1994;Nugent et al 1994;Ohlsson and Wranne 1986;Reybrouck et al 1978;Smith et al 1988;Vanhees et al 2000). The equilibrium method appears more valid for measurement of Q T at rest, while the exponential method is preferable during highintensity exercise (Muiesan et al 1968).…”

Section: Introductionmentioning

confidence: 99%

Comparison of cardiac output determined by different rebreathing methods at rest and at peak exercise

et al. 2007

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Several rebreathing methods are available for cardiac output (Q (T)) measurement. The aims of this study were threefold: first, to compare values for resting Q (T) produced by the equilibrium-CO(2), exponential-CO(2) and inert gas-N(2)O rebreathing methods and, second, to evaluate the reproducibility of these three methods at rest. The third aim was to assess the agreement between estimates of peak exercise Q (T) derived from the exponential and inert gas rebreathing methods. A total of 18 healthy subjects visited the exercise laboratory on different days. Repeated measures of Q (T), measured in a seated position, were separated by a 5 min rest period. Twelve participants performed an incremental exercise test to determine peak oxygen consumption. Two more exercise tests were used to measure Q (T) at peak exercise using the exponential and inert gas rebreathing methods. The exponential method produced significantly higher estimates at rest (averaging 10.9 l min(-1)) compared with the equilibrium method (averaging 6.6 l min(-1)) and the inert gas rebreathing method (averaging 5.1 l min(-1); P < 0.01). All methods were highly reproducible with the exponential method having the largest coefficient of variation (5.3%). At peak exercise, there were non-significant differences between the exponential and inert gas rebreathing methods (P = 0.14). The limits of agreement were -0.49 to 0.79 l min(-1). Due to the ability to evaluate the degree of gas mixing and to estimate intra-pulmonary shunt, we believe that the inert gas rebreathing method has the potential to measure Q (T) more precisely than either of the CO(2) rebreathing methods used in this study. At peak exercise, the exponential and inert gas rebreathing methods both showed acceptable limits of agreement.

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“…Analyses of exhaled CO 2 and rebreathing techniques have been tested for CO determination in the critical care setting. Several authors [8,9,10,11] have reported the accuracy of the rebreathing method for CO measurement in critically ill patients. Unfortunately, however, as this technique is technically difficult and time consuming, its routine use in the critical care arena is limited.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a noninvasive method for cardiac output measurement in critical care patients

et al. 2002

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Carbon dioxide rebreathing method of cardiac output measurement during acute respiratory failure in patients with chronic obstructive pulmonary disease

Cited by 10 publications

References 0 publications

Ratio of venous-to-arterial PCO2 to arteriovenous oxygen content difference during regional ischemic or hypoxic hypoxia

Ratio of venous-to-arterial PCO2 to arteriovenous oxygen content difference during regional ischemic or hypoxic hypoxia

Comparison of cardiac output determined by different rebreathing methods at rest and at peak exercise

Evaluation of a noninvasive method for cardiac output measurement in critical care patients

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