The Impact of Intra-aortic Balloon Pumping on Cardiac Output Determination by Pulmonary Arterial and Transpulmonary Thermodilution in Pigs

Janda, Matthias; Scheeren, Thomas; Bajorat, J.; Westphal, Bernd; Vagts, Dierk A.; Pohl, B.; Popescu, Corneliu Petru; Hofmockel, R.

doi:10.1053/j.jvca.2005.11.020

Cited by 17 publications

(15 citation statements)

References 26 publications

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“…A similar issue can occur during the use of an intra-aortic balloon pump (IABP). It should be noted that the use of continuous CO measurement based on the principle of pulse contour analysis is not a viable option during IABP [151]. The intermittent transpulmonary thermodilution derived parameters on the other hand remain accurate.…”

Section: Step 9 Catheter Whip Artefact and Use Of Intra-aortic Ballomentioning

confidence: 99%

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

Hofkens¹,

Verrijcken²,

Merveille³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Haemodynamic monitoring with transpulmonary thermodilution (TPTD) is less invasive than a pulmonary artery catheter, and is increasingly used in the Intensive Care Unit and the Operating Room. Optimal treatment of the critically ill patient demands adequate, precise and continuous monitoring of clinical parameters. Little is known about staff knowledge of the basic principles and practical implementation of TPTD measurements at the bedside. The aims of this review are to: 1) present the results of a survey on the knowledge of TPTD measurement among 252 nurses and doctors; and 2) to focus on specific situations and common pitfalls in order to improve patient management in daily practice. Methods: Web-based survey on knowledge of PiCCO technology (Pulsion Medical Systems, Feldkirchen, Germany), followed by PubMed and Medline search with review of the relevant literature regarding the use of TPTD in specific situations. Results: In total, 252 persons participated in the survey: 196 nurses (78%) and 56 medical doctors (22%) of whom 17 were residents in training. Knowledge on the use of TPTD appears to be suboptimal, with an average score of 58.3%. Doctors performed better than nurses (62.7% vs 57.0%, P = 0.012). About 190 out of 252 (75.4%) scored at least 50% but only 45 respondents (17.9%) obtained a score of 70% or more. Having five years of PiCCO experience was present in 15.8% of the participants and this was correlated to passing the test, defined as obtaining a test result of ≥ 50% (P = 0.07) or obtaining a test result of ≥ 70% (P = 0.05). There were no other parameters significantly predictive for obtaining a result above 50% or above 70% such as gender or doctor versus nurse or Belgian versus Dutch residency, or years of ICU experience. High quality education of nursing and medical staff is necessary to perform the technique correctly and to analyse and interpret the information that can be obtained. Visual inspection of thermodilution curves is important as this can point towards specific pathology. Interpretation of the parameters that can be obtained with TPTD in specific conditions is discussed. Finally, a practical approach is given in ten easy steps for nurses and doctors. Conclusion: TPTD has gained its place in the haemodynamic monitoring field, but, as with any technique, its virtue is only fully appreciated with correct use and interpretation.

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Section: Step 9 Catheter Whip Artefact and Use Of Intra-aortic Ballomentioning

confidence: 99%

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

Hofkens¹,

Verrijcken²,

Merveille³

et al. 2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

show abstract

“…Michard et al studied the effect of cardiac index changes in critically ill patients in the range 1.9 L/min/m 2 to 7.1 L/min/m 2 as well as hyper- an hypovolaemic states but found no change in the relationship between GEDV and ITBV [15]. The presence of an intra-aortic balloon pump (IABP) renders continuous pulse contour analysis inaccurate but does not affect the accurate estimation of EVLW [58]. The same applies for the concomitant use of renal replacement therapy.…”

Section: Limitations Of Evlwmentioning

confidence: 99%

Extravascular Lung Water and Acute Lung Injury

Maharaj

2012

Cardiology Research and Practice

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Acute lung injury carries a high burden of morbidity and mortality and is characterised by nonhydrostatic pulmonary oedema. The aim of this paper is to highlight the role of accurate quantification of extravascular lung water in diagnosis, management, and prognosis in “acute lung injury” and “acute respiratory distress syndrome”. Several studies have verified the accuracy of both the single and the double transpulmonary thermal indicator techniques. Both experimental and clinical studies were searched in PUBMED using the term “extravascular lung water” and “acute lung injury”. Extravascular lung water measurement offers information not otherwise available by other methods such as chest radiography, arterial blood gas, and chest auscultation at the bedside. Recent data have highlighted the role of extravascular lung water in response to treatment to guide fluid therapy and ventilator strategies. The quantification of extravascular lung water may predict mortality and multiorgan dysfunction. The limitations of the dilution method are also discussed.

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“…The continuous pulse contour analysis detects the area under the pulse wave for measuring the CO. In our experiment, an additional curve was integrated by the IABP that resulted in a greater area under the curve and led to higher CO values . Consequently, these results must be interpreted as a trend.…”

Section: Discussionmentioning

confidence: 69%

“…These results cannot be compared without restrictions because we used continuous pulse contour analysis to measure the CO. This method leads to higher CO measurements during IABP augmentation . It should be mentioned, however, that the CO during augmentation was higher in the group with the blocked visceral artery origin (group 3) in comparison to the free origin (group 2).…”

Section: Discussionmentioning

confidence: 90%

Intra‐Aortic Balloon Pump Malposition Reduces Visceral Artery Perfusion in an Acute Animal Model

et al. 2015

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Visceral artery perfusion can be potentially affected by intra-aortic balloon pump (IABP) catheters. We utilized an animal model to quantify the acute impact of a low balloon position on mesenteric artery perfusion. In six pigs (78 ± 7 kg), a 30-cc IABP was placed in the descending aorta in a transfemoral procedure. The celiac artery (CA) and the cranial mesenteric artery (CMA) were surgically dissected. Transit time blood flow was measured for (i) baseline, (ii) 1:1 augmentation with the balloon proximal to the visceral arteries, and (iii) 1:1 augmentation with the balloon covering the visceral arteries. Blood flow in the CMA and CA was reduced by 17 and 24%, respectively, when the balloon compromised visceral arteries compared with a position above the visceral arteries (flow in mL/min: CMA: (i) 1281 ± 512, (ii) 1389 ± 287, (iii) 1064 ± 276, P < 0.05 for 3 vs. 1 and 3 vs. 2; CA: (i) 885 ± 370, (ii) 819 ± 297, (iii) 673 ± 315; P < 0.05 for 3 vs. 1). The covering of visceral arteries by an IABP balloon causes a significant reduction of visceral artery perfusion; thus, the positioning of this device during implantation is critical for obtaining a satisfactory outcome.

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The Impact of Intra-aortic Balloon Pumping on Cardiac Output Determination by Pulmonary Arterial and Transpulmonary Thermodilution in Pigs

Cited by 17 publications

References 26 publications

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review

Extravascular Lung Water and Acute Lung Injury

Intra‐Aortic Balloon Pump Malposition Reduces Visceral Artery Perfusion in an Acute Animal Model

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