Transpulmonary thermodilution curves for detection of shunt

Abstract

Purpose: Monitoring using transpulmonary thermodilution (TPTD) via a single thermal indicator technique allows measurement of cardiac output, extravascular lung water (EVLW) and volumetric variables. Methods and results: This report describes two cases of systemic-venous circulation shunt generating early recirculation of thermal indicator with overestimation of EVLW. Conclusion: In the case of recirculation of thermal indicator, the observed overestimated EVLW in absence of gas exchanges abnormality could be an indicator suggesting the search for a circulatory shunt.

Monitoring intra-cardiac shunts correction with transpulmonary thermodilution curve: the best is yet to come!

“…However, in principle, this is not true in the presence of intra-cardiac left-to-right shunts due to atrial or ventricular septal defects as early recirculation of indicator may give rise to serious methodological problems in these cases [2]. Indeed, under varying levels of left-to-right shunt, the algorithms for calculation of flow considerably influence the validity of thermodilution measurements [3].…”

Impact of shunt on the transpulmonary thermodilution curve

“…The authors found that our explanation (Appendix, page 1086) was confused [2]! Thus, these authors proposed a much simpler and easier mathematical method to support our explanations [1].…”

“…However, retrospective calculations performed by these authors are based on mean values of three transpulmonary thermodilution (TPTD) curves [1,2]. In this regard, although some of these disagreements may be only semantic, these differences are important in trying to explain our results (Fig.…”

“…Dear Editor, We read with interest the comments by Nusmeier et al [1] regarding our article entitled ''Transpulmonary thermodilution curves for detection of shunt'' [2]. The authors found that our explanation (Appendix, page 1086) was confused [2]!…”

Hemodynamic monitoring development: helpful technology or expensive luxury?

“…As example, previous works have pointed out that classical thermodilution technique, transpulmonary thermodilution, and pulse-plethysmography, are valuable tools in evaluating the hemodynamic status of critically ill patients [4][5][6]. On the other hand, when occurrences not in accord with these principles are observed and unintelligible observations are documented [7], a new conception is gained concerning human pathophysiology [7,8]. In this specific case, such new scheme should improve our care and the outcome for ICU patients.…”