Validation of capnodynamic determination of cardiac output by measuring effective pulmonary blood flow: a study in anaesthetised children and piglets

Karlsson, Jacob; Winberg, P.; Scarr, Bronwyn; Lönnqvist, Per‐Arne; Neovius, Erik; Wallin, Mats; Hallbäck, Magnus

doi:10.1016/j.bja.2018.02.034

Cited by 19 publications

(48 citation statements)

References 29 publications

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“…Previous animal studies and our overall data show conflicting results in terms of higher PEEP (increased lung volume) and accuracy of the CO EPBF . Interestingly, in a recent clinical study (manuscript) where CO EPBF was compared to transpulmonary 114 (6) 124 (4) 115 (4) 133 (9) 118 (8) 117 7124 (12) 116 (10) 133 (13) MAP (mmHg) 74 (10) 73 (9) 57 (9) 83 (15) 78 (11) 75 (11) 83 (16) 60 (11) 90 (18) 89 (8) mPAP (mmHg) 312 (17) 310 (12) 310 (12) 310 (12) 310 (12) 309 (11) 310 (12) 310 (12) 310 (12) 310 (13) RR ( 19 219 215 215 215 215 ( thermodilution during open abdominal surgery, no over estimation was observed even at high PEEP levels (up to 20 cmH 2 O) [24]. The current experimental protocol using the improved capnodynamic method departs from our previous study [6] in three ways.…”

Section: Discussionmentioning

confidence: 99%

“…As previously described, the capnodynamic method with inspiratory holds (CO EPBFinsp ) showed acceptable performance in animals with low shunt [4], however when the animals were subjected to lavage-induced lung injury both accuracy and precision were affected [6]. After refinement of the method with the obliged holds inserted in expiration (CO EPBFexp ) instead of inspiration the performance in a porcine model with healthy lungs improved with sustained good trending ability during hemodynamic and ventilatory challenges [5,[7][8][9]. In addition, CO EPBFexp has been shown to provide stable CO monitoring in healthy infants undergoing cleft-lip surgery [8].…”

Section: Introductionmentioning

confidence: 95%

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Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recruitment

Öhman

Hallbäck

Redondo

et al. 2019

J Clin Monit Comput

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Respiratory failure may cause hemodynamic instability with strain on the right ventricle. The capnodynamic method continuously calculates cardiac output (CO) based on effective pulmonary blood flow (CO EPBF) and could provide CO monitoring complementary to mechanical ventilation during surgery and intensive care. The aim of the current study was to evaluate the ability of a revised capnodynamic method, based on short expiratory holds (CO EPBFexp), to estimate CO during acute respiratory failure (LI) with high shunt fractions before and after compliance-based lung recruitment. Ten pigs were submitted to lung lavage and subsequent ventilator-induced lung injury. CO EPBFexp , without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk (CO TS) at (1) baseline in healthy lungs with PEEP 5 cmH 2 O (HL P5), (2) LI with PEEP 5 cmH 2 O (LI P5) and (3) LI after lung recruitment and PEEP adjustment (LI Padj). CO changes were enforced during LI P5 and LI Padj to estimate trending. LI resulted in changes in shunt fraction from 0.1 (0.03) to 0.36 (0.1) and restored to 0.09 (0.04) after recruitment manoeuvre. Bias (levels of agreement) and percentage error between CO EPBFexp and CO TS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HL P5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LI P5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LI Padj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. CO EPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recruitment

Öhman

Hallbäck

Redondo

et al. 2019

J Clin Monit Comput

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“…We previously validated a continuous capnodynamic approach to determine cardiac output (CO) based upon effective pulmonary blood flow (CO EPBF ) during normal, high, and low CO states in animals 1e3 and in healthy infants. 4 Agreement of the CO EPBF with other established CO comparators has been encouraging and is associated with good trending capabilities. 1e5 However, how CO EPBF performs in a situation of selective pulmonary vasoconstriction or pulmonary hypertension, resulting in a selective right ventricle increase in afterload and consequent variations in pulmonary carbon dioxide (CO 2 ) content, is unknown.…”

Section: Editor's Key Pointsmentioning

confidence: 91%

“…The anaesthetic and surgical procedures have been described in detail in our previous work. 4 In summary, the pigs were sedated with atropine 0.04 mg kg À1 (Mylan AB, Stockholm, Sweden), tiletamine-zolazepam (Zoletil, Vibrac Laboratories, Carros, France) 6 mg kg À1 , and xylazine chloride (Rompun, Bayer AG, Leverkusen, Germany) 2.2 mg kg À1 administered i.m. Infusion of fentanyl (Fentanyl B. Braun, Melsungen, Germany) 5 mg kg À1 , ketamine 30 mg kg À1 h À1 , midazolam 0.1 mg kg À1 h À1 , and fentanyl 4 mg kg À1 h À1 was used for maintenance of anaesthesia and rocuronium 2 mg kg À1 h À1 for muscle relaxation.…”

Section: Animal Preparationmentioning

confidence: 99%

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Capnodynamic determination of cardiac output in hypoxia-induced pulmonary hypertension in pigs

Karlsson

Wallin

Hallbäck

et al. 2019

British Journal of Anaesthesia

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Background: Effective pulmonary blood flow (CO EPBF) has recently been validated for its ability to measure cardiac output (CO) in children and animals. This study compared CO EPBF with the Fick method (CO Fick) and CO measurements using an invasive pulmonary artery flow probe (CO TS). The aim of the study was to validate CO EPBF against these reference methods in a porcine model of hypoxia-induced selective pulmonary hypertension. Methods: Ten anaesthetised mechanically ventilated piglets (median weight 23.9 kg) were exposed to a hypoxic gas mixture inducing selective pulmonary hypertension. Pulmonary hypertension was subsequently reversed with inhaled nitric oxide. Simultaneous recordings of CO EPBF , CO Fick , and CO TS were performed throughout the protocol and examined for agreement and trending ability. Results: Overall bias (Bland-Altman) between CO EPBF and CO TS was 0.2 L min À1 (limits of agreement À0.5 and þ0.9 L min À1) with a mean percentage error of 25%. Overall bias between CO EPBF and CO Fick was À0.1 L min À1 (limits of agreement À0.9 and þ0.6 L min À1) and a mean percentage error of 25%. The concordance rate was 86% for CO EPBF when compared with CO TS using a 10% exclusion zone. Conclusions: Estimation of CO with CO EPBF results in values very close to the gold standard reference methods CO Fick and CO TS. CO EPBF appears to be an accurate tool for monitoring absolute values and changes in CO during hypoxia-induced pulmonary hypertension and inhaled nitric oxide treatment.

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Continuous cardiac output measured with a Swan‐Ganz catheter reacts too slowly in animal experiments with sudden circulatory failure

Magnúsdóttir

Simonsen

Rasmussen

et al. 2022

Anim Models and Exp Med

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Validation of capnodynamic determination of cardiac output by measuring effective pulmonary blood flow: a study in anaesthetised children and piglets

Cited by 19 publications

References 29 publications

Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recruitment

Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recruitment

Capnodynamic determination of cardiac output in hypoxia-induced pulmonary hypertension in pigs

Continuous cardiac output measured with a Swan‐Ganz catheter reacts too slowly in animal experiments with sudden circulatory failure

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