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Partial CO2 Rebreathing Indirect Fick Technique for Non-Invasive Measurement of Cardiac Output

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Abstract

Objective.Evaluation in animals of a non-invasive and continuous cardiac output monitoring system based on partial carbon-dioxide (CO2) rebreathing indirect Fick technique. Methods.We have developed a non-invasive cardiac output (NICO) monitoring system, based on the partial rebreathing method. The partial rebreathing technique employs a differential form of the Fick equation for calculating cardiac output (QT) using non-invasive measurements. Changes in CO2 elimination (ΔVCO2) and partial pressure of end-tidal CO2 (Δ PETCO2) in response to a brief period of partial rebreathing are used to measure pulmonary capillary blood flow (QPCBF). A non-invasive estimate of anatomic and intrapulmonary shunt fraction (QS/QT), based on oxygen saturation from pulse oximetry (SpO2) and inspired oxygen concentration (FIO2), is added to compute total cardiac output [QT=QPCBF/(1−QS/QT)]. The performance of the NICO was compared with iced 5% dextrose bolus thermodilution cardiac output (TDco) measurements in 6 dogs. Cardiac output was varied using dobutamine, and halothane, and by clamping of the inferior vena cava. Two hundred and forty-six (n = 246) paired measurements of TDco and NICO over a range of cardiac outputs (TDco range = 0.60–8.87 l/min) were compared using Bland-Altman analysis and weighted correlation coefficient. Results.The Bland–Altman technique yielded a NICO precision of ±  0.70 l/min (13.8%) with a mean bias of −0.07 l/min (−1.4%) compared to TDco. The weighted correlation coefficient between TDco and NICO values was: r= 0.93 (n= 246). Conclusion.The partial CO2 rebreathing technique for measurement of cardiac output is non-invasive, automated, and based on the well accepted Fick principle. The limits of agreement between NICO and TDco is within the recommended value for NICO to be a clinically acceptable method for cardiac output measurement. The results of this canine study show that NICO performed as well, and in some cases better, than other currently available non-invasive cardiac output techniques over a wide range of cardiac outputs.

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Authors and Affiliations

  1. Departments of Anesthesiology and Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A.

    Dinesh G. Haryadi, Joseph A. Orr, Kai Kuck, Scott McJames & Dwayne R. Westenskow

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  1. Dinesh G. Haryadi
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  2. Joseph A. Orr
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  4. Scott McJames
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  5. Dwayne R. Westenskow
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Haryadi, D.G., Orr, J.A., Kuck, K. et al. Partial CO2 Rebreathing Indirect Fick Technique for Non-Invasive Measurement of Cardiac Output. J Clin Monit Comput 16, 361–374 (2000). https://doi.org/10.1023/A:1011403717822

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