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An adequate strategy for the thermodilution technique in patients during mechanical ventilation

Abstract

The application of the thermodilution method in conditions associated with variations in blood flow implies a misuse of the Stewart Hamilton equation. Therefore, we studied the reliability of the thermodilution method for the estimation of mean cardiac output (CO) during mechanical ventilation in patients (n=9). Variation of the injection moment in the ventilatory cycle elicited a cyclic variation of CO estimates. This variation was not the same for all patients neither in phase nor in amplitude. Therefore, no specific phase in the ventilatory cycle could be selected for an accurate estimation of mean CO. Averaging CO estimates randomly distributed in the ventilatory cycle led to an improvement of accuracy with the square root of the number of observations. The averaging of CO estimates spread equally over the ventilatory cycle led to a much better result, e.g., the variation in the average of two estimates equally spread in the ventilatory cycle was similar to the variation in the average of four random estimates. We conclude that averaging of 3 or 4 estimates spread equally over the ventilatory cycle is an adequate strategy to estimate mean cardiac output in patients reliably.

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References

  1. 1.

    Hoffman JIE, Guz A, Charlier AA, Wilcken DEL (1965) Stroke volume in conscious dogs: effect of respiration, posture and vascular occlusion. J Appl Physiol 20:865–877

  2. 2.

    Morgan BC, Martin WE, Hornbein TF, Crawford EW, Fronek A (1966) Hemodynamic effects of intermittent positive pressure ventilation with and without an end-expiratory pause. Anesthesiology 27:584–590

  3. 3.

    Jansen JRC, Schreuder JJ, Bogaard JM, v Rooyen W, Versprille A (1981) The thermodilution technique for the measurement of cardiac output during artificial ventilation. J Appl Physiol 51:584–591

  4. 4.

    Jansen JRC, Versprille A (1986) Improvement of cardiac output estimation by the thermodilution method during mechanical ventilation. Intensive Care Med 12:71–79

  5. 5.

    Jansen JRC, Bogaard JM, Versprille A (1987) Extrapolation of thermodilution curves obtained during a pause in artificial ventilation. J Appl Physiol 63:1551–1557

  6. 6.

    Armengol J, Man GCW, Balsys AJ (1981) Effects of the respiratory cycle on cardiac output measurements: reproducibility of data enhanced by timing the thermodilution injections in dogs. Crit Care Med 9:852–854

  7. 7.

    Snyder JV, Powner DJ (1982) Effects of mechanical ventilation on the measurement of cardiac output by thermodilution. Crit Care Med 10:677–682

  8. 8.

    Okamoto K, Komatsu T, Kumar V, Sanchala V, Kabul K, Bhalodia R, Shibutani K (1986) Effects of intermittent positive-pressure ventilation on cardiac output measurements by thermodilution. Crit Care Med 14:977–980

  9. 9.

    Stevens JH, Raffin TA, Mihm FG, Rosenthal MH, Stetz CW (1985) Thermodilution cardiac output measurement. Effect of the respiratory cycle on its reproducibility. JAMA 253:2240–2242

  10. 10.

    Stetz CW, Miller RG, Kelly GE (1982) Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis 125:1001–1004

  11. 11.

    Wessel HU, Paul MH, James GW, Grahn AR (1971) Limitations of thermal dilution curves for cardiac output determinations. J Appl Physiol 30:643–652

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Jansen, J.R.C., Schreuder, J.J., Settels, J.J. et al. An adequate strategy for the thermodilution technique in patients during mechanical ventilation. Intensive Care Med 16, 422–425 (1990). https://doi.org/10.1007/BF01711218

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Key words

  • Cardiac output
  • Mechanical ventilation
  • Multiple injections
  • Thermodilution