Intensive Care Medicine

, Volume 30, Issue 6, pp 1182–1187 | Cite as

Monitoring of respiratory variations of aortic blood flow velocity using esophageal Doppler

  • Michel Slama
  • Henri Masson
  • Jean-Louis Teboul
  • Marie-Luce Arnould
  • Rachida Nait-Kaoudjt
  • Bouchra Colas
  • Marcel Peltier
  • Christophe Tribouilloy
  • Dinko Susic
  • Edward Frohlich
  • Michel Andréjak
Experimental

Abstract

Objective

The purpose of this study was to determine whether monitoring of respiratory changes in aortic blood flow velocity, recorded by esophageal Doppler, could be used to detect changes in volume depletion.

Design

Animal study.

Animals and interventions

After general anesthesia and tracheotomy, ten New Zealand female rabbits, weighing 4–4.5 kg were studied under mechanical ventilation at a fixed tidal volume; during this time 5-ml blood samples were withdrawn (in increments up to a total of 30 ml) and then retransfused.

Measurements and results

At each step, systolic (SBP), diastolic (DBP), pulse (PP) pressures and maximum descending aortic blood flow (V) were recorded. Respiratory changes of V (ΔV), SBP (ΔSBP) and PP (ΔPP) were calculated as the difference of maximal and minimal values divided by their respective means and expressed as a percentage. The amount of blood withdrawn correlated negatively with SBP, DBP, PP and V and positively with ΔSBP, ΔPP and ΔV. Among these parameters, ΔV correlated best with the amount of blood withdrawn (r=0.89, p<0.001) and it was the most accurate index of volume depletion.

Conclusion

Monitoring of the respiratory variation in V, calculated by esophageal Doppler technique, seems to be a highly accurate index of blood volume depletion and restitution.

Keywords

Esophageal Doppler Hypovolemia Stroke volume variation Cardiac preload 

Notes

Acknowledgements

Very special thanks to Olivier des Horts and Sophie Mourier from Agilent technologies (Philips Medical Systems), who made it possible for us to carry out this study by lending us an echocardiographic machine, and to Olivier Fructus from Arrow who lent us the esophageal Doppler advice.

References

  1. 1.
    Slama M, Masson H, Teboul JL, Arnout ML, Susic D, Frohlich E, Andrejak M (2002) Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness. Am J Physiol Heart Circ Physiol 283:H1729–1733PubMedGoogle Scholar
  2. 2.
    Perel A (1998) Assessing fluid responsiveness by the systolic pressure variation in mechanically ventilated patients. Anesthesiology 89:1309–1310PubMedGoogle Scholar
  3. 3.
    Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, Perel A (2001) Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 92:984–989PubMedGoogle Scholar
  4. 4.
    Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P (1998) Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 89:1313–1321PubMedGoogle Scholar
  5. 5.
    Coriat P, Vrillon M, Perel A, Baron JF, Le Bret F, Saada M, Viars P (1994) A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg 78:46–53PubMedGoogle Scholar
  6. 6.
    Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMedGoogle Scholar
  7. 7.
    Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873PubMedGoogle Scholar
  8. 8.
    Tousignant CP, Walsh F, Mazer CD (2000) The use of transesophageal echocardiography for preload assessment in critically ill patients. Anesth Analg 90:351–355PubMedGoogle Scholar
  9. 9.
    Cariou A, Monchi M, Joly LM, Bellenfant F, Claessens YE, Thebert D, Brunet F, Dhainaut JF (1998) Noninvasive cardiac output monitoring by aortic blood flow determination: evaluation of the Sometec Dynemo-3000 system. Crit Care Med 26:2066–2072Google Scholar
  10. 10.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476): 307–310PubMedGoogle Scholar
  11. 11.
    Side CD, Gosling RG (1971) Non-surgical assessment of cardiac function. Nature 232:335–336PubMedGoogle Scholar
  12. 12.
    Lavandier B, Cathignol D, Muchada R, Xuan BB, Motin J (1985) Noninvasive aortic blood flow measurement using an intraesophageal probe. Ultrasound Med Biol 11:451–460PubMedGoogle Scholar
  13. 13.
    Singer M, Clarke J, Bennett ED (1989) Continuous hemodynamic monitoring by esophageal Doppler. Crit Care Med 17:447–452PubMedGoogle Scholar
  14. 14.
    Valtier B, Cholley BP, Belot JP, de la Coussaye JE, Mateo J, Payen DM (1998) Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler. Am J Respir Crit Care Med 158:77–83Google Scholar
  15. 15.
    Perel A, Pizov R, Cotev S (1987) Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology 67:498–502PubMedGoogle Scholar
  16. 16.
    Reuter DA, Felbinger TW, Schmidt C, Kilger E, Goedje O, Lamm P, Goetz AE (2002) Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 28:392–398CrossRefPubMedGoogle Scholar
  17. 17.
    Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008PubMedGoogle Scholar
  18. 18.
    Jardin F, Farcot JC, Gueret P, Prost JF, Ozier Y, Bourdarias JP (1983) Cyclic changes in arterial pulse during respiratory support. Circulation 68:266–274Google Scholar
  19. 19.
    Vieillard-Baron A, Loubieres Y, Schmitt JM, Page B, Dubourg O, Jardin F (1999) Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 87:1644–1650Google Scholar
  20. 20.
    Vieillard-Baron A, Augarde R, Prin S, Page B, Beauchet A, Jardin F (2001) Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support. Anesthesiology 95:1083–1088PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Michel Slama
    • 1
  • Henri Masson
    • 1
  • Jean-Louis Teboul
    • 2
  • Marie-Luce Arnould
    • 1
  • Rachida Nait-Kaoudjt
    • 1
  • Bouchra Colas
    • 1
  • Marcel Peltier
    • 1
  • Christophe Tribouilloy
    • 1
  • Dinko Susic
    • 3
  • Edward Frohlich
    • 3
  • Michel Andréjak
    • 1
  1. 1.Laboratoire de Physiopathologie et de Pharmacologie Cardiovasculaire, Faculté de MédecineUniversité de Picardie Jules VerneAmiensFrance
  2. 2.Service de Réanimation MédicaleCHU BicêtreLe Kremelin-BicêtreFrance
  3. 3.Research DivisionOchsner Medical InstitutionsNew OrleansUSA

Personalised recommendations