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Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia

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Abstract

Objective

To assess the combination of a non-invasive blood oxygen content (CaO2) monitor and a non-invasive cardiac output (CO) monitor to continuously measure oxygen delivery (DO2; DO2 = CaO2 × CO).

Methods

DO2 was assessed during blood transfusions in an infant with acute hemolytic anemia following admission (~48 h). CaO2 was measured by Pulse Co-Oximetry, which also provides estimates of hemoglobin (Hgb) concentration and percent oxygen saturation. CO was measured by Electrical Velocimetry, which also provides an estimate of stroke volume (SV). Lactate levels, an indirect measure of adequate DO2, were assessed during the initial 8 h following admission.

Results

Incremental blood transfusions during the first 36 h increased Hgb from 2.7 to 9.5 g/dL during which time heart rate (HR) normalized from 156 to 115 beats/min. Lactate levels decreased from 20 to 0.8 mmol/L in the first 7 h. Non-invasive Hgb and CaO2 measurements were well correlated with invasive Hgb and CaO2 measures (r 2 = 0.88; P = 0.019; r 2 = 0.86; P = 0.0074, respectively). CO decreased from 2.47 ± 0.06 to 1.28 ± 0.02 L/min and SV decreased from 15.9 ± 0.4 to 11.1 ± 0.2 mL/beat. Mean arterial blood pressure was stable throughout the admission with systemic vascular resistance increasing from 407.6 ± 15.2 to 887.7 ± 30.1 dynes-s/cm5. DO2 was estimated to increase from 120.2 ± 18.9 to 182.4 ± 5.6 mL O2/min.

Conclusions

Non-invasive contin- uous CO and CaO2 monitors are shown in this single case to provide continuous DO2 measurement. The ability to assess DO2 may improve hemodynamic monitoring during goal directed therapies.

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Authors and Affiliations

  1. Department of Medicine: Medicine Critical Care Program, Children’s Hospital Boston, 330 Longwood Avenue 11 South, Boston, MA, 02115, USA

    Garry M. Steil PhD, Olive S. Eckstein MD, Julie Caplow BA, Michael S. D. Agus MD, Brian K. Walsh RRT & Jackson Wong MD

  2. Harvard Medical School, Boston, MA, USA

    Garry M. Steil PhD, Olive S. Eckstein MD, Julie Caplow BA, Michael S. D. Agus MD, Brian K. Walsh RRT & Jackson Wong MD

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  1. Garry M. Steil PhD
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  2. Olive S. Eckstein MD
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  3. Julie Caplow BA
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  4. Michael S. D. Agus MD
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Correspondence to Jackson Wong MD.

Additional information

Steil GM, Eckstein OS, Caplow J, Agus MSD, Walsh BK, Wong J. Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia.

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Steil, G.M., Eckstein, O.S., Caplow, J. et al. Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia. J Clin Monit Comput 25, 113–119 (2011). https://doi.org/10.1007/s10877-011-9287-z

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  • DOI: https://doi.org/10.1007/s10877-011-9287-z

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