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

2019 ◽  
Vol 34 (6) ◽  
pp. 1199-1207
Author(s):  
Thorir Svavar Sigmundsson ◽  
Tomas Öhman ◽  
Magnus Hallbäck ◽  
Eider Redondo ◽  
Fernando Suarez Sipmann ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Respiratory Failure ◽  
Reference Method ◽  
Hemodynamic Instability ◽  
Lung Lavage ◽  
Lung Recruitment ◽  
Recruitment Manoeuvre ◽  
Percentage Error ◽  
Before And After ◽  
The Right

AbstractRespiratory 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 (COEPBF) 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 (COEPBFexp), 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. COEPBFexp, without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk (COTS) at (1) baseline in healthy lungs with PEEP 5 cmH2O (HLP5), (2) LI with PEEP 5 cmH2O (LIP5) and (3) LI after lung recruitment and PEEP adjustment (LIPadj). CO changes were enforced during LIP5 and LIPadj 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 COEPBFexp and COTS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HLP5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LIP5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LIPadj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. COEPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre.

Cardiovascular hemodynamics in the fetal lamb before and after lung expansion

1965 ◽  
Vol 208 (1) ◽  
pp. 122-129 ◽  
Author(s):  
N. S. Assali ◽  
John A. Morris ◽  
Russell Beck
Keyword(s):  
Cardiac Output ◽  
Vascular Resistance ◽  
Lung Ventilation ◽  
Systemic Resistance ◽  
Cardiovascular Hemodynamics ◽  
Cord Clamping ◽  
Lung Expansion ◽  
Fetal Lamb ◽  
Before And After ◽  
The Right

Cardiovascular hemodynamic studies were carried out on fetal lambs before and after lung ventilation as well as before and after cord clamping. The findings are as follows: 1) Before lung expansion, pressures, output, and work in the right side of the heart are greater than those in the left side. This relation is reversed promptly after lung expansion. 2) When compared to adults, effective fetal cardiac output is high before lung expansion and falls significantly after lung expansion. 3) In the fetus, total pulmonary vascular resistance is considerably higher than systemic resistance. This relation is reversed immediately after lung expansion. 4) In the fetus, the flow of blood in the aorta and pulmonary artery is largely governed by inertial factors. 5) Cord clamping increases systemic resistance through elimination of low vascular resistance of the placental bed.

scholarly journals Rapidly progressive respiratory failure with multiple halo signs on computed tomography in a patient with primary cardiac angiosarcoma derived from the right atrium: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Masaoki Saito ◽  
Takeshi Saraya ◽  
Miku Oda ◽  
Toshinori Minamishima ◽  
Ken Kongoji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Output ◽  
Respiratory Failure ◽  
Lung Tissue ◽  
Right Atrium ◽  
Cardiac Ct ◽  
Loss Of Consciousness ◽  
Cardiac Angiosarcoma ◽  
Thoracic Ct ◽  
The Right

Abstract Background Primary cardiac neoplasms are extremely rare, with an autopsy incidence of 0.0001–0.003%. Primary cardiac sarcoma is usually derived from the right atrium and it manifests as chest pain, arrhythmia, hemoptysis, dyspnea, and fatigue. The most common target organ for metastasis of primary angiosarcoma is the lungs, but the radiological-pathological correlation has been rarely reported. Case presentation A 38-year-old healthy Japanese man was admitted to our hospital with persistent hemoptysis, exaggerated dyspnea, and two episodes of loss of consciousness in the past 3 months. Non-enhanced thoracic computed tomography (CT) revealed multiple scattered nodules with halo signs. Contrast-enhanced thoracic CT revealed a filling defect in the right atrium, which corresponded to the inhomogeneously enhancing tumor in the right atrium on enhanced electrocardiogram-gated cardiac CT. On day 2, acute respiratory failure occurred, and the patient was placed on mechanical ventilation. The patient was diagnosed with primary cardiac angiosarcoma based on the urgent transcatheter biopsied specimen of the right atrium mass and was treated with intravenous administration of doxorubicin. However, his respiratory status rapidly deteriorated, and he died on day 20. Postmortem biopsy showed that the multiple lung nodules with the halo signs corresponded to the intratumoral hemorrhagic necrosis and peripheral parenchymal hemorrhage in their background, suggesting the fragility of the lung tissue where the tumor had invaded, which caused hemoptysis. Furthermore, two episodes of loss of consciousness occurred probably due to a decreased cardiac output because of a massive tumor occupying the right atrium, recognized as an inhomogeneous centripetal enhancement on enhanced electrocardiogram-gated cardiac CT. Conclusions This case clearly demonstrated that primary cardiac angiosarcoma could expand in the right atrial cavity, which led to a decreased cardiac output resulting in repeated syncope, together with the fragility of lung tissue by tumor invasion, thereby generating a halo sign on thoracic CT.

scholarly journals Indirect Calorimetry Overestimates Oxygen Consumption in Young Children: Caution is Advised Using Direct Fick Method as a Reference Method in Cardiac Output Comparison Studies

2019 ◽  
Vol 41 (1) ◽  
pp. 149-154
Author(s):  
Theodor S. Sigurdsson ◽  
Lars Lindberg
Keyword(s):  
Cardiac Output ◽  
Oxygen Consumption ◽  
Young Children ◽  
Indirect Calorimetry ◽  
Method Comparison ◽  
Reference Method ◽  
Percentage Error ◽  
Measure Oxygen Consumption ◽  
A Minor ◽  
Method Comparison Study

AbstractDirect Fick method is considered a standard reference method for estimation of cardiac output. It relies on indirect calorimetry to measure oxygen consumption. This is important as only a minor measurement error in oxygen consumption can result in false estimation of cardiac output. A number of studies have shown that indirect calorimetry overestimates oxygen consumption in adults. The aim of this prospective single center observational method comparison study was to compare the determination of oxygen consumption by indirect calorimetry and reverse Fick method in pediatric patients. Forty-two children mean age 352 days (range 30 to 1303 days) and mean weight 7.1 kg (range 2.7–13.6 kg) undergoing corrective cardiac surgery were included in the study. The mean (standard deviation) oxygen consumption by reverse Fick method was 43.5 (16.2) ml/min and by indirect calorimetry 49.9 (18.8) ml/min (p < 0.001). Indirect calorimetry overestimated the reverse Fick oxygen consumption by 14.7%. Bias between methods was 6.5 (11.3) ml/min, limits of agreement (LOA) − 15.7 and 28.7 ml/min and percentage error of 47.7%. A significant bias and large percentage error indicates that the methods are not interchangeable. Indirect calorimetry and the direct Fick method should be used with caution as a reference method in cardiac output comparison studies in young children.

Measurement of Cardiac Output by Pulse Dye Densitometry Using Indocyanine Green 

1997 ◽  
Vol 87 (4) ◽  
pp. 816-822 ◽  
Author(s):  
Takasuke Imai ◽  
Kenichirou Takahashi ◽  
Haruhiko Fukura ◽  
Yasuo Morishita
Keyword(s):  
Cardiac Output ◽  
Indocyanine Green ◽  
Major Surgery ◽  
Percentage Error ◽  
Paired Data ◽  
Thermodilution Method ◽  
Accuracy And Precision ◽  
Before And After ◽  
Pulmonary Arterial Catheter ◽  
A Prospective Study

Background A new method for determining cardiac output (CO, l/min) using dye dilution combined with pulse dye densitometry (PDD), based on the principle of pulse oximetry, has been developed. The aim of the study was to determine the accuracy and precision of PDD by comparing it with the thermodilution method. Methods A prospective study was performed in 22 patients having surgery who were monitored using a pulmonary arterial catheter. In addition to the catheter, a specially designed photodetector was placed on the nasal wing. Ten milliliters of ice-cold indocyanine green dissolved in a 5% glucose solution (0.5 mg/ml) was injected. The dye and thermal dilution curves were simultaneously measured to calculate CO. Three to six injections were performed before and after surgery. Paired data were assessed in absolute terms, and the percentage errors were calculated by the degree of agreement and compared at three levels of CO (low &lt; or = 3.5 &lt; medium &lt; or = 6 &lt; high) by analysis of variance. Results The mean and SDs of the differences between dye and thermodilution CO were 0.16 +/- 0.80 l/min or 4.5 +/- 19.6% for 191 paired data. Measurement after surgery failed in one patient. The percentage error with low CO (9.3 +/- 19.3%) was greater (P &lt; 0.05) than those obtained with other CO. Conclusions Pulse dye densitometry could measure CO repeatedly in patients having major surgery with the same degree of accuracy as the thermodilution method; however, a considerable degree of error was observed in some patients.

scholarly journals Estimation of cardiac output variations induced by hemodynamic interventions using multi-beat analysis of arterial waveform: a comparative off-line study with transesophageal Doppler method during non-cardiac surgery

2021 ◽  
Author(s):  
Arthur Le Gall ◽  
Fabrice Vallée ◽  
Jona Joachim ◽  
Alex Hong ◽  
Joaquim Matéo ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Fluid Challenge ◽  
Percentage Error ◽  
Exclusion Zone ◽  
Upper Limits ◽  
Before And After ◽  
Transesophageal Doppler ◽  
Trending Ability ◽  
Arterial Wave Reflection

AbstractMulti-beat analysis (MBA) of the radial arterial pressure (AP) waveform is a new method that may improve cardiac output (CO) estimation via modelling of the confounding arterial wave reflection. We evaluated the precision and accuracy using the trending ability of the MBA method to estimate absolute CO and variations (ΔCO) during hemodynamic challenges. We reviewed the hemodynamic challenges (fluid challenge or vasopressors) performed when intra-operative hypotension occurred during non-cardiac surgery. The CO was calculated offline using transesophageal Doppler (TED) waveform (COTED) or via application of the MBA algorithm onto the AP waveform (COMBA) before and after hemodynamic challenges. We evaluated the precision and the accuracy according to the Bland & Altman method. We also assessed the trending ability of the MBA by evaluating the percentage of concordance with 15% exclusion zone between ΔCOMBA and ΔCOTED. A non-inferiority margin was set at 87.5%. Among the 58 patients included, 23 (40%) received at least 1 fluid challenge, and 46 (81%) received at least 1 bolus of vasopressors. Before treatment, the COTED was 5.3 (IQR [4.1–8.1]) l min−1, and the COMBA was 4.1 (IQR [3–5.4]) l min−1. The agreement between COTED and COMBA was poor with a 70% percentage error. The bias and lower and upper limits of agreement between COTED and COMBA were 0.9 (CI95 = 0.82 to 1.07) l min−1, −2.8 (CI95 = −2.71 to−2.96) l min−1 and 4.7 (CI95 = 4.61 to 4.86) l min−1, respectively. After hemodynamic challenge, the percentage of concordance (PC) with 15% exclusion zone for ΔCO was 93 (CI97.5 = 90 to 97)%. In this retrospective offline analysis, the accuracy, limits of agreements and percentage error between TED and MBA for the absolute estimation of CO were poor, but the MBA could adequately track induced CO variations measured by TED. The MBA needs further evaluation in prospective studies to confirm those results in clinical practice conditions.

Impact of pericardial restraint on right atrial mechanics during acute right ventricular pressure load

2003 ◽  
Vol 284 (1) ◽  
pp. H350-H357 ◽  
Author(s):  
Hersh S. Maniar ◽  
Sunil M. Prasad ◽  
Sydney L. Gaynor ◽  
Celeste M. Chu ◽  
Paul Steendijk ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Right Atrium ◽  
Right Atrial ◽  
Compensatory Response ◽  
Before And After ◽  
The Right ◽  
The Impact

Optimization of right atrial (RA) mechanics is important for maintaining right ventricular (RV) filling and global cardiac output. However, the impact of pericardial restraint on RA function and the compensatory role of the right atrium to changes in RV afterload remain poorly characterized. In eight open-chest sheep, RA elastance (contractility) and chamber stiffness were measured (RA pressure-volume relations) at baseline and during partial pulmonary artery (PA) occlusion. Data were collected before and after pericardiotomy. With the pericardium intact and partial PA occlusion, RA elastance increased by 28% ( P < 0.04), whereas RA stiffness tended to rise ( P = 0.08). However, after pericardiotomy, there was a significant fall in both RA elastance (54%, P < 0.04) and stiffness (39%, P < 0.04), and subsequent PA occlusion failed to induce a change in elastance ( P > 0.19) or stiffness ( P > 0.84). After pericardiotomy, RA elastance and stiffness fell dramatically, and the compensatory response of the right atrium to elevated RV afterload was lost. The ability of the right atrium to respond to changes in RV hemodynamics is highly dependent on pericardial integrity.

scholarly journals Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Ole Broch ◽  
Berthold Bein ◽  
Matthias Gruenewald ◽  
Sarah Masing ◽  
Katharina Huenges ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Transpulmonary Thermodilution ◽  
Pulse Contour ◽  
Passive Leg Raising ◽  
Percentage Error ◽  
Poor Correlation ◽  
Hemodynamic Changes ◽  
Before And After ◽  
Four Quadrant ◽  
Trending Ability

Objective. Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB). Methods. Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD) and by nine pulse contour algorithms (COX1–9). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. Results. There was only a poor correlation between COTPTD and COX1–9 during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Conclusions. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).

Comparative Arterial Antithrombotic Activity of Clopidogrel and Acetyl Salicylic Acid in the Pig

1992 ◽  
Vol 68 (05) ◽  
pp. 500-505 ◽  
Author(s):  
Ch M Samama ◽  
Ph Bonnin ◽  
M Bonneau ◽  
G Pignaud ◽  
E Mazoyer ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Femoral Artery ◽  
Bleeding Time ◽  
Ex Vivo ◽  
Flow Reduction ◽  
Cyclic Flow ◽  
Left Femoral Artery ◽  
Before And After ◽  
The Right ◽  
Induced Aggregation

SummaryWe investigated the comparative antithrombotic properties of clopidogrel, an analogue of ticlopidine, and aspirin, using the Folts' model on femoral arteries in 22 pigs. On each animal, clopidogrel or aspirin were used to treat the thrombotic process on the left femoral artery and to prevent this process on the right femoral artery. Sequentially: an injury and stenosis were carried out on the left femoral artery; the thrombotic process was monitored with a Doppler during a 30-min observation period for cyclic flow reductions or permanent cessation of flow; after the first cyclic flow reduction occurred, clopidogrel (5 mg kg-1) or aspirin (2.5, 5, 100 mg kg-1) were injected intravenously; if cyclic flow reductions were abolished, epinephrine (0.4 µg kg-1 min-1) was injected to try to restore cyclic flow reductions and/or permanent cessation of flow; then injury and stenosis were applied on the right femoral artery. Before and after injection of clopidogrel or aspirin, ear immersion bleeding times and ex-vivo platelet aggregation were performed. Clopidogrel (n = 7) abolished cyclic flow reductions in all animals and epinephrine did not restore any cyclic flow reduction. On the right femoral artery, cyclic flow reductions were efficiently prevented, even for two injuries. Basal bleeding time (5 min 28) was lengthened (>15 min, 30 min after clopidogrel and remained prolonged even after 24 h). ADP-induced platelet aggregation was inhibited (more than 78%). Comparatively, aspirin had a moderate and no dose-dependent effect. Aspirin 2.5 mg kg-1 (n = 6) abolished cyclic flow reductions in 2 animals, CFR reoccurred spontaneously in one animal and epinephrine restored it in a second animal. Aspirin 5 mg kg-1 (n = 6) abolished cyclic flow reductions in only 3 animals and epinephrine always restored it. Aspirin 100 mg kg-1 (n = 3) was unable to abolish cyclic flow reductions. On the right femoral artery, aspirin did not significantly prevent cyclic flow reductions which occurred in all animals after one (n = 14) or two injuries (n = 1), except for one animal. Basal bleeding time was lengthened but it shortened rapidly, reaching its basal value after 24 h. ADP-induced aggregation was not significantly inhibited, whereas arachidonic acid induced aggregation was always inhibited. Clopidogrel appears as a more potent antithrombotic drug than aspirin in this model, in treating and preventing spontaneous or epinephrine-induced cyclic flow reductions and lengthening bleeding time.

EFEKTIVITAS METODE DEMONSTRASI DALAM MENINGKATKAN HASIL BELAJAR SISWA SEKOLAH MENENGAH KEJURUAN PADA PENGAJARAN SISTEM KOLOID

2013 ◽  
Vol 19 (1) ◽  
pp. 28
Author(s):  
Hamda Situmorang ◽  
Manihar Situmorang
Keyword(s):  
High School ◽  
High School Students ◽  
Abstract Concept ◽  
Vocational High School ◽  
School Students ◽  
Lecture Method ◽  
Colloid System ◽  
Before And After ◽  
The Right ◽  
And Control

Abstract Implementation of demonstration method in the teaching of chemistry is assigned as the right strategy to improve students’ achievement as it is proved that the method can bring an abstract concept to reality in the class. The study is conducted to vocational high school students in SMKN1 Pargetteng getteng Sengkut Pakfak Barat at accademic year 2013. The teaching has been carried out three cycles on the teaching of chemistry topic of colloid system. In the study, the class is divided into two class, experiment class and control class. The demontration method is used to teach students in experimental class while the teaching in control class is conducted with lecture method. Both are evaluated by using multiple choise tests before and after the teaching procedures, and the ability of students to answer the problems are assigned as students’ achievements. The results showed that demonstration method improved students’ achievement in chemistry. The students in experimental class who are taughed with demonstration method (M=19.08±0.74) have higher achievements compare with control class (M=12.91±2.52), and both are significantly different (tcalculation 22.85 > ttable 1.66). The effectivity of demostration method in experimental class (97%) is found higer compare to conventional method in control class (91%).

Case Report: Hemoptysis localization – hearing with your eyes

POCUS Journal ◽  
2016 ◽  
Vol 1 (2) ◽  
pp. 7
Author(s):  
Barry Chan, MD
Keyword(s):  
Case Report ◽  
Respiratory Failure ◽  
Hemodynamic Instability ◽  
Clinical Vignette ◽  
Massive Hemoptysis ◽  
Airway Patency ◽  
Peripheral Site ◽  
Adventitious Sound

Clinical Vignette: 45 year old was transferred from a peripheral facility for acute massive hemoptysis though maintained sufficient airway patency with no evidence of hemodynamic instability or respiratory failure. Thoracic auscultation revealed vesicular breathing with no adventitious sound. CXR from the peripheral site was normal.

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