Transcutaneous Fluorescence Dilution Cardiac Output and Circulating Blood Volume during Hemorrhagic Hypovolemia

2005 ◽  
Vol 102 (4) ◽  
pp. 774-782 ◽  
Author(s):  
Jean-Michel I. Maarek ◽  
Daniel P. Holschneider ◽  
Jun Yang ◽  
Sarah N. Pniak ◽  
Eduardo H. Rubinstein
Keyword(s):  
Cardiac Output ◽  
Indocyanine Green ◽  
Blood Volume ◽  
Local Heating ◽  
Blood Perfusion ◽  
Optical Probe ◽  
Output Measurement ◽  
Circulating Blood Volume ◽  
Thermodilution Cardiac Output ◽  
Baseline Conditions

Background Cardiac output and circulating blood volume are important parameters for assessing cardiac function in the intensive care setting and during major surgeries. The authors tested in an animal model of hemorrhagic hypovolemia the feasibility of measuring these parameters simultaneously by transcutaneous fluorescence monitoring of an intravenous bolus injection of indocyanine green. Methods Fluorescence dilution cardiac output was measured in seven anesthetized rabbits and compared to thermodilution cardiac output. The optical probe used to excite the indocyanine green fluorescence was in contact with the skin above the ear artery. Local heating enhanced blood perfusion of the measurement site. Cardiac output was measured during baseline conditions, during hemorrhagic hypovolemia, and after partial restoration of the blood volume with reinfused blood. Estimates of the circulating blood volume were simultaneously obtained from the analysis of the fluorescence dilution traces. Results Cardiac output measured by fluorescence dilution (thermodilution) averaged 455 +/- 16 (450 +/- 13) ml/min in baseline conditions and 323 +/- 15 (330 +/- 13) ml/min during hypovolemia. Fluorescence dilution cardiac output was linearly related to thermodilution cardiac output (slope = 1.13 +/- 0.05, ordinate = -50 +/- 19 ml/min, R = 0.92). Interanimal differences explained most of the variance between cardiac output estimates obtained with the two techniques. Circulating blood volume decreased from 204 +/- 5 ml in baseline conditions to 174 +/- 8 ml after bleeding and reflected blood volume changes in this acute bleeding-reinfusion model. Conclusions The study extends the applicability of the fluorescence dilution technique for cardiac output measurement to hypovolemic conditions and demonstrates its ability to produce accurate estimates of the circulating blood volume in experimental animals.

Measurement of Cardiac Output with Indocyanine Green Transcutaneous Fluorescence Dilution Technique

2004 ◽  
Vol 100 (6) ◽  
pp. 1476-1483 ◽  
Author(s):  
Jean-Michel I. Maarek ◽  
Daniel P. Holschneider ◽  
Juji Harimoto ◽  
Jun Yang ◽  
Oscar U. Scremin ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Indocyanine Green ◽  
Near Infrared ◽  
Optical Probe ◽  
Thermodilution Cardiac Output ◽  
Indocyanine Green Fluorescence ◽  
Arterial Blood ◽  
Ear Artery ◽  
Hemodynamic Assessment ◽  
Baseline Conditions

Background Cardiac output is an essential parameter for the hemodynamic assessment of patients with cardiovascular disease. The authors tested in an animal model the feasibility of measuring cardiac output by transcutaneous fluorescence monitoring of an intravenous bolus injection of indocyanine green. Methods Fluorescence dilution cardiac output was measured in 10 anesthetized rabbits and compared with cardiac output measured with a pulmonary thermodilution catheter and to aortic velocity measured by Doppler ultrasound. Indocyanine green fluorescence was excited with a near-infrared laser and measured with an optical probe positioned on the central ear artery. Measurements were obtained during baseline conditions as well as during short-term decreases and increases of the cardiac output. Results The fluorescence of circulating indocyanine green detected transcutaneously varied proportionally to that of arterial blood samples, which allowed for calibration in terms of blood concentration of indocyanine green. Average values of fluorescence dilution cardiac output and thermodilution cardiac output measured in baseline conditions were 412 (+/- 13) and 366 (+/- 11) ml/min, respectively. Fluorescence dilution cardiac output showed a close, one-to-one linear relation with thermodilution cardiac output in each animal and in the pooled data from all animals (slope = 0.95 x 0.03; R = 0.94). Fluorescence dilution cardiac output overestimated thermodilution cardiac output by an average of 46 (+/- 6) ml/min during baseline conditions. Fluorescence dilution cardiac output was tightly correlated with aortic velocity. Conclusions The proposed technique yielded accurate estimates of the cardiac output in experimental animals. This study should provide an initial framework for clinical testing of this new minimally invasive method for measuring cardiac output.

Fluorescence Dilution Technique for Measurement of Cardiac Output and Circulating Blood Volume in Healthy Human Subjects

2007 ◽  
Vol 106 (3) ◽  
pp. 491-498 ◽  
Author(s):  
Jean-Michel I. Maarek ◽  
Daniel P. Holschneider ◽  
Eduardo H. Rubinstein
Keyword(s):  
Cardiac Output ◽  
Indocyanine Green ◽  
Blood Volume ◽  
Human Subjects ◽  
Optical Probe ◽  
Dilution Technique ◽  
Healthy Human ◽  
Circulating Blood Volume ◽  
Healthy Humans ◽  
The Temple

Background The authors previously validated in an animal model a new indicator dilution technique for measuring cardiac output and circulating blood volume by recording transcutaneously the fluorescence of circulating indocyanine green with an optical probe placed on the skin surface. The current study compared fluorescence dilution recordings recorded from several locations on the human face in terms of signal intensity and stability and estimated the subjects' cardiac output and circulating blood volume from the recordings. Methods Fluorescence dilution traces were recorded transcutaneously in six healthy human volunteers after rapid intravenous injection of 1 mg indocyanine green. Three placements of the optical probe were tested: the nose ala, the ear lobe, and the temple area. In three subjects, the recordings were calibrated in terms of circulating indocyanine green concentration to estimate cardiac output and circulating blood volume. Results Fluorescence dilution traces had the same duration for the three locations, but the recordings obtained from the nose ala and the ear lobe were twice as intense as those from the temple. The fluorescence intensity at each site was linearly related to the local laser Doppler perfusion index. The coefficient of variation for the area under the first pass curve (inversely proportional to cardiac output) was approximately 6% for triplicate measurements at the same location. Cardiac output and circulating blood volume derived from the fluorescence recordings were in the normal range. Conclusions The study demonstrates that intense and reproducible fluorescence dilution signals can be measured transcutaneously in healthy humans and could potentially be used to measure cardiac output and circulating blood volume minimally invasively.

Cardiac output, GFR, and renal excretion rates during maintained volume load in rats

1978 ◽  
Vol 235 (6) ◽  
pp. H670-H676 ◽  
Author(s):  
U. Ackermann
Keyword(s):  
Cardiac Output ◽  
Blood Volume ◽  
Renal Excretion ◽  
Venous Pressure ◽  
Circulating Blood Volume ◽  
Reservoir Volume ◽  
Volume Load ◽  
Blood Volume Expansion ◽  
Highly Correlated ◽  
Excretion Rates

The correlation among cardiac output (CO), glomerular filtration rate (GFR), fractional tubular sodium rejection (TFRNa), and renal excretion rates of water and salt was investigated during ischemic blood volume expansion in rats. Initially circulating blood volume was equilibrated isovolemically with a reservoir volume of 6% albumin solution equal to one-third the estimated blood volume. Later the equilibrated reservoir contents were infused intravenously. CO was measured by thermodilution, GFR by inulin clearance. Significant linear correlations existed between GFR and the rates of urine flow (r = 0.90), sodium excretion (r = 0.75) and potassium excretion (r = 0.76) that prevailed 5--10 min after a given GFR change. The increased GFR was highly correlated with CO (r = 0.94), probably correlated with mean central venous pressure (r = 0.45), but not correlated with mean abdominal aortic blood pressure. The correlation between CO and time-delayed (5--10 min) TRFNa was also highly significant (r = 0.98). The saluresis appears to have been caused initially by increased tubular load and subsequently by decreased absolute tubular reabsorption.

Cardiac Output Determination

1993 ◽  
Vol 4 (1) ◽  
pp. 81-97 ◽  
Author(s):  
Susan L. Woods ◽  
Susan Osguthorpe
Keyword(s):  
Cardiac Output ◽  
Critical Care Nurses ◽  
Cardiac Output Measurement ◽  
Nursing Management ◽  
Output Measurement ◽  
Thermodilution Cardiac Output ◽  
Cardiac Output Determination ◽  
Output System ◽  
Cardiac Output Measurements ◽  
Management Issues

Critical care nurses frequently are involved in obtaining cardiac output measurements and in using these data to assess and to plan therapy. This article reviews the physiologic determinants of cardiac output and the clinical factors that influence these determinants. Principles and techniques of common methods of cardiac output measurement are discussed. A thorough presentation of guidelines for troubleshooting problems with thermodilution cardiac output measurement is provided in a table. Nursing management issues are discussed using relevant nursing research. Future considerations in cardiac output measurement are discussed, and suggestions of an ideal cardiac output system are provided

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