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Performance of a capnodynamic method estimating effective pulmonary blood flow during transient and sustained hypercapnia
Karolinska Univ Hosp, Dept Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
Karolinska Univ Hosp, Dept Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
Maquet Crit Care AB, Solna, Sweden..
Hosp Navarra, Dept Intens Care Med, Pamplona, Spain..
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2018 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 32, no 2, p. 311-319Article in journal (Refereed) Published
Abstract [en]

The capnodynamic method is a minimally invasive method continuously calculating effective pulmonary blood flow (COEPBF), equivalent to cardiac output when intra pulmonary shunt flow is low. The capnodynamic equation joined with a ventilator pattern containing cyclic reoccurring expiratory holds, provides breath to breath hemodynamic monitoring in the anesthetized patient. Its performance however, might be affected by changes in the mixed venous content of carbon dioxide (CvCO2). The aim of the current study was to evaluate COEPBF during rapid measurable changes in mixed venous carbon dioxide partial pressure (PvCO2) following ischemia-reperfusion and during sustained hypercapnia in a porcine model. Sixteen pigs were submitted to either ischemia-reperfusion (n = 8) after the release of an aortic balloon inflated during 30 min or to prolonged hypercapnia (n = 8) induced by adding an instrumental dead space. Reference cardiac output (CO) was measured by an ultrasonic flow probe placed around the pulmonary artery trunk (COTS). Hemodynamic measurements were obtained at baseline, end of ischemia and during the first 5 min of reperfusion as well as during prolonged hypercapnia at high and low CO states. Ischemia-reperfusion resulted in large changes in PvCO2, hemodynamics and lactate. Bias (limits of agreement) was 0.7 (-0.4 to 1.8) L/min with a mean error of 28% at baseline. COEPBF was impaired during reperfusion but agreement was restored within 5 min. During prolonged hypercapnia, agreement remained good during changes in CO. The mean polar angle was -4.19A degrees (-8.8A degrees to 0.42A degrees). Capnodynamic COEPBF is affected but recovers rapidly after transient large changes in PvCO2 and preserves good agreement and trending ability during states of prolonged hypercapnia at different levels of CO.

Place, publisher, year, edition, pages
SPRINGER HEIDELBERG , 2018. Vol. 32, no 2, p. 311-319
Keywords [en]
Carbon dioxide, Cardiac output, Intraoperative monitoring, Effective pulmonary blood flow, Capnodynamic, Animal model
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-350733DOI: 10.1007/s10877-017-0021-3ISI: 000426788500016PubMedID: 28497180OAI: oai:DiVA.org:uu-350733DiVA, id: diva2:1206129
Funder
Stockholm County Council, 20140430, 20150910Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-05-16Bibliographically approved

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Suarez-Sipmann, Fernando

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