Abstract
Introduction: Cardiac output measurement using the transpulmonary thermodilution (TPTD) technique is considered the gold standard in pediatric patients in no-shunt circulation. Goal of this study was to validate TPTD cardiac output measurement in an animal model with a left-to-right shunt.
Method: We prospectively studied 7 mechanically ventilated lambs under general anaesthesia with a surgically constructed aortic-pulmonary (left-to-right) shunt that could be opened and closed. Cardiac output measured with the TPTD technique (COTPTD) was performed with the PiCCOplus (Pulsion, Germany). An ultrasound perivascular flow probe (Transonic Systems, USA) around the pulmonary artery proximal to the shunt entrance (COPA) served as reference method. During the experiment animals were bled into hypovolaemic shock and were subsequently volume resuscitated. We compared all measurements of COTPTD and COPA using Bland Altman analysis.
Results: A total of 90 (36 with open shunt) simultaneous measurements were analyzed. The mean COPA with closed shunt was 1,21 (range 0,61 - 2,06) l/min and with open shunt 0,93 (range 0,48 - 1,45) l/min.
Bland Altman analysis showed a mean bias of 0, 17 l/min (limits of agreement (LOA) ± 0,27 l/min) with closed shunt and 0,14 l/min (LOA ± 0,32 l/min) with open shunt. The percentage errors were 22% with closed and 34% with open shunt.
Conclusions: The transpulmonary thermodilution technique can measure cardiac output in a juvenile animal model with a surgically constructed left-to-right shunt, however results are less reliable.
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[Bland Altman plot closed shunt]
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[Bland Altman plot open shunt]
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Nusmeier, A., Lemson, J., De Boode, W. et al. 209 Cardiac Output Measurement in Juvenile Animals with a Surgically Constructed Extra Cardiac Left-To-Right Shunt Using the Transpulmonary Thermodilution Technique. Pediatr Res 68 (Suppl 1), 109–110 (2010). https://doi.org/10.1203/00006450-201011001-00209
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DOI: https://doi.org/10.1203/00006450-201011001-00209
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