ABSTRACT
ObjectiveTo compare the effects of different tidal volumes and positive end expiratory pressures （PEEPs） during mechanical ventilation on the cardiac output of pigs measured by pulmonary artery catheter， transpulmonary thermodilution and pulse contour analysis， and to explore their consistency in cardiac output determination. MethodsTwelve experimental pigs were selected and randomly divided into 3 groups， with 4 pigs in each. Cardiac output was measured by different methods， control group by pulmonary artery catheter， group A by transpulmonary thermodilution and group B by pulse contour analysis. Then we compared the effects of different tidal volumes and PEEPs on the cardiac output of pigs and to explore the consistency. The correlation coefficient between pulse contour analysis and pulmonary artery catheter was r=0.754， and they were positively correlated. The correlation coefficient between transpulmonary thermodilution and pulmonary artery catheter was r=0.771， and they were positively correlated. In determining cardiac output， pulse contour analysis was consistent with pulmonary artery catheter， with a relative error of 13.5% between them； transpulmonary thermodilution was consistent with pulmonary artery catheter， with a relative error of 12.9% between them. The cardiac output decreased significantly along with the increase of tidal volumes or PEEPs and the differences were statistically significant （P<0.05） ConclusionPulmonary artery catheter， transpulmonary thermodilution and pulse contour analysis are well consistent with each other in measuring the cardiac output of pigs. The pigs’cardiac output gradually decreased along with the increase of tidal volumes or PEEPs during mechanical ventilation.
ABSTRACT
Objective To compare the early fluid resuscitation effect of transpulmonary thermodilution (PICCO) monitoring combined with the passive leg raising (PLR) test and central venous pressure(CVP) mo-nitoring in severe sepsis .Methods Sixty patients with severe sepsis admitted in this hospital from January to December 2016 were selected and divided into the treatment group (n=28) and control group(n=32) accord-ing to the random number table method .The treatment group adopted PICCO monitoring combined with PLR ,while the control group adopted CVP monitoring .The changes of plasma natriuretic peptide (BNP) and blood lactic acid(LAC) levels at 6 ,24 ,48 ,72 h in two groups ,time of vasoactive drugs withdrawn ,mechanical ventilation time ,ICU stay length ,and occurrence situation of multiple organ dysfunction syndrome (MODS) and death were compared between the two groups .Results The plasma BNP levels at 24 ,48 ,72 h in the treat-ment group were lower than those in the control group at the same period ,the difference was statistically sig-nificant(P<0 .05);The plasma LAC levels at 24 ,48 ,72 h in the treatment group were lower than those in the control group at the same periods ,the difference was statistically significant (P<0 .05);The vasoactive drug withdrawal time in the treatment group was faster than that in the control group ,the mechanical ventilation time was shorter than that in the control group ,and the ICU stay time was shorter than that in the control group ,the difference was statistically significant (P<0 .05);The occurrence rates of MODS and death had no statistical difference between the two groups (P>0 .05) .Conclusion The PICCO monitoring combined with PLR in severe sepsis has better early fluid resuscitation curative effect than the CVP monitoring and has im-portant study significance .
ABSTRACT
A reliable estimation of cardiac preload is helpful in the management of severe circulatory dysfunction. The estimation of cardiac preload has evolved from nuclear angiography, pulmonary artery catheterization to echocardiography, and transpulmonary thermodilution (TPTD). Global end‑diastolic volume (GEDV) is the combined end‑diastolic volumes of all the four cardiac chambers. GEDV has been demonstrated to be a reliable preload marker in comparison with traditionally used pulmonary artery catheter‑derived pressure preload parameters. Recently, a new TPTD system called EV1000™ has been developed and introduced into the expanding field of advanced hemodynamic monitoring. GEDV has emerged as a better preload marker than its previous conventional counterparts. The advantage of it being measured by minimum invasive methods such as PiCCO™ and newly developed EV1000™ system makes it a promising bedside advanced hemodynamic parameter.
ABSTRACT
ObjectiveTo evaluate the influence of continuous venovenous hemofiltration (CVVH) on measurement of transpulmonary thermodilution parameters.MethodsA prospective observational study was conducted. Fifty-six patients who received CVVH and hemodynamic monitoring at the same time admitted to the Department of Critical Care Medicine of Tianjin Third Central Hospital from July 2012 to July 2014 were enrolled. In all the patients, the dialysis catheter was inserted through the femoral vein, and transpulmonary thermodilution measurements were performed by pulse indicator continuous cardiac output (PiCCO) monitoring technology at the same time. Mean arterial pressure (MAP), central blood temperature, cardiac index (CI), global end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI) and extravascular lung water index (EVLWI) were measured before CVVH, immediately after CVVH, and 30 minutes after CVVH, respectively.Results In the 56 patients, there were 36 males and 20 females, (66±16) years of old, height of (172±6) cm, body weight of (68±10) kg. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores was 26±6. After CVVH,the central blood temperature was gradually decreased, and blood temperature at 30 minutes after CVVH was significantly lower than that before CVVH (℃: 37.17±1.06 vs. 37.57±1.26,P 0.05]. CI, GEDVI, ITBVI at 30 minutes after CVVH were significantly decreased [CI (mL·s-1·m-2): 57.84±20.50 vs. 63.85±21.84, GEDVI (mL/m2):681±106 vs. 727±100, ITBVI (mL/m2): 851±133 vs. 908±125, allP< 0.05]. CVVH was associated with a decline of 6.01 mL·s-1·m-2 at 30 minutes after CVVH [95% confidence interval (95%CI) = -10.67 to -1.50,P = 0.011]. The declines of GEDVI and ITBVI were observed with 46 mL/m2 (95%CI = -81 to - 11,P = 0.014), 57 mL/m2 (95%CI =-101 to - 13,P = 0.014 ) respectively 30 minutes after CVVH.Conclusions CVVH had no significant effect on the transpulmonary thermodilution measurements of CI, GEDVI, ITBVI and EVLWI. Thirty minutes after the start of CVVH, CI, GEDVI and ITBVI was decreased significantly, but had no effect on EVLWI.
ABSTRACT
Currently, hemodynamic monitoring system is developing rapidly, with many different devices now available, which makes anesthesiologists feel somewhat confused by the various possibilities and issue of noninvasiveness. By the order of degree of invasiveness, these devices can be classified into the highly invasive pulmonary artery catheter and the completely noninvasive bioimpedance/bioreactance technique and Doppler echocardiography. Recently, trans-cardiopulmonary thermodilution-derived hemodynamic parameters, such as global end-diastolic volume, global ejection fraction, cardiac function index, extravascular lung water, pulmonary vascular permeability index and its cardiac output, are available in anesthetic practice by PiCCO(R)(Pulsion Medical Systems) and VolumeView(R) (Edwards Life Sciences). This article provides objective review of the monitoring systems, as well as the advantages and limitations, in order to offer better management of the critically ill patients undergoing surgery.
Subject(s)
Humans , Capillary Permeability , Cardiac Output , Catheters , Critical Illness , Echocardiography, Doppler , Extravascular Lung Water , Hemodynamics , Pulmonary ArteryABSTRACT
Objective To evaluate the reliability of transpulmonary thermodilution technique,for the quantification of extravascular lung water.Method Eighteen dogs were randomly divided into 3 groups:normal group(n=6),ALIp(acute lung injury caused by pulmonary monary origin causes)group(n=6)and a ALIexp(acute lung injury caused by extra-pulmonary origin causes)(n=6).ALI_(exp)model was prepared by intravenous injection of injection of oleie acid.ALI_p model was made by inhalation of detergent.Extravascular lung water(EVLW)was measured by PiCCO monitor(PULSION,Germany)before and immediately after the intratracheal introduction of normal saline into the alveoh of lungs of normal and ALI dogs.Results The EVLW of the normal group was(254.5?13.0)mL.The volume of the normal between pre-and postinstillation(?EVLW) was approximate to the volume of normal saline instilled with a good correlation(r=0.986,P