Otsuki Denise A, Cardieri Fernando A, Schmidt André P, Brudniewski Marcio, Fantoni Denise T, Auler José O C
Department of Anesthesia (LIMOS), University of São Paulo Medical School, São Paulo, Brazil.
Artif Organs. 2006 Jun;30(6):458-66. doi: 10.1111/j.1525-1594.2006.00242.x.
Continuous cardiac output (CO) and mixed venous oxygen saturation (SvO2) determined through the pulmonary artery catheter may be helpful in monitoring hemodynamic conditions in critically ill patients. This study aimed to evaluate CO and SvO2 in a model of acute normovolemic hemodilution (ANH), analyzing the accuracy of the continuous versus intermittent method for CO and SvO2 measurement in pigs. Twenty-three pigs were enrolled to three groups: control, ANH with 6% hydroxyethyl starch (HES), or ANH with lactated Ringer's (LR) solution. After hemodilution, we showed that SvO2 was reduced in both groups, mainly in LR animals (P < 0.05). Regarding the evaluation of CO, we showed an increase in both groups submitted to ANH (P < 0.05). Through Bland-Altman analysis, we showed that the continuous CO catheter presented lower values than the intermittent method after hemodilution, mainly with HES (P < 0.001), and there was no difference in the measurement of SvO2. The ANH promoted a decrease in SvO2 and an increase in CO values, mainly in animals submitted to hemodilution with HES. The use of continuous and intermittent (laboratory) measurement of SvO2 showed clinical applicability and good agreement, an effect not reproduced by the CO measurement. New studies are needed to further investigate the agreement between the continuous and intermittent methods for the measurement of CO in adverse hemodynamic conditions such as ANH.
通过肺动脉导管测定的连续心输出量（CO）和混合静脉血氧饱和度（SvO2）可能有助于监测危重症患者的血流动力学状况。本研究旨在评估急性等容血液稀释（ANH）模型中的CO和SvO2，分析猪中连续与间断测量CO和SvO2方法的准确性。23头猪被纳入三组：对照组、用6%羟乙基淀粉（HES）进行ANH的组或用乳酸林格氏液（LR）进行ANH的组。血液稀释后，我们发现两组的SvO2均降低，主要是LR组动物（P<0.05）。关于CO的评估，我们发现接受ANH的两组CO均增加（P<0.05）。通过Bland-Altman分析，我们发现血液稀释后连续CO导管显示的值低于间断测量法，主要是HES组（P<0.001），且SvO2测量无差异。ANH导致SvO2降低和CO值增加，主要是在接受HES血液稀释的动物中。SvO2连续和间断（实验室）测量的应用显示出临床适用性和良好的一致性，CO测量未再现此效果。需要新的研究来进一步调查在诸如ANH等不良血流动力学状况下CO连续和间断测量方法之间的一致性。
