Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Br J Anaesth. 2012 Jun;108(6):922-8. doi: 10.1093/bja/aes032. Epub 2012 Mar 22.
Cardiac output (CO) monitoring can be useful in high-risk patients during one-lung ventilation (OLV), but it is unclear whether thermodilution-derived CO monitoring is valid during OLV. Therefore, we compared pulmonary artery (CO(PATD)) and transcardiopulmonary thermodilution (CO(TPTD)) with an experimental reference in a porcine model.
CO(PATD) and CO(TPTD) were measured in 23 pigs during double-lung ventilation (DLV) and 15 min after the onset of OLV, during conditions of normovolaemia and after haemorrhage. An ultrasonic flow probe placed around the pulmonary artery (CO(PAFP)) was used for reference.
The range of CO in these experiments was 1.5-3 litre min(-1). Normovolaemia: during DLV and conditions of normovolaemia, the mean (95% limits of agreement) bias for CO(PATD) compared with CO(PAFP) was -0.05 (-0.92 and 0.83) litre min(-1), and 0.58 (-0.40 and 1.55) litre min(-1) for CO(TPTD). During OLV, the bias for CO(PATD) remained unchanged at 0.08 (-0.51 and 0.66) litre min(-1), P=0.15, and the bias for CO(TPTD) increased significantly to 0.85 (0.05 and 1.64) litre min(-1), P=0.047. Hypovolaemia: during DLV, the bias for CO(PATD) compared with CO(PAFP) was 0.22 (-0.20 and 0.66) litre min(-1) and for CO(TPTD) was 0.60 (0.12 and 1.10) litre min(-1). There was no significant change of bias during OLV for CO(PATD) [0.30 (-0.10 and 0.70) (litre min(-1)), P=0.25] or bias CO(TPTD) [0.72 (0.21 and 1.22) (litre min(-1)), P=0.14]. Trending ability during OLV, quantified by the mean of angles θ, showed good values for both CO(PATD) (θ=11.2°) and CO(TPTD) (θ=1.3°).
CO(TPTD) is, to some extent, affected by OLV, whereas CO(PATD) is unchanged. Nonetheless, both methods provide an acceptable estimation of CO and particularly of relative changes of CO during OLV.
在单肺通气（OLV）期间，心输出量（CO）监测对于高危患者可能有用，但在 OLV 期间，热稀释法 CO 监测是否有效尚不清楚。因此，我们在猪模型中比较了肺动脉（CO（PATD））和经心肺热稀释（CO（TPTD））与实验参考值的相关性。
在双肺通气（DLV）和 OLV 开始后 15 分钟的正常血容量和出血期间，对 23 头猪进行 CO（PATD）和 CO（TPTD）测量。放置在肺动脉周围的超声流量探头（CO（PAFP））用于参考。
这些实验中的 CO 范围为 1.5-3 升/分钟。正常血容量：在 DLV 和正常血容量条件下，与 CO（PAFP）相比，CO（PATD）的平均（95%一致性界限）偏差为-0.05（-0.92 和 0.83）升/分钟，CO（TPTD）的偏差为 0.58（-0.40 和 1.55）升/分钟。在 OLV 期间，CO（PATD）的偏差保持不变，为 0.08（-0.51 和 0.66）升/分钟，P=0.15，而 CO（TPTD）的偏差显著增加至 0.85（0.05 和 1.64）升/分钟，P=0.047。低血容量：在 DLV 期间，与 CO（PAFP）相比，CO（PATD）的偏差为 0.22（-0.20 和 0.66）升/分钟，CO（TPTD）的偏差为 0.60（0.12 和 1.10）升/分钟。在 OLV 期间，CO（PATD）的偏差没有明显变化[0.30（-0.10 和 0.70）（升/分钟），P=0.25]或 CO（TPTD）的偏差[0.72（0.21 和 1.22）（升/分钟），P=0.14]。OLV 期间的趋势能力，用角度θ的平均值量化，对 CO（PATD）（θ=11.2°）和 CO（TPTD）（θ=1.3°）都表现出良好的值。
CO（TPTD）在某种程度上受到 OLV 的影响，而 CO（PATD）则保持不变。尽管如此，这两种方法都能提供对 CO 的可接受估计，特别是在 OLV 期间对 CO 的相对变化的估计。
