Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Anesth Analg. 2013 Jul;117(1):83-90. doi: 10.1213/ANE.0b013e31828f2c39. Epub 2013 Apr 16.
The thermodilution curve assessed by transpulmonary thermodilution is the basis for calculation of global end-diastolic volume index (GEDI) and extravascular lung water index (EVLWI). Until now, it was unclear whether the method is affected by 1-lung ventilation. Therefore, aim of our study was to evaluate the impact of 1-lung ventilation on the thermodilution curve and assessment of GEDI and EVLWI.
In 23 pigs, mean transit time, down slope time, and difference in blood temperature (ΔTb) were assessed by transpulmonary thermodilution. "Gold standard" cardiac output was measured by pulmonary artery flowprobe (PAFP) and used for GEDIPAFP and EVLWIPAFP calculations. Measurements were performed during normovolemia during double-lung ventilation (M1), 15 minutes after 1-lung ventilation (M2) and during hypovolemia (blood withdrawal 20 mL/kg) during double-lung ventilation (M3) and again 15 minutes after 1-lung ventilation (M4).
Configuration of the thermodilution curve was significantly affected by 1-lung ventilation demonstrated by an increase in ΔTb and a decrease in mean transit time and down slope time (all P < 0.04) during normovolemia and hypovolemia. GEDIPAFP was lower after 1-lung ventilation during normovolemia (M1: 459.9 ± 67.5 mL/m(2); M2: 397.0 ± 54.8 mL/m(2); P = 0.001) and hypovolemia (M3: 300.6 ± 40.9 mL/m(2); M4: 275.2 ± 37.6 mL/m(2); P = 0.03). EVLWIPAFP also decreased after 1-lung ventilation in normovolemia (M1: 9.0 [7.3, 10.1] mL/kg; M2: 7.4 [5.8, 8.3] mL/kg; P = 0.01) and hypovolemia (M3: 7.4 [6.3, 9.7] mL/kg; M4: 5.8 [5.2, 7.4]) mL/kg; P = 0.0009).
Configuration of the thermodilution curve and therefore assessment of GEDI and EVLWI are significantly affected by 1-lung ventilation.
经肺温度稀释法评估的温度稀释曲线是计算全心舒张末期容积指数（GEDI）和血管外肺水指数（EVLWI）的基础。到目前为止，尚不清楚该方法是否受单肺通气的影响。因此，我们的研究目的是评估单肺通气对温度稀释曲线以及 GEDI 和 EVLWI 评估的影响。
在 23 头猪中，通过经肺温度稀释法评估平均通过时间、下降斜率时间和血液温度差（ΔTb）。通过肺动脉血流探头（PAFP）测量“金标准”心输出量，并用于计算 GEDIPAFP 和 EVLWIPAFP。在正常血容量下进行双肺通气时（M1）、单肺通气 15 分钟后（M2）、正常血容量下进行血容量减少（失血 20 mL/kg）时（M3）以及再次进行单肺通气 15 分钟后（M4）进行测量。
单肺通气显著影响温度稀释曲线的形态，表现为正常血容量和低血容量时ΔTb 增加，平均通过时间和下降斜率时间缩短（均 P < 0.04）。正常血容量（M1：459.9 ± 67.5 mL/m2；M2：397.0 ± 54.8 mL/m2；P = 0.001）和低血容量（M3：300.6 ± 40.9 mL/m2；M4：275.2 ± 37.6 mL/m2；P = 0.03）时，1 肺通气后 GEDIPAFP 降低。在正常血容量（M1：9.0 [7.3, 10.1] mL/kg；M2：7.4 [5.8, 8.3] mL/kg；P = 0.01）和低血容量（M3：7.4 [6.3, 9.7] mL/kg；M4：5.8 [5.2, 7.4]）mL/kg；P = 0.0009）时，1 肺通气后 EVLWIPAFP 也降低。
温度稀释曲线的形态以及因此对 GEDI 和 EVLWI 的评估均受单肺通气的显著影响。
Zotero 插件