Hopster Klaus, Ambrisko Tamas D, Kästner Sabine B R
Equine Clinic, University of Veterinary Medicine Hanover, Hanover, Germany.
The Section of Anaesthesiology and Perioperative Intensive-Care Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria.
J Vet Emerg Crit Care (San Antonio). 2017 Nov;27(6):651-657. doi: 10.1111/vec.12672. Epub 2017 Oct 24.
To compare the lithium dilution method for cardiac output (LiDCO) and bolus-thermo-dilution (BTD) measurements before and during infusion of dobutamine, dopamine, phenylephrine, or noradrenaline at 2 different doses in anesthetized horses and to examine the correlation between sensor voltages (saline-blood exposed) and possible measurement errors.
Prospective experimental study.
University teaching hospital.
Nine Warmblood horses.
Following 90 minutes of equilibration, 3 different doses of dobutamine (0.5-3 μg/kg/min), dopamine (1-5 μg/kg/min), phenylephrine (0.5-3 μg/kg/min), or noradrenaline (0.1-0.5 μg/kg/min) were administered for 15 minutes in anesthetized horses, and measurements using the LiDCO were performed at the lowest and highest doses. Pairs of LiDCO and BTD measurements were collected and sensor voltages exposed to blood and saline were measured before and at the end of each infusion period. Agreement between LiDCO and BTD was assessed with the Bland-Altman method.
The biases (2 standard deviations) before infusion of dobutamine, dopamine, phenylephrine, and noradrenaline were 1.1 (5.7), 1.6 (7.3), 0.2 (6.6), and 1.5 (4.1) L/min, respectively, and minimally and nonsignificantly changed following low-dose catecholamine infusions. Following infusion of higher doses, biases were significantly higher compared to baseline with 10.7 (7.8), 11.2 (11.9), 6.9 (11.7), and 3.5 (3.8) L/min, respectively. The difference between saline- and blood-exposed sensor voltage decreased during infusion of high doses of catecholamines with correlations (r = 0.62) between cardiac output differences and sensor voltage differences (saline-blood).
This study demonstrated that catecholamines could lead to overestimation in a dose-dependent fashion in LiDCO measurements. Monitoring changes in sensor voltage differences (saline-blood) is a valuable and clinically applicable tool to predict errors in LiDCO measurements.
比较在麻醉马匹中，在输注不同剂量的多巴酚丁胺、多巴胺、去氧肾上腺素或去甲肾上腺素之前及期间，锂稀释法测量心输出量（LiDCO）和团注热稀释法（BTD）的差异，并研究传感器电压（盐水-血液暴露）与可能的测量误差之间的相关性。
前瞻性实验研究。
大学教学医院。
9匹温血马。
在90分钟的平衡期后，对麻醉马匹输注3种不同剂量的多巴酚丁胺（0.5 - 3μg/kg/min）、多巴胺（1 - 5μg/kg/min）、去氧肾上腺素（0.5 - 3μg/kg/min）或去甲肾上腺素（0.1 - 0.5μg/kg/min），持续15分钟，并在最低和最高剂量时使用LiDCO进行测量。在每次输注期开始前和结束时收集LiDCO和BTD测量值，并测量暴露于血液和盐水中的传感器电压。采用Bland-Altman方法评估LiDCO和BTD之间的一致性。
在输注多巴酚丁胺、多巴胺、去氧肾上腺素和去甲肾上腺素之前，偏差（2个标准差）分别为1.1（5.7）、1.6（7.3）、0.2（6.6）和1.5（4.1）L/min，在低剂量儿茶酚胺输注后变化极小且无统计学意义。在输注高剂量后，偏差与基线相比显著更高，分别为10.7（7.8）、11.2（11.9）,6.9（11.7）和3.5（3.8）L/min。在高剂量儿茶酚胺输注期间，盐水和血液暴露传感器电压之间的差异减小，心输出量差异与传感器电压差异（盐水-血液）之间存在相关性（r = 0.62）。
本研究表明，儿茶酚胺可导致LiDCO测量中出现剂量依赖性高估。监测传感器电压差异（盐水-血液）的变化是预测LiDCO测量误差的一种有价值且临床适用的工具。
