Quintana-Villamandos Begoña, Barranco Mónica, Fernández Ignacio, Ruiz Manuel, Del Cañizo Juan Francisco
Department of Anesthesiology and Intensive Care, Gregorio Marañón Hospital, Madrid, Spain.
Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
Front Physiol. 2021 Mar 4;12:634779. doi: 10.3389/fphys.2021.634779. eCollection 2021.
Cardiac output (CO) measurement by continuous pulmonary artery thermodilution (CO ) has been studied in patients with pulsatile-flow LVADs (left ventricular assist devices), confirming the clinical utility. However, it has not been validated in patients with continuous-flow LVADs. Therefore, the aim of this study was to assess the validity of CO in continuous-flow LVADs. Continuous-flow LVADs were implanted in six miniature pigs for partial assistance of the left ventricle. Both methods of measuring CO-measurement by CO and intermittent pulmonary artery thermodilution, standard technique (CO )-were used in four consecutive moments of the study: before starting the LVAD (basal moment), and with the LVAD started in normovolemia, hypervolemia (fluid overloading), and hypovolemia (shock hemorrhage). At the basal moment, CO and CO were closely correlated ( = 0.97), with a mean bias of -0.13 ± 0.16 L/min and percentage error of 11%. After 15 min of partial support LVAD, CO and CO were closely correlated ( = 0.91), with a mean bias of 0.31 ± 0.35 L/min and percentage error of 20%. After inducing hypervolemia, CO and CO were closely correlated ( = 0.99), with a mean bias of 0.04 ± 0.07 L/min and percentage error of 5%. After inducing hypovolemia, CO and CO were closely correlated ( = 0.74), with a mean bias of 0.08 ± 0.22 L/min and percentage error of 19%. This study shows that continuous pulmonary thermodilution could be an alternative method of monitoring CO in a porcine model with a continuous-flow LVAD.
通过连续肺动脉热稀释法（CO ）测量心输出量（CO）已在搏动血流左心室辅助装置（LVAD）患者中进行了研究，证实了其临床实用性。然而，尚未在连续血流LVAD患者中得到验证。因此，本研究的目的是评估CO 在连续血流LVAD中的有效性。将连续血流LVAD植入六只小型猪体内，用于左心室的部分辅助。在研究的四个连续时刻使用两种测量CO的方法——通过CO 测量和间歇性肺动脉热稀释法（标准技术，CO ）：在启动LVAD之前（基础时刻），以及在LVAD启动后处于正常血容量、高血容量（液体过载）和低血容量（休克出血）状态时。在基础时刻，CO 和CO 密切相关（ = 0.97），平均偏差为-0.13±0.16 L/分钟，百分比误差为11%。在部分支持LVAD15分钟后，CO 和CO 密切相关（ = 0.91），平均偏差为0.31±0.35 L/分钟，百分比误差为20%。在诱导高血容量后，CO 和CO 密切相关（ = 0.99），平均偏差为0.04±0.07 L/分钟，百分比误差为5%。在诱导低血容量后，CO 和CO 密切相关（ = 0.74），平均偏差为0.08±0.22 L/分钟，百分比误差为19%。本研究表明，在具有连续血流LVAD的猪模型中，连续肺热稀释法可能是监测CO的一种替代方法。
