Cardiac output measurement with transpulmonary ultrasound dilution is feasible in the presence of a left-to-right shunt: a validation study in lambs

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Presentation transcript:

Cardiac output measurement with transpulmonary ultrasound dilution is feasible in the presence of a left-to-right shunt: a validation study in lambs S.L. Vrancken, W.P. de Boode, J.C. Hopman, S.K. Singh, K.D. Liem, A.F. van Heijst British Journal of Anaesthesia Volume 108, Issue 3, Pages 409-416 (March 2012) DOI: 10.1093/bja/aer401 Copyright © 2012 The Author(s) Terms and Conditions

Fig 1 Schematic set-up of CO measurement with TPUD (reproduced with kind permission of Wolters Kluwer Health, from Krivitski and colleagues).19 British Journal of Anaesthesia 2012 108, 409-416DOI: (10.1093/bja/aer401) Copyright © 2012 The Author(s) Terms and Conditions

Fig 2 Study protocol. Circles indicate the timing of three consecutive paired CO measurements. British Journal of Anaesthesia 2012 108, 409-416DOI: (10.1093/bja/aer401) Copyright © 2012 The Author(s) Terms and Conditions

Fig 3 The Bland–Altman plot for the comparison of CO measurements with TPUD (COtpud) and the flow probe around the pulmonary artery (COufp). The solid line represents mean bias and the dotted lines represent LOA for all data. British Journal of Anaesthesia 2012 108, 409-416DOI: (10.1093/bja/aer401) Copyright © 2012 The Author(s) Terms and Conditions

Fig 4 Polar plot representing the changes in CO measured with TPUD (COtpud) and the ultrasound flow probe around the main pulmonary artery (COufp) with open shunt and closed shunt. Dotted lines represent the 10% boundaries (i.e. 10%=0.1 litre min−1 as mean CO=1.0 litre min−1). The distance from the centre of the plot (vector) represents the mean change in CO. The angle with the horizontal (0° radial) axis represents disagreement. British Journal of Anaesthesia 2012 108, 409-416DOI: (10.1093/bja/aer401) Copyright © 2012 The Author(s) Terms and Conditions

Fig 5 Examples of TPUD curves (green) without (a) and with (b) a left-to-right shunt of lamb 6. Notice the change in height and downslope. The blue curves represent the change in ultrasound velocity recorded by the venous sensor. Example of a dilution curve during left-to-right shunt (c): the continuous line shows the derived curve, the interrupted line shows the primary curve after extrapolation and elimination of the indicator recirculation. British Journal of Anaesthesia 2012 108, 409-416DOI: (10.1093/bja/aer401) Copyright © 2012 The Author(s) Terms and Conditions