Measuring Cardiac Output: A New Respiratory Method David Preiss Institute for Biomaterials and Biomedical Engineering University of Toronto Department.

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Presentation transcript:

Measuring Cardiac Output: A New Respiratory Method David Preiss Institute for Biomaterials and Biomedical Engineering University of Toronto Department of Anesthesia University Health Network November 29, 2004

Introduction – Cardiac Output Swan-Ganz Catheter

Non-Invasive: The Fick Equation CvCO 2 CaCO 2 VCO 2 Fick Equation:

Change Ventilation to get CvCO 2 Breathing Rate Final Lung CO 2 concentration Mixed venous arterial CO 2 level Time

Problem creating change in CO 2 Time Intubated, Ventilated ? Time Spontaneous Breathing

Change in CO 2 in Awake Patients Must be independent of ventilation No physical manoeuvre Comfortable

Constant O 2 flow

Exhaling…

Exhalation ends

Inhalation starts…

Valve opens

Rebreathing

Deeper breath

Problem Solved! CO 2 level Time Flow

Problem Solved! Breathing Rate Final Lung CO 2 concentration Mixed venous arterial

Compare with direct measurements 3 pilot studies: –Jan, 2003 (32 patients) –June, 2003 (36 patients) –Feb, 2004 (37 patients) Patients were conscious and extubated Evaluating the Method

Comparison with Invasive Methods

Results – 1 st and 2 nd cohorts

Results – 3 rd cohort SD = 0.80 L/min

Periodic breathing Good seal around mouth required Requires supply of compressed air Pain for some patients – deeper breaths Limitations

Future Work Larger range of cardiac outputs Exercise Patients in poorer health Alveolar deadspace Shunt

Thanks! Joseph Fisher MD Arthur Slutsky MD Jim Duffin PhD Al Olszowka MD Takafumi Azami MD Cliff Ansel MBA Ludwik Fedorko MD PhD George Djaiani MD Jo Caroll RN Marat Slessarev Steve Iscoe PhD Ron Somogyi MSc Hiroshi Sasano MD CVICU Nursing Staff University Health Network