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Related Experiment Videos

Right ventricular function assessed by thermodilution technique during apnea and mechanical ventilation.

R Assmann1, C F Heidelmeyer, H J Trampisch

  • 1Zentrum für Anaesthesiologie, Universität Düsseldorf, FRG.

Critical Care Medicine
|June 1, 1991
PubMed
Summary

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Optimizing cardiac output (CO) and right ventricular ejection fraction (RVEF) measurements during mechanical ventilation requires careful strategy selection. Averaging phase-selected thermodilution measurements significantly improves reproducibility, approaching apnea-based reference values.

Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Medical Instrumentation

Background:

  • Accurate measurement of cardiac output (CO) and right ventricular ejection fraction (RVEF) is crucial in intensive care settings.
  • Controlled mechanical ventilation can introduce significant variability into these measurements.
  • Thermodilution is a common method for assessing hemodynamic parameters.

Purpose of the Study:

  • To evaluate different thermodilution strategies for measuring CO and RVEF during controlled mechanical ventilation.
  • To assess the impact of ventilation on measurement reproducibility.
  • To compare these strategies against reference values obtained during apnea.

Main Methods:

  • A crossover trial design was employed in six male ICU patients and two sheep.

Related Experiment Videos

  • Measurements were taken at varying ventilatory rates (8, 16, 24 cycles/min) and during short periods of apnea (15 seconds).
  • A pulmonary artery catheter and a prototype cardiac output computer were used, with thermal indicator injections timed automatically or manually.

    • Main Results:

    • At a low ventilatory rate (8 cycles/min), coefficients of variation for CO and RVEF were 11.6% and 23.2%, respectively.
    • Adjusting for ventilatory phase or increasing the rate to 16 cycles/min halved these errors.
    • Combining both adjustments reduced the coefficient of variation to 4.7% (CO) and 6.6% (RVEF), approaching apnea values (2.1% and 4.5%).

    Conclusions:

    • Averaging four phase-selected thermodilution measurements at low ventilatory rates optimizes reproducibility.
    • Single-point measurements are less accurate, and random point measurements are less reproducible.
    • Optimized thermodilution strategies can yield reliable hemodynamic data even during mechanical ventilation.