Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recrui
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ORIGINAL RESEARCH
Performance of a capnodynamic method estimating cardiac output during respiratory failure ‑ before and after lung recruitment Thorir Svavar Sigmundsson1,2 · Tomas Öhman1,2 · Magnus Hallbäck3 · Eider Redondo4 · Fernando Suarez Sipmann5,6 · Mats Wallin2,3 · Anders Oldner1,2 · Caroline Hällsjö‑Sander1,2 · Håkan Björne1,2 Received: 1 July 2019 / Accepted: 12 October 2019 © The Author(s) 2019
Abstract Respiratory failure may cause hemodynamic instability with strain on the right ventricle. The capnodynamic method continuously calculates cardiac output (CO) based on effective pulmonary blood flow (COEPBF) and could provide CO monitoring complementary to mechanical ventilation during surgery and intensive care. The aim of the current study was to evaluate the ability of a revised capnodynamic method, based on short expiratory holds ( COEPBFexp), to estimate CO during acute respiratory failure (LI) with high shunt fractions before and after compliance-based lung recruitment. Ten pigs were submitted to lung lavage and subsequent ventilator-induced lung injury. COEPBFexp, without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk ( COTS) at (1) baseline in healthy lungs with PEEP 5 cmH2O (HLP5), (2) LI with PEEP 5 cmH2O (LIP5) and (3) LI after lung recruitment and PEEP adjustment (LIPadj). CO changes were enforced during LIP5 and LIPadj to estimate trending. LI resulted in changes in shunt fraction from 0.1 (0.03) to 0.36 (0.1) and restored to 0.09 (0.04) after recruitment manoeuvre. Bias (levels of agreement) and percentage error between COEPBFexp and C OTS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HLP5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LIP5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LIPadj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. COEPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre. Keywords Carbon dioxide · Cardiac output · Effective pulmonary blood flow · Capnodynamic · Lung injury · Respiratory failure · Animal model
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-019-00421-w) contains supplementary material, which is available to authorized users. * Thorir Svavar Sigmundsson [email protected] 1
Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76 Solna, Stockholm, Sweden
2
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
3
Maquet Critical Care AB, Solna, Sweden
4
Department of Intensive Care Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
5
Department of Surgical Sciences, Section of Anaesthesiology and Critical Care, Hedenstierna’s Laboratory, Uppsala University, Uppsala, Sweden
6
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos I
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