Document Detail


Evaluation of stroke volume via arterial pulse pressure waveforms in neonatal lambs.
MedLine Citation:
PMID:  15249755     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Arterial pulse waveforms contain information about stroke volume (SV) as an integral of pulsatile flow. SV estimation is accurate in adults with proper pulse pressure measurement technique. It is unclear whether the same methods are suitable in critically ill infants in the neonatal clinical setting where the fidelity of pulse pressure measurements are uncertain. We compared three pulse waveform SV methods with three systolic area SV methods in neonatal lambs in order to identify the most accurate and precise approach. Six newborn lambs were studied. Each lamb had a ligated ductus arteriosus and was instrumented to record high-fidelity pulsatile waveforms of arterial blood pressure using a transducer-tipped catheter and pulsatile flow via calibrated ultrasonic flow probe, respectively. Three steady-state hemodynamic conditions were induced experimentally: control, hypertension via infusion of angiotensin II, and hypotension by phlebotomy. Recordings of a range of SVs were made during a steady state that was interrupted by a transient period of decreasing SV, induced by momentarily increasing preload by pulmonary artery occlusion. Modification of pulse wave pressure measurement conditions, simulating an overdamped fluid-filled catheter system, were achieved by low-pass digital filtering of the original high-fidelity waveforms (high) to an 8-Hz cut-off (medium) and to a 2-Hz cut-off (low). The six SV estimates were then calibrated against flowmeter-derived SV and their accuracy and precision evaluated. Based on 6,479 waveforms, a systolic area method with pulse contour integration was the most accurate and precise. We conclude that neonatal pulse arterial waveforms embed SV information under a wide variety of hemodynamic and pressure waveform measurement conditions, and thus may be of potential clinical value in the assessment of newborn cardiovascular status.
Authors:
Sherri Kappler; Jay M Milstein; Anita J Moon-Grady; Stephen H Bennett
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article     Date:  2004-07-06
Journal Detail:
Title:  Biology of the neonate     Volume:  86     ISSN:  0006-3126     ISO Abbreviation:  Biol. Neonate     Publication Date:  2004  
Date Detail:
Created Date:  2004-10-01     Completed Date:  2005-02-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0247551     Medline TA:  Biol Neonate     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  184-94     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Division of NeonatologyNeonatolgy TB193, University of CaliforniaDavis, CA 95616, USA.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Animals, Newborn*
Arteries
Blood Pressure*
Hypertension / physiopathology
Hypotension / physiopathology
Mathematics
Pulsatile Flow
Regression Analysis
Sensitivity and Specificity
Sheep
Stroke Volume*
Systole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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