Document Detail


Pulmonary capillary blood flow and cardiac output measurement by partial carbon dioxide rebreathing in patients with acute respiratory distress syndrome receiving lung protective ventilation.
MedLine Citation:
PMID:  19809287     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Partial carbon dioxide rebreathing noninvasively measures the pulmonary capillary blood flow and estimates the cardiac output with the use of a predicted shunt value. It has been reported that the accuracy of the method is decreased in patients with high pulmonary shunt. The aim of this study was to investigate the agreement between partial rebreathing and thermodilution for the determination of pulmonary capillary blood flow and cardiac output in the setting of acute respiratory distress syndrome. METHODS: Twenty consecutive patients with the acute respiratory distress syndrome were enrolled. Ventilator settings include low tidal volume (6 ml x kg(-1)) and positive end-expiratory pressure + 2 cm H2O higher than the lower inflection point if present or 10 cm H2O if not. Seven pairs of cardiac output and pulmonary capillary blood flows were recorded every 20 min over a 2-h period. The authors determined bias, SD, limit of agreement (95% confidence interval) and percentage error. RESULTS: Bias and agreement for cardiac output measurement were 0.8 +/- 1.2 l x min(-1) (-2.1 to 3.7 l x min(-1)), and percentage error was 36%. Bias and agreement for pulmonary capillary blood flow measurement were -0.1 +/- 0.8 l x min(-1) (-2.1 to 1.9 l x min(-1)), and percentage error was 35%. Dead space, arteriovenous oxygen content difference, mean pulmonary arterial pressure, and baseline cardiac output were independently associated with differences between methods. CONCLUSIONS: In patients with the acute respiratory distress syndrome, partial rebreathing cannot yet replace thermodilution for measuring pulmonary capillary blood flow or cardiac output. However, accuracy of the method is close to the boundary of clinical relevance.
Authors:
Jérôme Allardet-Servent; Jean-Marie Forel; Antoine Roch; Laurent Chiche; Christophe Guervilly; Fouad Bouzana; Agnès Vincent; Marc Gainnier; Anderson Loundou; Laurent Papazian
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  111     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-28     Completed Date:  2009-11-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1085-92     Citation Subset:  AIM; IM    
Affiliation:
Service de Réanimation Médicale, Hôpital Sainte Marguerite, Marseille Cedex 9, France. j.allardetservent@ch-ambroisepare.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Capillaries / physiopathology
Carbon Dioxide / diagnostic use,  metabolism*
Cardiac Output*
Female
Humans
Male
Middle Aged
Pulmonary Circulation*
Respiration, Artificial*
Respiratory Distress Syndrome, Adult / physiopathology*
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

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


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