J Clin Monit Comput - Hemodynamic volumetry using transpulmonary ultrasound dilution (TPUD) technology in a neonatal animal model.

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Resumo

To analyze changes in cardiac output and hemodynamic volumes using transpulmonary ultrasound dilution (TPUD) in a neonatal animal model under different hemodynamic conditions. 7 lambs (3.5-8.3?kg) under general anesthesia received arterial and central venous catheters. A Gore-Tex(?) shunt was surgically inserted between the descending aorta?and the left pulmonary artery to mimic a patent ductus arteriosus. After shunt opening and closure, induced hemorrhagic hypotension (by repetitive blood withdrawals) and repetitive volume challenges, the following parameters were assessed using TPUD: cardiac output, active circulating volume index (ACVI), central blood volume index (CBVI) and total end-diastolic volume index (TEDVI). 27 measurement sessions were analyzed. After shunt opening, there was a significant increase in TEDVI and a significant decrease in cardiac output with minimal change in CBVI and ACVI. With shunt closure, these results reversed. After progressive hemorrhage, cardiac output and all volumes decreased significantly, except for ACVI. Following repetitive volume resuscitation, cardiac output increased and all hemodynamic volumes increased significantly. Correlations between changes in COufp and changes in hemodynamic volumes (ACVI 0.83; CBVI 0.84 and TEDVI 0.78 respectively) were (slightly) better than between changes in COufp and changes in heart rate (0.44) and central venous pressure (0.7). Changes in hemodynamic volumes using TPUD were as expected under different conditions. Hemodynamic volumetry using TPUD might be a promising technique that has the potential to improve the assessment and interpretation of the hemodynamic status in critically ill newborns and children.

Resumo Limpo

analyz chang cardiac output hemodynam volum use transpulmonari ultrasound dilut tpud neonat anim model differ hemodynam condit lamb kg general anesthesia receiv arteri central venous cathet goretex shunt surgic insert descend aortaand left pulmonari arteri mimic patent ductus arteriosus shunt open closur induc hemorrhag hypotens repetit blood withdraw repetit volum challeng follow paramet assess use tpud cardiac output activ circul volum index acvi central blood volum index cbvi total enddiastol volum index tedvi measur session analyz shunt open signific increas tedvi signific decreas cardiac output minim chang cbvi acvi shunt closur result revers progress hemorrhag cardiac output volum decreas signific except acvi follow repetit volum resuscit cardiac output increas hemodynam volum increas signific correl chang coufp chang hemodynam volum acvi cbvi tedvi respect slight better chang coufp chang heart rate central venous pressur chang hemodynam volum use tpud expect differ condit hemodynam volumetri use tpud might promis techniqu potenti improv assess interpret hemodynam status critic ill newborn children

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