title: Cardiac output determination during experimental hemorrhage and resuscitation using a transesophageal Doppler monitor.
abstract: Transesophageal Doppler (TED) monitoring has been considered a noninvasive and accurate alternative to pulmonary artery catheterization for volume replacement and cardiac output measurement in patients undergoing major surgery. This study tested the hypothesis that TED can accurately predict cardiac output during hemorrhage, shock, and resuscitation, by comparing it to total pulmonary artery blood flow (PABF) and to standard intermittent bolus cardiac output (ICO). In eight anesthetized dogs (18 +/- 1.0 kg), PABF was measured with an ultrasonic flowprobe while ICO and mixed venous O2 saturation (SvO2) were measured through a Swan-Ganz catheter. A TED probe (CardioQ, Deltex Medical Inc., Irving, TX, U.S.A.), designed for adult use (minimum 30 kg, 16 years), was placed in midesophageous to evaluate stroke volume. A graded hemorrhage (20 mL/min) was produced (H5-H35) to a mean arterial pressure (MAP) of 40 mm Hg and maintained by additional blood removal for 30 min (S1-S30). Total shed blood volume was retransfused (541 +/- 54.2 mL) over 30 min (T5-T30), after which a massive hemorrhage, 100 mL/min rate, was produced over 10 min (MH5-MH10). In general, TED overestimated PABF (r2 = 0.3472), but changes in TED paralleled PABF throughout the experimental protocol, particularly during massive hemorrhage (r2 = 0.9001). We concluded that TED accurately reflected the direction and magnitude of the changes of cardiac output over time during abrupt hemodynamic changes. Probes designed for lower weights and smaller aortas may improve its accuracy in medium size animal models under less dramatic alterations induced by hemorrhage, shock, and resuscitation.
authors.affiliation: Division of Applied Physiology, InCor-Heart Institute, University of São Paulo Medical School, São Paulo, Brazil. expluiz@incor.usp.br
authors.forename: Luiz Francisco Poli
authors.initials: LF
authors.lastname: de Figueiredo
authors.forename: Ruy Jorge
authors.initials: RJ
authors.lastname: Cruz
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
authors.forename: Maurício
authors.initials: M
authors.lastname: Rocha E Silva
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology*; D002407:Catheterization, Swan-Ganz; D004285:Dogs; D017548:Echocardiography, Transesophageal; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D016014:Linear Models; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000000981:diagnostic imaging / Q000503:physiopathology; D014465:Ultrasonics
chemical_list: D010100:Oxygen