title: Inverse thermodilution with conventional pulmonary artery catheters for the assessment of cerebral, hepatic, renal, and femoral blood flow.
abstract: Assessment of regional blood flow changes is difficult in the clinical setting. We tested whether conventional pulmonary artery catheters (PACs) can be used to measure regional venous blood flows by inverse thermodilution (ITD). Inverse thermodilution was tested in vitro and in vivo using perivascular ultrasound Doppler (USD) flow probes as a reference. In anesthetized pigs, PACs were inserted in jugular, hepatic, renal, and femoral veins, and their measurements were compared with simultaneous USD flow measurements from carotid, hepatic, renal, and femoral arteries and from portal vein. Fluid boluses were injected through the PAC's distal port, and temperature changes were recorded from the proximally located thermistor. Injectates of 2 and 5 mL at 22 degrees C and 4 degrees C were used. Flows were altered by using a roller pump (in vitro), and infusion of dobutamine and induction of cardiac tamponade, respectively. In vitro: At blood flows between 400 mL . min-1 and 700 mL . min-1 (n = 50), ITD and USD correlated well (r = 0.86, P < 0.0001), with bias and limits of agreement of 3 +/- 101 mL . min-1. In vivo: 514 pairs of measurements had to be excluded from analysis for technical reasons, and 976 were analyzed. Best correlations were r = 0.87 (P < 0.0001) for renal flow and r = 0.46 (P < 0.0001) for hepatic flow. No significant correlation was found for cerebral and femoral flows. Inverse thermodilution using conventional PAC compared moderately well with USD for renal but not for other flows despite good in vitro correlation in various conditions. In addition, this method has significant technical limitations.
authors.affiliation: Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Christoph C
authors.initials: CC
authors.lastname: Ganter
authors.forename: Christof
authors.initials: C
authors.lastname: Buser
authors.forename: Matthias
authors.initials: M
authors.lastname: Haenggi
authors.forename: Hanswilly
authors.initials: H
authors.lastname: Mattes
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity / Q000187:drug effects; D002305:Cardiac Tamponade / Q000139:chemically induced / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000494:pharmacology; D002404:Catheterization; D002407:Catheterization, Swan-Ganz / Q000295:instrumentation* / Q000379:methods*; D002560:Cerebrovascular Circulation; D004280:Dobutamine / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D005268:Femoral Vein / Q000503:physiopathology*; D007668:Kidney / Q000098:blood supply*; D008099:Liver / Q000098:blood supply*; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology*; D013552:Swine; D013815:Thermodilution / Q000295:instrumentation / Q000379:methods
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine