title: Inert gas rebreathing: the effect of haemoglobin based pulmonary shunt flow correction on the accuracy of cardiac output measurements in clinical practice.
abstract: BACKGROUND
  Cardiac output (CO) is an important cardiac parameter, however its determination is difficult in clinical routine. Non-invasive inert gas rebreathing (IGR) measurements yielded promising results in recent studies. It directly measures pulmonary blood flow (PBF) which equals CO in absence of significant pulmonary shunt flow (Q(S)). A reliable shunt correction requiring the haemoglobin concentration (c(Hb)) as only value to be entered manually has been implemented. Therefore, the aim of the study was to evaluate the effect of various approaches to Q(S) correction on the accuracy of IGR.
  
  
  METHODS
  Cardiac output determined by cardiac magnetic resonance imaging (CMR) served as reference values. The data was analysed in four groups: PBF without correcting for Q(S) (group A), shunt correction using the patients' individual c(Hb) values (group B), a fixed standard c(Hb) of 14.0 g dl(-1) (group C) and a gender-adapted standard c(Hb) for male (15.0 g dl(-1)) and female (13.5 g dl(-1)) probands each (group D).
  
  
  RESULTS
  147 patients were analysed. Mean CO(CMR) was 5.2 +/- 1.4 l min(-1), mean CO(IGR) was 4.8 +/- 1.3 l min(-1) in group A, 5.1 +/- 1.3 in group B, 5.1 +/- 1.3 l min(-1) in group C and 5.1 +/- 1.4 l min(-1) in group D. The accuracy in group A (mean bias 0.5 +/- 1.1 l min(-1)) was significantly lower as compared to groups B, C and D (0.1 +/- 1.1 l min(-1); P<0.01).
  
  
  CONCLUSIONS
  IGR allows a reliable non-invasive determination of CO. Since PBF significantly increased the measurement bias, shunt correction should always be applied. A fixed c(Hb) of 14.0 g dl(-1) can be used for both genders if the exact c(Hb) value is not known. Nevertheless, the individual value should be used if any possible.
authors.affiliation: First Department of Medicine - Cardiology, Angiology, Pneumology, Intensive Care, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Trinkmann
authors.forename: T
authors.initials: T
authors.lastname: Papavassiliu
authors.forename: F
authors.initials: F
authors.lastname: Kraus
authors.forename: H
authors.initials: H
authors.lastname: Leweling
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: M
authors.initials: M
authors.lastname: Borggrefe
authors.forename: J J
authors.initials: JJ
authors.lastname: Kaden
authors.forename: J
authors.initials: J
authors.lastname: Saur
mesh_terms: D001944:Breath Tests / Q000379:methods*; D002302:Cardiac Output / Q000502:physiology*; D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D005741:Noble Gases / Q000032:analysis* / Q000378:metabolism; D011652:Pulmonary Circulation / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D006454:Hemoglobins; D005741:Noble Gases