title: Hemodynamic volumetry using transpulmonary ultrasound dilution (TPUD) technology in a neonatal animal model.
abstract: 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.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. s.vrancken@radboudumc.nl.
authors.forename: Sabine L
authors.initials: SL
authors.lastname: Vrancken
authors.affiliation: Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Arno F
authors.initials: AF
authors.lastname: van Heijst
authors.affiliation: Department of Radiology, Medical Ultrasound Imaging Centre, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Jeroen C
authors.initials: JC
authors.lastname: Hopman
authors.affiliation: Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Kian D
authors.initials: KD
authors.lastname: Liem
authors.affiliation: Department of Pediatric Intensive Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Johannes G
authors.initials: JG
authors.lastname: van der Hoeven
authors.affiliation: Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Willem P
authors.initials: WP
authors.lastname: de Boode
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001783:Blood Flow Velocity / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D001811:Blood Volume Determination / Q000379:methods*; D002302:Cardiac Output / Q000502:physiology*; D003287:Contrast Media; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D055420:Perfusion Imaging / Q000379:methods*; D011652:Pulmonary Circulation / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012756:Sheep; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Cardiac output; Child; Ductus arteriosus; Hemodynamic volumes; Infant; Newborn; Transpulmonary ultrasound dilution technique