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PubMed1987

Effect of dietary restriction during lactation on cardiac output, organ blood flow and organ weights of rats.

Cardiac output, organ blood flow and organ weights were examined in rats assigned at d 0 of lactation to a control (C) group fed ad libitum or an acutely restricted (AR) group fed 50% of the intake of C dams. Dams in each group were assigned to subgroups for measurement of milk yield or cardiac output, blood flow and organ weights. At d 14 of lactation, cardiac output and blood flow were measured with radiolabeled microspheres and milk yield with the tritiated water method. In AR dams cardiac output was 55% of that of C dams, but cardiac output relative to body weight did not differ between groups. Mammary gland blood flow and weight were reduced in AR dams. The weight of the kidneys, gastrointestinal tract and liver of the AR dams was less than that of C dams; however, relative blood flow to these organs did not differ between groups. Milk yield was reduced by 58% in AR dams compared to C dams. We conclude that dietary restriction during lactation negatively affects absolute cardiac output, blood flow to the mammary glands and milk yield, and that the reduced milk yield is associated with the decrease in mammary gland weight and blood flow.

Animals↗
PubMed1977

Evaluation of the CO2 rebreathing cardiac output method in seriously ill patients.

The CO2 rebreathing cardiac output method is a totally noninvasive Fick procedure needing validation in various disease states to become clinically applicable. Simultaneous measurements of cardiac output by CO2 rebreathing and dye-dilution or direct Fick techniques were performed in 53 patients. In nine patients with pulmonary disease rebreathing cardiac output averaged 4.85 L/min compared to 5.18 L/min by dye-dilution or Fick (r = 0.16). In 14 instances of acute myocardial infarction cardiac output was 5.53 L/min by rebreathing and 5.87 L/min by dye-dilution (r = 0.95), while in nine shock cases it averaged 3.98 L/min by dye-dilution or Fick and 3.75 L/min by CO2 rebreathing (r = 0.94). In five heart failure cases with mitral insufficiency, which may distort dye durves, correlation between standard and rebreathing methods was r = 0.09, but in 16 cases without mitral regurgitation, r = 0.89. Acute interventions in ten patients increased dye-dilution cardiac output by 0.92 L/min and rebreathing outputs by 0.60 L/min (r = 0.87). The data suggest that the CO2 rebreathing cardiac output method may be useful in the CCU-MICU setting.

Carbon Dioxide↗
PubMed1996

Noninvasive determination of cardiac output using single breath CO2 analysis.

OBJECTIVE: To examine the utility of single breath CO2 analysis as a noninvasive measure of cardiac output. SETTING: An animal laboratory in a university-affiliated medical center. DESIGN: A prospective, animal cohort study comparing 21 parameters derived from single breath CO2 analysis with cardiac output determined by an ultrasonic flow probe. SUBJECTS: Six healthy adult sheep. METHODS: The single breath CO2 analysis station consists of a mainstream capnometer, a variable orifice pneumotachometer, a signal processor, and computer software with capability for both on- and off-line data analysis. Twenty-one derived components of the CO2 expirogram were evaluated as predictors of cardiac output. Cardiac output was manipulated by successive injections of a hydraulic constrictor placed around the inferior vena cava. MEASUREMENTS AND MAIN RESULTS: Thirty-four measurements of cardiac output were available for comparison with derived variables from the CO2 expirogram. Stepwise linear regression identified two variables that were most predictive of cardiac output: a) the angle between the slope lines for phase II and III of the CO2 expirogram divided by the volume of CO2 per breath (angle/mL CO2); and b) the slope of phase II. The multivariate equation was highly statistically significant and explained 94% of the variance (adjusted r2 = .94, p < .0001). The bias and precision of the calculated cardiac output were .00 and .23, respectively. The mean percent difference for the cardiac output estimate derived from the single breath CO2 analysis station was 0.36%. CONCLUSIONS: Our data indicate that analysis of the CO2 expirogram can yield accurate information about the cardiovascular system. Specifically, two variables derived from a plot of expired CO2 concentration vs. expired volume predict changes in cardiac output in healthy adult sheep with an adjusted coefficient of determination of .94. Prospective application of this technology in the setting of lung injury and rapidly changing physiology will be essential in determining the clinical usefulness of the technique.

Animals↗
PubMed1995

Effect of dopamine on renal blood flow and cardiac output.

OBJECTIVE: To characterize the relationship between changes in renal blood flow and cardiac output induced by dopamine, hypothesizing that at low doses renal blood flow changes more than cardiac output. DESIGN: Anesthetized swine had renal blood flow and cardiac output measured during either continuous dopamine infusions (2 to 8 micrograms/kg per minute) or bolus dosing (1 to 16 micrograms/kg), and increases in both were compared. Two different fluid protocols were compared using constant dopamine infusions. In the constant pulmonary capillary wedge pressure protocol, intravenous fluids were titrated to keep this parameter constant. In the other protocol, fluid therapy was held constant at 10 mL/kg per hour. RESULTS: With infusions, mean increases in renal blood flow and cardiac output were relatively equal. The maximum increase was 35% at 8 micrograms/kg per minute under the constant pulmonary capillary wedge pressure protocol, with no significant differences (P > .1) found between the change in renal blood flow and cardiac output at any dose in either protocol. With bolus dosing, renal blood flow increased significantly more than cardiac output at 1, 4, and 8 micrograms/kg (P < .05). CONCLUSION: Disproportionate increases in renal blood flow compared with cardiac output at low bolus doses show initial renal responses to be independent of cardiac output. The infusion data suggest that renal responses exhibit tachyphylaxis or that cardiac output slowly accommodates to decreased total peripheral resistance.

Animals↗
PubMed1989

Noninvasive measurement of cardiac output during surgery using a new continuous-wave Doppler esophageal probe.

The ability of a new continuous-wave Doppler esophageal probe to measure cardiac output noninvasively during surgery under general anesthesia was tested and compared with simultaneously measured thermodilution cardiac output. A Doppler computer, calibrated for the aortic diameter and the transcutaneously measured cardiac output from the suprasternal notch, computed the Doppler cardiac output from the descending aortic blood flow velocity signal. A total of 246 paired Doppler cardiac output and thermodilution cardiac output measurements were made in 14 patients during surgery. The average thermodilution cardiac output was 5.90 +/- 3.27 (standard deviation) liters/min (range 1.20 to 19.18); the average Doppler cardiac output was 6.21 +/- 4.0 liters/min (range 2.30 to 28.20). The difference between the cardiac output measured by the 2 techniques was 1.38 +/- 2.2 liters/min (range 0.04 to 16.8). Two to 5 cardiac output measurements were averaged and arranged into "time periods." The average standard deviations for thermodilution and Doppler cardiac outputs within each time period were 0.64 and 0.47 liters/min, respectively. There was a correlation between the 2 measurements over a range of cardiac output values (r = 0.76, Doppler cardiac output = 0.93 x thermodilution cardiac output +0.7, standard error of the estimate = 1.76). Reproducible measurements of Doppler cardiac output were obtained during intraobserver (mean difference 0.64 +/- 0.52 liter/min) and interobserver (mean difference 0.41 +/- 0.36 liter/min) studies (n = 8). Cardiac output measurement by the Doppler esophageal probe could be used for hemodynamic monitoring during surgery in selected patients with cardiopulmonary disease.

Adult↗
PubMed1991

Cardiac output in anencephalic fetuses.

The cardiac output was measured by means of Doppler echocardiography in four anencephalic fetuses during the late second or third trimester of pregnancy. Anencephalic fetuses showed a higher dominance of right ventricular output when compared to healthy fetuses, suggesting that the relationship between brain mass and body weight affects the distribution of cardiac output.

Anencephaly↗
PubMed1976

Assessment of thermodilution cardiac output in small subjects.

Thermodilution cardiac output determinations were compared with dye-dilution measurements in normovolemic and hypovolemic puppies. Good correlation was achieved with small volumes of cold and warm saline. Injectate volumes and significant caval displacement of the injectate port did not significantly affect thermodilution output measurements. This study demonstrates that thermodilution is a reliable and practical method of cardiac output determination in small subjects and suggests that this technique may be useful in the clinical management of neonates and small infants.

Animals↗
PubMed1980

Clinical comparison of pressure-pulse and indicator-dilution cardiac output determination.

Two clinical studies of cardiac output determination using the pressure-pulse technique are presented. The Warner pressure-pulse method of estimating cardiac output was compared with the dye-dilution technique in 17 patients. Both the Warner and a variation of the Bourgeosis pressure-pulse methods were compared with thermodilution in 13 patients. The Warner vs dye-dilution comparison resulted in a poor correlation coefficient (r = 0.61). Values for the Warner equation calibration constant (K) were nonstationary, varying with time from --69 to 135% of the initial value in individual patients. When thermodilution was compared with the two methods, the correlation was poor (r = 0.58 for the Warner method; r = 0.50 for the modified Bourgeois method). The Warner and a variation of the Bourgeois pressure-pulse methods for monitoring the cardiac output of critically ill patients with widely varying mean arterial pressures are not sufficiently reliable for clinical decision-making.

Blood Pressure↗
PubMed1994

Non-invasive measurement of cardiac output by a carbon dioxide rebreathing method at rest and during exercise.

Cardiac output was measured in 11 patients undergoing routine cardiac catheterization using a carbon dioxide rebreathing technique and compared with cardiac output measured by direct Fick and thermodilution. The carbon dioxide rebreathing technique gave consistently lower values for cardiac output than the other two methods (mean difference -0.73, 95% CI -0.95 to -0.51 l.min-1 with the direct Fick and -0.72, 95% CI -1.19 to -0.26 l.min-1 with thermodilution). The direct Fick and thermodilution methods gave similar results (mean difference -0.08, 95% CI -0.32 to 0.16 l.min-1). Cardiac output was also measured in 10 healthy subjects at rest and during two steady-state levels of exercise using the carbon dioxide rebreathing technique. Measurements were made in triplicate on 3 separate days. The technique gave reproducible results between replicates at rest (coefficient of variation 9.1%) and became more reproducible on exercise (coefficients of variation 5.6% and 5.4% respectively at each exercise level). There was a good correlation between cardiac output and oxygen consumption (r = 0.98). The carbon dioxide rebreathing technique is a feasible non-invasive way of measuring cardiac output. It tends to underestimate cardiac output at rest but is reproducible and becomes more so on exercise which is where it should be of most value.

Adult↗
PubMed1986

Cardiac output during exercise in patients with COPD.

Cardiac output response was examined to determine its relationship to exercise and arterial hypoxia, pulmonary hemodynamics, and the clinical/lung mechanics profile of patients with chronic obstructive pulmonary disease (COPD). Twenty patients with COPD were examined on the treadmill at rest and during steady state exercise at the highest workload comfortably tolerable to the subjects (60-70% VO2 max). In eight patients, the exercise cardiac output was less than 80% of predicted, while in the remainder (n = 12), the cardiac output response was normal (greater than 80% of predicted). It was concluded that hyperinflation and severe expiratory airflow limitation may be important determinants of the low exercise cardiac output response in some patients with COPD.

Aged↗
PubMed1990

Doppler ultrasonic measurement of cardiac output: reproducibility and validation.

The Doppler ultrasonic estimation of cardiac output in man is reviewed. Minimal requirements for accurate measurements are discussed, and the published results of reproducibility studies and validation studies are summarized and analysed. Analysis of Doppler records has a coefficient of repeat determination of 5-8% for aortic or LV outflow tract measurements and this is higher for other sites. Short-term variability varies from 4 to 10%, and that over days to weeks from 9 to 14%. Thus a single measurement may vary up to +/- 28% over time with no true change in cardiac output. For cardiac output determination, the Doppler methods show accuracies varying from 10 to 22% (coefficient of variation of the differences between methods) indicating that a single aortic based measurement only reliably lies within +/- 28% compared with other 'standard' methods, and during exercise the accuracy is less (+/- 44%). Doppler methods are safe, fairly reproducible and reasonably accurate methods for measuring cardiac output in selected patients provided signal quality is adequate during recording.

Blood Flow Velocity↗
PubMed1990

The dye dilution method for measurement of cardiac output.

The dye dilution method for measuring cardiac output is based on injecting rapidly a known quantity of a dye at one site into the circulatory system, and withdrawing blood at a distal site for determination of a concentration curve of the dye. Flow (Q) is calculated by the formula: (formula: see text) where m is the amount of dye injected, c mean concentration of dye and t the time of the concentration curve without recirculation. In recent years the only dye used has been indocyanine green (cardiogreen) which has its absorption maximum in the infrared part of the spectrum (at 805 microns) - where oxyhaemoglobin and reduced haemoglobin transmit light equally. Several densitometers for cardiogreen have been developed. The Christian Michelsen Institute densitometer used in our laboratory was found to give very accurate measurements (error less than +/- 2%) of blood flow in model experiments, for flows ranging from 2 to 12 l min-1. The more modern densitometers are usually equipped with computers. The cardiogreen method is probably one of the most accurate methods to study cardiac output during exercise. The error of a single determination of cardiac output values at rest and during exercise is less than +/- 5%. The method does not allow measurement of 'beat to beat' changes, and requires a cardiac output which is stable for approximately 10 s during exercise and 30 s at rest. It has been extensively used in our laboratory to study changes in central haemodynamics in essential hypertension at rest and during exercise, and also to study the haemodynamic alterations induced by anti-hypertensive agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed2001

Lack of agreement between thermodilution and carbon dioxide-rebreathing cardiac output.

BACKGROUND: A continuous, accurate, non-invasive monitor of cardiac output would represent a major step forward in patient management. A cardiac output computer, NICO2, based on the Fick principle and an automatic partial carbon dioxide (CO2)-rebreathing technique has just become available. We compared the performance of this monitor with the standard thermodilution method. METHODS: Thirty patients were investigated after cardiac surgery. Replicate measurements were performed simultaneously with the thermodilution and NICO2 techniques. An Altman-Bland analysis was used to assess repeatability of each of the two methods and to determine the agreement between the two techniques. RESULTS: The repeatabilities of thermodilution and CO2-rebreathing cardiac output were excellent, with coefficients of repeatability of 0.35 l/min and 0.60 l/min. Mean thermodilution and NICO2 cardiac output were 4.4 l/min (SD 0.9, range 2.7-6.1) and 4.6 l/min (SD 1.3, range 1.6-6.9). A comparison of the methods, however, revealed excessive limits of agreement (+/-1.80 l/min). CONCLUSION: The agreement between the NICO2 derived cardiac output and the de facto standard - thermodilution cardiac output - is poor. The methods are not interchangeable with the present version of the NICO2. The repeatability of the partial CO2-rebreathing technique holds promise that a sufficient accuracy may be obtained by suitable modifications of the monitor's algorithms.

Adult↗
PubMed1981

Effect of cardiac output on extravascular lung water.

Extravascular lung water (EVLW) and cardiac output (CO) were determined in 21 mongrel dogs using the thermal-green dye double indicator dilution technique. In 12 of the animals the renal vessels were ligated bilaterally to increase peripheral resistance and reduce cardiac output without altering actual EVLW. Measurements before and after renal pedicle ligation revealed an average 47 per cent decrease in cardiac output with an 11 per cent increase in measured lung water. In the remaining nine animals an external arteriovenous fistula was constructed to reduce afterload and increase cardiac output. In the baseline state, opening the fistula caused a 63 per cent increase in cardiac output with a simultaneous five per cent decrease in measured EVLW. This second group of animals was then given intravenous acid sufficient to cause 30-50 per cent increases in EVLW. Measurements of EVLW and CO with the fistula open and closed were continued for three hours. The inverse relation between cardiac output and EVLW continued. The results of these experiments show that cardiac output does exert a small effect on the measurement of EVLW.

Animals↗
PubMed1985

Cardiac output in newborn infants with transient myocardial dysfunction.

Decreased cardiac output is a common presumption in left ventricular myocardial dysfunction in neonates, but because of a lack of reliable noninvasive techniques, data on cardiac output are missing. We measured cardiac output by pulsed Doppler echocardiography in 22 newborn infants with left ventricular myocardial dysfunction diagnosed by M-mode echocardiography. Eleven neonates had severe perinatal asphyxia, seven had tachypnea, two hypoglycemia, and one septic shock; one had no symptoms. Right ventricular function was abnormal in 13 of the 22 infants. Hypotension was found in eight; cardiac output and stroke volume were low in 20. The abnormalities were more pronounced in infants with asphyxia. Six such infants were given dopamine (4 to 10 micrograms/kg/min). Within 1 hour, arterial blood pressure, cardiac output, stroke volume, and heart rate increased sharply, with normalization of the myocardial contractility; the other echocardiographic abnormalities normalized over 24 to 48 hours. Pulsed Doppler echocardiography is an advance in the detection and evaluation of therapy for left ventricular myocardial dysfunction in the neonate.

Asphyxia Neonatorum↗
PubMed1979

Influence of cardiac output on intrapulmonary shunt.

The effect of changing cardiac output on intrapulmonary shunt was studied in the setting of hemorrhagic pulmonary edema induced by intravenous oleic acid in 17 alpha-chloralose-anesthetized dogs. The dogs were mechanically ventilated and cardiac output was alternately depressed and augmented using either pharmacologic means or mechanical alteration of venous return. Following oleic acid, the measured ventilation-perfusion distributions, as measured by the multiple inert gas elimination technique, demonstrated a two-compartment blood flow distribution consisting of shunt and normal units. Changes in cardiac output were not associated with change in the shape of the distributions but there was a significant linear correlation between the level of cardiac output and the shunt fraction. The shunt fraction also varied directly with the mixed venous partial oxygen pressure and inversely with the pulmonary vascular resistance. These data suggest that shunt and nonshunt vessels behave differently in response to alterations of blood flow and emphasize that any interpretation of changes in shunt in the setting of diffuse lung injury must be interpreted in light of changes in cardiac output.

Animals↗
PubMed2000

Prolonged recovery of cardiac output after maximal exercise in patients with chronic heart failure.

OBJECTIVES: The aim of this study was to characterize the kinetics of cardiac output during recovery from maximal exercise in patients with chronic heart failure (CHF). BACKGROUND: Recent studies have shown that oxygen uptake kinetics during recovery from exercise are delayed in patients with CHF. However, the kinetics of cardiac output during recovery from maximal exercise in CHF has not been examined. METHODS: Thirty patients with CHF performed maximal upright ergometer exercise with respiratory gas analysis. Kinetics of oxygen uptake (VO2) and carbon dioxide output (VCO2) during recovery were characterized by T1/2, the time to reach 50% of the peak values. Cardiac output was measured at 1-min intervals during exercise and recovery. Kinetics of cardiac output during recovery were characterized by the ratios of cardiac output during the first 4 min of recovery to cardiac output at peak exercise. Overshoot of cardiac output was defined as a further increase in cardiac output at 1 min of recovery above the cardiac output at peak exercise. RESULTS: Both T1/2 VO2 and T1/2 VCO2 increased as CHF worsened. The ratios of cardiac output during recovery to cardiac output at peak exercise were significantly correlated with T1/2 VO2 (r = 0.47 to 0.62, p < 0.05) and T1/2 VCO2 (r = 0.40 to 0.70, p < 0.05). There was a negative correlation between cardiac index at peak exercise and both T1/2 VO2 (r = -0.65, p < 0.001) and T1/2 VCO2 (r = -0.60, p < 0.001). Overshoot of cardiac output was recognized in 11 of 30 patients. Cardiac index at peak exercise was significantly lower in patients with overshoot (4.5 +/- 0.9 L/min/m2) than in those without overshoot (6.1 +/- 2.1 L/min/m2, p < 0.05). However, because of a continued increase in cardiac output at 1 min of recovery in patients with overshoot, there were no differences in cardiac index after the first minute of recovery. Heart rate at peak exercise and recovery of heart rate did not differ between these groups. Overshoot of cardiac output was caused by a rebound increase in stroke volume which was due to a reduction in systemic vascular resistance. CONCLUSIONS: Prolonged kinetics of VO2 or VCO2 during recovery from maximal exercise represent impairment of circulatory response to exercise and delayed recovery of cardiac output after exercise. Overshoot of cardiac output at 1 min of recovery was characteristic of severe CHF with poor cardiac output response to exercise.

Analysis of Variance↗
PubMed1988

Mammary blood flow and cardiac output during initiated involution of the mammary gland in the rabbit.

1. Cardiac output and its distribution to the mammary gland, kidneys, heart, liver and gastrointestinal tract were measured in conscious rabbits at day 1, day 3 and day 6 after removal of the young at day 0. 2. There was no change in cardiac output, proportion of cardiac output delivered to the mammary gland or mammary blood flow 24 hr after the last suckling period. After a further 48 hr there was a significant reduction in the cardiac output, proportion of the cardiac output and blood flow to the mammary gland compared to the values measured in lactating animals. 3. There was no significant difference in blood flow to the other organs although there were changes in the proportion of the cardiac output delivered to the heart, kidney and liver during this period. 4. The change in uptake of glucose, acetate, non-esterified fatty acids and triacylglycerols by the mammary gland are discussed in relation to the reabsorption of milk components.

Animals↗