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PubMed1999

A comparison of lithium dilution cardiac output measurements made using central and antecubital venous injection of lithium chloride.

OBJECTIVE: We have previously described an indicator dilution technique of measuring cardiac output in which lithium chloride is injected as a bolus via a central venous catheter and cardiac output derived from the arterial lithium dilution curve recorded from a lithium-selective electrode, which we have developed for this purpose. It would be an advantage if the lithium could be injected via the basilic vein (in the antecubital fossa) in those patients who do not need central venous catheterisation for other reasons. We have therefore compared cardiac output measurements made using these two routes of lithium chloride administration. METHODS: Lithium dilution cardiac output was measured 10 times in each of 10 patients, injecting the lithium chloride alternately via the basilic or central venous catheter. RESULTS: The mean difference was 0.8 +/- 5.2% (SD) (range -8.5 to +7.0%) over a range of cardiac output of 4.5-13 l/min. CONCLUSIONS: Injection of lithium chloride via the basilic vein in the antecubital fossa allows accurate lithium dilution cardiac output measurements to be made in patients who do not have central venous catheters in place.

Adjuvants, Immunologic↗
PubMed1997

The influence of high-frequency jet ventilation with varying cardiac-cycle specific synchronization on cardiac output in ARDS.

BACKGROUND: Previous studies have shown "beat-to-beat" variation in systemic BP with high-frequency jet ventilation (HFJV). However, it is not clear if such changes are paralleled by changes in cardiac output. OBJECTIVE: To characterize the effect of HFJV near or equal to the heart rate (HR) on beat-to-beat cardiac output in an adult human subject with ARDS. DESIGN: Case study. SETTING: ICU, university teaching hospital. PATIENTS: One patient with end-stage liver disease complicated by sepsis, severe pancreatitis, ARDS, and multisystem organ failure. METHODS: The patient was intubated, sedated, paralyzed, and ventilated with controlled mechanical ventilation (CMV). Ventilatory mode was then switched to HFJV at fixed frequencies (f) near but not equal to the HR (f= 100, 110, and 120 beats/min; HR=108/min). HFJV was then synchronized to the ECG such that f and HR were equal. Continuous cardiac output (COc) was monitored during change of ventilator mode from CMV to fixed-rate HFJV to synchronized HFJV, then followed through progressive delays in jet triggering within the cardiac cycle during the synchronous HFJV mode. COc was monitored by arterial pulse-contour analysis, allowing assessment of beat-to-beat changes in cardiac output. MEASUREMENTS AND MAIN RESULTS: A cyclic variation in COc equal to the beat frequency difference between f and HR was observed (harmonic interaction) during fixed-rate HFJV. This COc oscillation was abolished during synchronous HFJV. COc was significantly greater during systolic synchronous HFJV as compared to diastolic synchronous HFJV or fixed-rate HFJV (10.1 to 9.0 [p<0.05] and to 8.6 [p<0.05] L/min, systolic synchronous to diastolic synchronous and to fixed-rate HFJV, respectively). CONCLUSIONS: This study demonstrates instantaneous variations in cardiac output in a human subject with fixed rates of HFJV near to the HR in humans. These variations are abolished by synchronous HFJV but cardiac output was dependent on the timing of the HFJV inspiration in relation to the cardiac cycle. COc is a potentially valuable method to monitor sudden changes in cardiac output and facilitate attempts to maximize cardiac output during synchronized HFJV.

Adult↗
PubMed1991

Distribution of cardiac output during diurnal changes of activity in rats.

Rat locomotor and feeding behavior varies on a diurnal basis; at night the animals actively forage and eat, whereas during the day they are more inactive and somnolent. At night, cardiac output is higher, presumably for enhanced perfusion of the active muscles to support increased metabolism and for enhanced perfusion of the digestive organs to support increased digestion and nutrient absorption. Conversely, it is hypothesized that during the daytime, blood flow to these two tissues is relatively low. The purpose of this study was to test these hypotheses by measuring cardiac output and the distribution of cardiac output in rats at various times in the diurnal cycle (8:00 A.M., 4:00 P.M., and 8:00 P.M.). The radiolabeled microsphere technique was used to measure cardiac output and distribution of blood flow to the tissues. Distribution of the total cardiac output was accounted for by complete dissection, weighing, and counting of organs and carcass. Cardiac output at 8:00 P.M. (136 +/- 9 ml/min) was elevated 13% (P less than 0.05) over that at 4:00 P.M. The proportion of the cardiac output distributed to the skeletal muscles (4:00 P.M.: 25%; 8:00 P.M.: 27%) and to the digestive tract (4:00 P.M.: 14%; 8:00 P.M.: 14%) did not change between the two time periods. Thus total muscle blood flow increased (P less than 0.05) from 31 +/- 2 at 4:00 P.M. to 36 +/- 4 ml/min at 8:00 P.M.; the only digestive organ to show a significant increase in blood flow from 4:00 P.M. to 8:00 P.M. was the stomach (133 +/- 17 to 166 +/- 19 ml/min, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Acidaemia reduces cardiac output and left ventricular contractility in conscious lambs.

We studied the effects of HCI-induced metabolic acidaemia on cardiac output, contractile function, myocardial blood flow, and myocardial oxygen consumption in nine unanaesthetized newborn lambs. Through a left thoracotomy, catheters were placed in the aorta, left atrium and coronary sinus. A pressure transducer was placed in the left ventricle. Three to four days after surgery, we measured cardiac output, dP/dt, left ventricular end diastolic and aortic mean blood pressures, heart rate, aortic and coronary sinus blood oxygen contents, and left ventricular myocardial blood flow during a control period, during metabolic acidaemia, and after the aortic pH was restored to normal. We calculated systemic vascular resistance, myocardial oxygen consumption and left ventricular work. Acidaemia was associated with reduction in cardiac output, maximal dP/dt, and aortic mean blood pressure. Left ventricular end diastolic pressure and systemic vascular resistance increased, and heart rate did not change significantly. The reduction in myocardial blood flow and oxygen consumption was accompanied by fall in cardiac work. Cardiac output returned to control levels after the pH had been normalized but maximal dP/dt was incompletely restored. Myocardial blood flow and oxygen consumption increased beyond control levels. This study demonstrates that HCI-induced metabolic acidaemia in conscious newborn lambs is associated with a reduction in cardiac output which could have been mediated by the reduction in contractile function and/or the increase in systemic vascular resistance. The decreases in myocardial blood flow and oxygen consumption appear to reflect diminished cardiac work. The restoration of a normal cardiac output after normalization of the pH appears to have resulted from the increases in heart rate and left ventricular filling pressures in conjunction with an incomplete restoration of contractile function.

Acidosis↗
PubMed1991

Relationship among cardiac output, shunt, and inspired O2 concentration.

In comparing gas exchange responses of the methacholine- (MCh) challenged mongrel dog with leukotriene receptor blockers and placebo at different inspiratory O2 fractions (FIO2), we previously noted systematically different values of cardiac output as a function of drug administration and/or FIO2. This confounds identification of the effects of FIO2 and/or drugs on gas exchange, because shunt is well known to vary directly with cardiac output when other factors are equal. Accordingly, in six dogs we examined the dependence of combined shunt and low ventilation-perfusion (VA/Q) blood flow ("shunt") on cardiac output in the MCh-challenged mongrel dog. Two dogs breathed 100% O2, another two breathed room air, and the final pair breathed 12% O2 while cardiac output was altered several times by sequentially opening and closing arteriovenous fistulas every 10 min for approximately 90 min after a standard MCh challenge. On 100% O2, shunt increased by 11.0% of the cardiac output per 1-l/min increase in cardiac output. On room air, the value was 7.4%. With 12% O2 breathing shunt rose by only 2.2% per 1-l/min rise in blood flow. This FIO2 -dependent behavior of the shunt-cardiac output relationship was highly reproducible, both within and between animals. It suggests that the increase in shunt with cardiac output depends more on vascular tone of noninjured areas than on tone of the low VA/Q regions (which are hypoxic at all FIO2 values).

Animals↗
PubMed2005

Validation of the use of foreign gas rebreathing method for non-invasive determination of cardiac output in heart disease patients.

OBJECTIVE: To compare a new device (Innocor) for non-invasive measurement of cardiac output (CO) by foreign gas rebreathing method with conventional techniques used in the measurements of cardiac function. METHODS: Cardiac outputs measured by Innocor (CO(RB)) were compared with CO obtained by echocardiography (CO(EC)), Swan-Ganz thermodilution (CO(TD)), and left ventricle radiography (CO(LVR)) in 34 patients subjected to cardiac catheterization. Values obtained from the four methods were analyzed by linear regression and paired values were compared by the method of Bland and Altman in SPSS. RESULTS: There was strong positive correlation (r=0.94) between Innocor cardiac output values and the corresponding values obtained by thermodilution and between CO(EC) and CO(LVR) values. Thermodilution appears to overestimate cardiac output when compared to the values obtained with Innocor by (0.66+/-0.22) L/min (P<0.0001). There was no correlation between data obtained by Innocor and the corresponding CO(EC) and CO(LVR) values. CONCLUSION: Innocor CO(RB) is an easy, safe and well established method for non-invasive measurement of cardiac output with good prospects for clinical application in heart disease patients.

Adult↗
PubMed1993

Measurements of cardiac output by impedance cardiography in pacemaker patients at rest: effects of various atrioventricular delays.

OBJECTIVES: The purpose of this study was to evaluate the ability of impedance cardiography to determine the change in cardiac output caused by modifications in the atrioventricular (AV) delay in DDD (dual-chamber) pacing mode while pacing the atrium and ventricle at different programmed rates. BACKGROUND: Impedance cardiography permits continuous noninvasive monitoring of hemodynamic variables on a beat to beat basis. METHODS: Eleven patients with a DDD pacemaker were evaluated by impedance cardiography. Stroke volume, cardiac output and total peripheral resistance were assessed in the supine rest position during both DDD and ventricular (VVI) pacing. Hemodynamic variables were measured during DDD pacing at rates ranging from 60 to 110 beats/min in 10-beats/min increments with programmed AV delay varying from 50 to 250 ms in 50-ms increments. When the pacemaker was reprogrammed to the VVI pacing mode, these measurements were repeated at the same pacing rates. RESULTS: Cardiac output measurements during programmed conditions were found to be highly reproducible. The mean coefficient of variation was 3% during DDD pacing; it was 6% in the VVI pacing mode. A large decrease in cardiac output (approximately 30%) was found when a pacemaker was reprogrammed from the DDD to the VVI pacing mode. At DDD pacing rates between 70 to 110 beats/min, the highest cardiac output occurred at an average AV delay of < 120 ms from atrial stimulus to ventricular stimulus. At an average AV delay of > or = 200 ms, the cardiac output in the DDD and VVI pacing modes was similar. CONCLUSIONS: 1) Impedance cardiography allows highly reproducible noninvasive assessments of cardiac output in pacemaker patients; 2) inappropriate programming of the AV interval in patients with atrial and ventricular pacing can decrease cardiac output significantly, and the extent of the decrease is similar to or less than that observed in ventricular pacing; 3) hemodynamic measurements obtained with impedance cardiography can facilitate optimal programming of pacemaker variables.

Cardiac Output↗
PubMed1996

Comparison of impedance cardiography with indirect Fick (CO2) method of measuring cardiac output in healthy children during exercise.

Electric bioimpedance has been used to measure cardiac output for decades. Improvements in modeling and microprocessor technology have spawned newer generations of such devices. This method would be especially useful in children, in whom the use of invasive methods is limited. We tested a device (ICG-M401, ASK Ltd.) in 30 healthy children at 2 levels of exercise (0.5 and 1.5 W/kg), and compared impedance measurements of cardiac output (QICG) with carbon dioxide (CO2) rebreathing measurements of cardiac output (QRB). The QICG-oxygen uptake (VO2) rel ation was expressed by QICG = 3.8 + 4.6 VO2; r(2) = 0.68. Mean +/- SD bias (QICG-QRB) was 0.14 +/- 1.05 L/min, not significantly different from zero (95% confidence interval -0.12 to +0.44 L/min). All QICG results were within +/- 15% of the hypothetical mean value (Bland and Altman analysis). The largest deviation of QICG from QRB was +30%, found in 1 of 57 paired determinations. Eighty percent of QICG values were within +/- 20% of the QRB result. We conclude that impedance cardiography with the ICG-M401 provided realistic and reliable estimates of cardiac output in healthy children during exercise. This, along with its ease of operation and utility at rest and during exercise, make it both useful and attractive for clinic and research purposes.

Adolescent↗
PubMed1979

Hemodynamic improvement following a single dose of oral phentolamine. Administration in patients with chronic low output cardiac failure.

Hemodynamic studies were made in 15 patients with chronic low output cardiac failure before and following a single dose of oral phentolamine (150 mg). After two hours significant (P less than .05) reduction occurred in mean pulmonary, wedge and right atrial pressures and increases in cardiac index and heart rate. In ten patients studied at four hours, wedge pressure remained significantly reduced (-18 percent) and cardiac index significantly increased (+19 percent) from control values. Oral phentolamine results in significant hemodynamic improvement in patients with severe heart failure. Duration of effect for at least four hours after a single dose suggests that intermittent oral therapy may be useful in the management of such patients.

Administration, Oral↗
PubMed2000

[Study of the reproducibility of cardiac output measurement during exercise in pre-pubertal children by doppler echocardiography and CO2 inhalation].

Non-invasive measurement of the cardiac output is essential in investigations of healthy children. However, the data concerning the reproducibility of the measurements are very limited. The aim of this study was to assess the reproducibility of the measurement of cardiac output during exercise by Doppler echocardiography and reinhalation of CO2 (extrapolation method). Fourteen pre-pubertal children underwent two similar tests at increasingly intense levels of exercise. The cardiac output was measured at rest and during the last minute of each stepwise increment of exercise. The results show no difference between the cardiac outputs of the two tests, whichever method was used and at all levels of exercise. They also demonstrate a better reproducibility of cardiac output measurement by Doppler echocardiography (coefficient of variation: 7.5% at rest and 5.2% at maximal effort) compared with reinhalation of CO2 (coefficient of variation: 16.8% at rest and 11.7% at maximal effort). Both methods showed better reproducibility on exercise, resulting from smaller variations in heart rate and stroke volume on effort than at rest. The authors conclude that Doppler echocardiography is very accurate and its simplicity makes it the method of choice in pre-pubertal children for measuring cardiac output during exercise.

Carbon Dioxide↗
PubMed1975

Estimation of cardiac output by analysis of respiratory gas exchange.

Cardiac output is estimated by least squares fitting of a model of pulmonary gas exchange to measurements of respiratory gas composition obtained with a mass spectrometer during a rebreathing maneuver. This new technique estimates cardiac output on spontaneously breathing subjects at rest and requires neither central venous nor arterial blood samples. Principal features of the technique are the use of multiple gases simultaneously in the analysis, the use of a mathematical model for breath-to-breath evaluation of gas exchange, and simultaneous estimation of gas exchange and alveolar gas tensions with the same instrumentation. The technique is compared with thermal dilution estimates in dogs before and during hemorrhagic shock. Two-thirds of these estimates were within 20% of one another. The standard deviation of replication was 15%. Shortcomings, possibilities for improvement, and possible applications are discussed.

Animals↗
PubMed2002

Normal fluctuations in pulmonary artery pressures and cardiac output in patients with severe left ventricular dysfunction.

BACKGROUND: One barrier to accurate interpretation of changes in hemodynamic pressures and cardiac output is lack of data about what constitutes a normal fluctuation. Few investigators have examined normal fluctuations in these parameters and none have done so in patients with left ventricular dysfunction. AIMS: To describe normal fluctuations in pulmonary artery pressures and cardiac output in patients with left ventricular dysfunction. METHODS: Hemodynamically stable advanced heart failure patients (N=39; 55+/-6 years old; 62% male) with left ventricular dysfunction (mean ejection fraction 22+/-5%) were studied. Cardiac output and pulmonary artery pressures were measured every 15 min for 2 h. RESULTS: Mean+/-standard deviation fluctuations were as follows: pulmonary artery systolic pressure=7+/-4 mmHg; pulmonary artery diastolic pressure=6+/-3 mmHg; pulmonary capillary wedge pressure=5+/-3 mmHg; cardiac output=0.7+/-0.3 l/min. The coefficient of variation for fluctuations in pulmonary artery systolic pressure was 6.7%, in pulmonary artery diastolic pressure was 9.3%, in pulmonary capillary wedge pressure was 9.2%, and in cardiac output was 7.2%. CONCLUSIONS: Values that vary <8% for pulmonary artery systolic pressure, <11% for pulmonary artery diastolic pressure, <12% for pulmonary capillary wedge pressure, and <9% for cardiac output from baseline represent normal fluctuations in these parameters in patients with left ventricular dysfunction.

Blood Pressure↗
PubMed1997

Prediction of the changes in cardiac output in association with preload reduction therapy in patients with hypertensive heart failure.

In treating patients with acute hypertensive heart failure we often try preload-reduction therapy using diuretics or vasodilators, but this may frequently produce a considerable decrease in cardiac output, particularly in hypertensive patients with diastolic dysfunction. Therefore, it is important from the clinical standpoint to predict the change in cardiac output following preload-reduction therapy. The objective of this study was to assess whether the change in cardiac output in association with preload-reduction therapy is predictable before treatment by analysis of mitral flow velocity patterns in patients with hypertensive heart failure. Changes in left ventricular volumes and cardiac output in association with preload-reduction therapy and Doppler echocardiographic parameters of the mitral flow velocity pattern before treatment were studied in 18 patients with hypertensive heart failure. Cardiac output increased in six patients with systolic dysfunction (fractional shortening < 25%). In the other 12 patients (those with normal systolic function), the changes in cardiac output were homogenous among the patients. In this subset there was a greater decrease in cardiac output in patients with a shorter deceleration time. Thus, analysis of deceleration time of the early diastolic filling wave before treatment may be useful in estimating the change in cardiac output following preload reduction in patients with hypertensive heart failure due to diastolic dysfunction.

Adult↗
PubMed1992

Comparison of cardiac output measured by intrapulmonary artery Doppler, thermodilution, and electromagnetometry.

A Doppler pulmonary artery catheter system (Doppler cardiac output monitor or DOPCOM) that continuously measures instantaneous and mean cardiac output was recently introduced. Because thermodilution (TD) flow measurements may not represent an adequate standard, the present study was designed to compare TD and DOPCOM cardiac output measurements with aortic electromagnetic (EM) flow in cardiac surgical patients. Twenty-one patients scheduled for elective coronary artery bypass grafting were enrolled in the study. Simultaneous measurement of cardiac output by all three methods was performed before cardiopulmonary bypass, after cardiopulmonary bypass with the aorta cannulated and volume intermittently infused, and after decannulation. Analysis of all data demonstrated fair TD and EM correlation (r = 0.80), with minimal bias (0.03 +/- 1.21 L/min) and a median absolute error of 0.53 L/min; DOPCOM and EM data showed moderate correlation (r = 0.64), a bias of -0.61 +/- 1.50 L/min, and a median absolute error the same as TD (0.51 L/min). However, distribution of DOPCOM values was heavily skewed by 3 patients in whom flow measurements immediately after cardiopulmonary bypass were markedly different between the DOPCOM and electromagnetometry, probably because of malposition of the Doppler transducers secondary to partial catheter withdrawal during bypass. Consistent with this theory was the finding that before CPB, the DOPCOM was significantly better than TD in predicting EM flow (median absolute error: DOPCOM, 0.12 L/min, and TD, 0.48 L/min; p = 0.04). Our data suggest that, in general, the DOPCOM shows similar precision to TD for predicting EM flow measurements, although the DOPCOM may underestimate actual flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1977

Determination of cardiac output by the CO2 - rebreathing method in fifteen-year-old boys subjected to graduated loading.

The dynamics of cardiac output changes were studied in 23 15-year-old boys subjected to graduated loading up to maximum on an bicycle ergometer and relationships between cardiac output and other indexes of cardiorespiratory functions were determined. The correlation between cardiac output (Q in 1/min) and oxygen consumption (VO2 in 1/min) was Q = 6.84 + 5.64. VO2. CO2-rebreathing was found to be a suitable non-invasive method for determining cardiac output in loading tests in adolescents. Maximum cardiac output correlated with maximum oxygen consumption, maximum pulmonary ventilation, body weight, lean body mass and physical working capacity W 170 and did not correlate with systolic volume, the arteriovenous oxygen difference, the pulse rate and ballistocardiographic force. The absence of any statistically significant differences between the various functional indexes of the physical fitness of trained and untrained boys indicates that training was not very effective.

Adolescent↗
PubMed1984

Mathematical basis for the measurement of absolute and fractional cardiac output with diffusible tracers by compartmental analysis methods.

Using compartmental analysis methods, a mathematical basis is given for the measurement of absolute and fractional cardiac output with diffusible tracers. Cardiac output is shown to be the product of the blood volume and the sum of the rate constants of tracer egress from blood, modified by a factor reflecting transcapillary diffusibility, the transfer fraction. The return of tracer to the blood and distant (intracellular) events are shown to play no role in the solution. Fractional cardiac output is the ratio of the rate constant of tracer egress from blood to an organ, divided by the sum of the egress constants from blood. Predominantly extracellular ions such as sodium or bromide are best suited for this technique, although theoretically any diffusible tracer whose compartmental model can be solved may be used. It is shown that fractional cardiac output is independent of the transfer fraction, and therefore can be measured accurately by tracers which are not freely diffusible.

Animals↗
PubMed2004

Reduced nocturnal cardiac output associated with preeclampsia is minimized with the use of nocturnal nasal CPAP.

STUDY OBJECTIVES: Recent studies suggest a specific association between intrauterine growth restriction that commonly occurs in preeclampsia and decreased maternal cardiac output. Sleep is associated with marked hypertension in preeclampsia. We therefore aimed to determine how sleep influences other hemodynamic parameters in preeclampsia, specifically to determine if sleep-induced exacerbation of hypertension was associated with reductions in cardiac output. STUDY DESIGN: Randomized controlled trial of nasal continuous positive airway pressure. SETTING: King George V, Royal Prince Alfred Hospital. PATIENTS: Twenty-four women with severe preeclampsia and 15 control nulliparous subjects. INTERVENTION: Full polysomnography including beat-to-beat blood-pressure recording. Stroke volume, heart rate, cardiac output, total peripheral resistance, and ejection duration were derived from the blood pressure waveform. Half of the 24 preeclamptic subjects were randomly assigned to receive treatment with nasal continuous positive airway pressure and the other half to receive no treatment. MEASUREMENTS AND RESULTS: Heart rate, stroke volume, and cardiac output were similar in controls and patients with preeclampsia during wakefulness, while total peripheral resistance was significantly elevated. Sleep induced marked decrements in heart rate, stroke volume, and cardiac output in preeclamptic subjects and resulted in further increments in total peripheral resistance. Cardiac output during sleep was correlated with fetal birth weight (r2 = 0.64, P < .001). When preeclamptic subjects were treated with continuous positive airway pressure, reductions in cardiac output were minimized, while increments in total peripheral resistance were also reduced. CONCLUSIONS: These data indicate that sleep is associated with adverse hemodynamic changes in women with preeclampsia. These changes are minimized with the use of continuous positive airway pressure. Reduced cardiac output during sleep may have an adverse effect on fetal development.

Adult↗