Investigating the ability of non-invasive measures of cardiac output to detect a reduction in blood volume resulting from venesection in spontaneously breathing subjects

Autor: Benjamin Mothibe Bussmann, Andrew Tang, William Hulme, Tim Harris
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Cardiac output
Venesection
Diagnostic Techniques
Cardiovascular
LiDCO
Hemodynamics
Blood Pressure
Blood volume
Critical Care and Intensive Care Medicine
0302 clinical medicine
Inferior vena cava collapsibility index
Phlebotomy
030202 anesthesiology
USCOM
Original Research
education.field_of_study
Blood Volume
Respiration
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Stroke volume
Middle Aged
Pulse pressure
medicine.vein
Echocardiography
Emergency Medicine
Cardiology
Female
Hemochromatosis
Adult
medicine.medical_specialty
Population
Vena Cava
Inferior
Polycythemia
Inferior vena cava
03 medical and health sciences
CNAP
Internal medicine
Carotid blood flow
medicine
Humans
education
Aged
business.industry
030208 emergency & critical care medicine
Blood flow
lcsh:RC86-88.9
Flow time
Spirometry
Circulating blood volume
business
Zdroj: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 26, Iss 1, Pp 1-7 (2018)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
ISSN: 1757-7241
Popis: Background Monitoring cardiac output (CO) in shocked patients provides key etiological information and can be used to guide fluid resuscitation to improve patient outcomes. Previously this relied on invasive monitoring, restricting its use in the Emergency Department (ED) setting. The development of non-invasive devices (such as LiDCOrapidv2 with CNAP™ and USCOM 1A), and ultrasound based measurements (Transthoracic echocardiography, inferior vena cava collapsibility index (IVCCI), carotid artery blood flow (CABF) and carotid artery corrected flow time (FTc)) enables stroke volume (SV) and CO to be measured non-invasively in the ED. We investigated the ability of these techniques to detect a change in CO resulting from a 500 ml reduction in circulating blood volume (CBV) following venesection in spontaneously breathing subjects. Additionally, we investigated if using incentive spirometry to standardise inspiratory effort improved the accuracy of IVC based measurements in spontaneously breathing subjects. Methods We recorded blood pressure, heart rate, IVCCI, CABF, FTc, transthoracic echocardiographic (TTE) SV and CO, USCOM 1A SV and CO, LIDCOrapidv2 SV, CO, Stroke volume variation (SVV) and pulse pressure variation (PPV) in 40 subjects immediately before and after venesection. The Log-Odds and coefficient of variation of the difference between pre- and post-venesection values for each technique were used to compare their ability to consistently detect CO changes resulting from a reduction in CBV resulting from venesection. Results TTE consistently detected a reduction in CO associated with venesection with an average decrease in measured CO of 0.86 L/min (95% CI 0.61 to 1.12) across subjects. None of the other investigated techniques changed in a consistent manner following venesection. The use of incentive spirometry improved the consistency with which IVC ultrasound was able to detect a reduction in CBV. Conclusions In a population of spontaneously breathing patients, TTE is able to consistency detect a reduction in CO associated with venesection.
Databáze: OpenAIRE
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