A new method for non-invasive determination of effective pulmonary blood flow and cardiac output in spontaneously breathing subjects.

IF 2.8 4区 医学 Q2 PHYSIOLOGY
Andras Gedeon, Jakob Jansson, David Patrickson, Mats Wallin
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Abstract

The differential Fick method is well established for measuring effective pulmonary blood flow (EPBF) and cardiac output (CO) but until now it has only been used for patients on mechanical ventilation. Here we present and evaluate a new approach adapted to spontaneous breathing situations. Ten healthy subjects with diverse anthropometric and respiratory parameters were studied in the sitting position. Rebreathing through a dead space of precisely known volume and recording the resulting rise in the end-tidal CO2 value allowed the determination of EPBF. The shunted blood flow fraction was estimated from the arterial oxygen saturation to obtain cardiac output (FickCO). Two measurements were made on each subject 15 min apart. Reference values for cardiac output (RefCO), were calculated as the product of stroke volume and heart rate where the stroke volume was measured with established echocardiography techniques. Heart rate and arterial oxygen saturation were measured with an ordinary pulse oximeter. Comparing FickCO to RefCO using a Bland-Altman analysis, we obtained a mean bias of 0.03 L/min, limits of agreement (LoA) of +1.43 to -1.37 (95% CI) L/min and a percentage error (PE) of 0.25. For the mean of two FickCO observations, we obtained a mean bias of -0.04 L/min, LoA +0.94 to -1.01 (95% CI) and PE of 0.17. The differential Fick method can be adapted to spontaneously breathing situations with good absolute accuracy using simple equipment. Short data collection times make it possible to use the mean of repeated observations and thereby get adequate precision. The new method could therefore be of value both in the pre-operative and the post-operative setting.

一种无创测定自主呼吸受试者有效肺血流量和心输出量的新方法。
差分菲克法是测量有效肺血流量(EPBF)和心输出量(CO)的有效方法,但到目前为止,它仅用于机械通气患者。在这里,我们提出并评价一种适应于自发呼吸情况的新方法。对10名不同人体测量和呼吸参数的健康受试者进行坐姿研究。通过一个精确已知容积的死区重新呼吸,并记录由此产生的潮末二氧化碳值的上升,从而确定EPBF。分流血流分数由动脉血氧饱和度估算得到心输出量(FickCO)。每名受试者间隔15分钟进行两次测量。心输出量参考值(RefCO)计算为脑卒中量和心率的乘积,其中脑卒中量是用既定的超声心动图技术测量的。用普通脉搏血氧仪测量心率和动脉血氧饱和度。使用Bland-Altman分析将FickCO与RefCO进行比较,我们获得的平均偏差为0.03 L/min,一致性限(LoA)为+1.43至-1.37 (95% CI) L/min,百分比误差(PE)为0.25。对于两次FickCO观察的平均值,我们获得的平均偏差为-0.04 L/min, LoA为+0.94至-1.01 (95% CI), PE为0.17。微分菲克方法可以适应自然呼吸的情况下,使用简单的设备,具有良好的绝对准确性。数据收集时间短,可以使用重复观测的平均值,从而获得足够的精度。因此,这种新方法在术前和术后都有价值。
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来源期刊
Experimental Physiology
Experimental Physiology 医学-生理学
CiteScore
5.10
自引率
3.70%
发文量
262
审稿时长
1 months
期刊介绍: Experimental Physiology publishes research papers that report novel insights into homeostatic and adaptive responses in health, as well as those that further our understanding of pathophysiological mechanisms in disease. We encourage papers that embrace the journal’s orientation of translation and integration, including studies of the adaptive responses to exercise, acute and chronic environmental stressors, growth and aging, and diseases where integrative homeostatic mechanisms play a key role in the response to and evolution of the disease process. Examples of such diseases include hypertension, heart failure, hypoxic lung disease, endocrine and neurological disorders. We are also keen to publish research that has a translational aspect or clinical application. Comparative physiology work that can be applied to aid the understanding human physiology is also encouraged. Manuscripts that report the use of bioinformatic, genomic, molecular, proteomic and cellular techniques to provide novel insights into integrative physiological and pathophysiological mechanisms are welcomed.
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