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Titolo:
Noninvasive cardiac output by partial CO2 rebreathing after severe chest trauma
Autore:
Maxwell, RA; Gibson, JB; Slade, JB; Fabian, TC; Proctor, KG;
Indirizzi:
Univ Tennessee, Ctr Hlth Sci, Dept Surg, Memphis, TN 38163 USA Univ Tennessee Memphis TN USA 38163 Sci, Dept Surg, Memphis, TN 38163 USA Univ Tennessee, Ctr Hlth Sci, Dept Anesthesiol, Memphis, TN 38163 USA UnivTennessee Memphis TN USA 38163 pt Anesthesiol, Memphis, TN 38163 USA Univ Tennessee, Ctr Hlth Sci, Dept Physiol, Memphis, TN 38163 USA Univ Tennessee Memphis TN USA 38163 , Dept Physiol, Memphis, TN 38163 USA Univ Tennessee, Erlanger Med Ctr, Dept Surg, Chattanooga, TN USA Univ Tennessee Chattanooga TN USA ed Ctr, Dept Surg, Chattanooga, TN USA
Titolo Testata:
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE
fascicolo: 5, volume: 51, anno: 2001,
pagine: 849 - 853
Fonte:
ISI
Lingua:
ENG
Soggetto:
CARBON-DIOXIDE; BLOOD-FLOW;
Keywords:
noninvasive cardiac output monitoring; Fick principle; pulmonary contusion; swine;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
13
Recensione:
Indirizzi per estratti:
Indirizzo: Proctor, KG Univ Miami, Sch Med, Ryder Trauma Ctr, Daughtry Family Dept Surg, 1800 NW 10th Ave,POB 016960,D40, Miami, FL 33136 USA Univ Miami 1800 NW10th Ave,POB 016960,D40 Miami FL USA 33136
Citazione:
R.A. Maxwell et al., "Noninvasive cardiac output by partial CO2 rebreathing after severe chest trauma", J TRAUMA, 51(5), 2001, pp. 849-853

Abstract

Background: In multiple trauma patients, early continuous cardiac output (CCO) monitoring is frequently desired but is difficult to routinely employ in most emergency departments because it requires invasive procedures. Recently, a noninvasive cardiac output (NICO) technique based on the Fick principle and partial CO2 rebreathing has shown promise under a variety of conditions. Since this method has not been tested after lung damage, we evaluated its utility in a clinically relevant model. Methods: Anesthetized, ventilated swine (n = 11, 35-45 kg) received a unilateral blunt trauma via a captive bolt gun followed by a 25% hemorrhage. After 60 min of shock, crystalloid resuscitation was given as needed to maintain heart rate < 100 beats/min and mean arterial pressure > 70 min Hg. Standard CCO by thermodilution (Baxter Vigilance, Irvine, CA) was compared withNICO (Novametrix Medical Systems Inc., Wallingford, CT) for 8 hr. Results: The severity of the injury is reflected by seven deaths (average survival time = 4.25 hr). Trauma increased dead space ventilation (19%), airway resistance (30%), and lactate (3.2 mmol/L), and decreased dynamic compliance (48%) and Pao(2)/FIO2 (54%). In these extreme conditions, the time course and magnitude of change of CCO and NICO were superimposed. Bland-Altman analysis reveal a bias and precision of 0.01 +/- 0.69 liters/min. The linear relationship between individual CCO and NICO values was significant (p< 0.0001) and was described by the equation NICO = (0.74 +/- 0.1)CCO + (0.65 +/- 0.16 liters/min) but the correlation coefficient (r(2) = 0.541) was relatively low. The cause for the low correlation could not be attributed to increased pulmonary shunt, venous desaturation, anemia, hypercapnia, increased dead space ventilation, or hyperlactacidemia. Conclusion: NICO correlated with thermodilution CCO, but underestimated this standard by 26% in extreme laboratory conditions of trauma-induced cardiopulmonary dysfunction; 95% of the NICO values fall within 1.38 liters/min of CCO; and with further improvements, NICO may be useful in multiple trauma patients requiring emergency intubation during initial assessment and workup.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/07/20 alle ore 01:14:33