Thermodilution and esophageal Doppler ultrasound in the assessment of blood flow changes induced by endotoxin and dobutamine

Taniguchi, Yoshie; Bracht, Hendrik; Porta, Francesca; Krejci, Vladimir; Ali, Sayed Z; Beck, Mario; Mettler, Daniel; Takala, Jukka; Jakob, Stephan M (2008). Thermodilution and esophageal Doppler ultrasound in the assessment of blood flow changes induced by endotoxin and dobutamine. Journal of trauma - injury, infection, and critical care, 65(1), pp. 175-82. Baltimore, Md.: Lippincott, Williams, & Wilkins 10.1097/TA.0b013e31815eb0ff

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BACKGROUND: Intermittent (IT) and continuous (CT) thermodilution and esophageal Doppler (ED), are all used for hemodynamic monitoring. The aim of this study was to test the agreement between these methods during endotoxin (ET) and dobutamine infusion. METHODS: Twenty-two pigs (39 +/- 1.8 kg body weight) were randomized to general anesthesia and either continuous ET (n = 9) or placebo (PL, n = 13) infusion. After 18 hours of ET or PL infusion, the animals were further randomized to receive dobutamine (n = 3 in ET, n = 5 in PL) or PL. A set of measurements using the three methods were obtained every hour, and the relative blood flow changes between two subsequent measurements were calculated. RESULTS: Bias or limits of agreement for flows were 0.73 L/min or 1.80 L/min for IT and CT, -0.33 L/min or 4.29 L/min for IT and ED, and -1.06 or 3.94 for CT and ED (n = 515, each). For flow changes they were 1% or 44%, 2% or 59%, and 3% or 45%, respectively. Bias and limits of agreement did not differ in ET- and PL-treated animals or in animals with or without dobutamine. Despite significant correlation between any two methods, the respective correlation coefficients (r) were small (IT vs. CT: 0.452; IT vs. ED: 0.042; CT vs. ED: 0.069; all p < 0.001). The same directional changes were measured by any two methods in 49%, 40%, and 50%. When IT flows >5 L/min were compared with IT flows </=5 L/min, the latter had 49% (p < 0.001), 23% (p < 0.001), and 24% smaller limits of agreement than the former (p = 0.012). CONCLUSION: IT and CT cardiac output agree only to a moderate level, and agreement between the respective relative blood flow changes is even worse. ED has poor agreement with both thermodilution methods, especially when cardiac output is >5 L/min.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care 04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
UniBE Contributor:	Bracht, Hendrik, Porta, Francesca Margherita, Krejci, Vladimir, Ali, Syed Z., Beck, Mario, Takala, Jukka, Jakob, Stephan
ISSN:	0022-5282
ISBN:	18580513
Publisher:	Lippincott, Williams, & Wilkins
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	04 Oct 2013 15:01
Last Modified:	05 Dec 2022 14:19
Publisher DOI:	10.1097/TA.0b013e31815eb0ff
PubMed ID:	18580513
Web of Science ID:	000257767300029
URI:	https://boris.unibe.ch/id/eprint/26658 (FactScience: 81071)