Noninvasive cardiac output by partial CO2 rebreathing after severe chest trauma

R. A. Maxwell, J. B. Gibson, J. B. Slade, T. C. Fabian, Kenneth G Proctor

Research output: Contribution to journalArticle

36 Citations (Scopus)

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 mm Hg. Standard CCO by thermodilution (Baxter Vigilance, Irvine, CA) was compared with NICO (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 PaO2/F1O2 (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 (r2 = 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.

Original languageEnglish
Pages (from-to)849-853
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume51
Issue number5
StatePublished - Dec 17 2001

Fingerprint

Cardiac Output
Thorax
Wounds and Injuries
Thermodilution
Multiple Trauma
Ventilation
Lung
Airway Resistance
Hypercapnia
Firearms
Intubation
Resuscitation
Compliance
Hospital Emergency Service
Anemia
Shock
Lactic Acid
Emergencies
Swine
Heart Rate

Keywords

  • Fick principle
  • Noninvasive cardiac output monitoring
  • Pulmonary contusion
  • Swine

ASJC Scopus subject areas

  • Surgery

Cite this

Noninvasive cardiac output by partial CO2 rebreathing after severe chest trauma. / Maxwell, R. A.; Gibson, J. B.; Slade, J. B.; Fabian, T. C.; Proctor, Kenneth G.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 51, No. 5, 17.12.2001, p. 849-853.

Research output: Contribution to journalArticle

Maxwell, R. A. ; Gibson, J. B. ; Slade, J. B. ; Fabian, T. C. ; Proctor, Kenneth G. / Noninvasive cardiac output by partial CO2 rebreathing after severe chest trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 2001 ; Vol. 51, No. 5. pp. 849-853.
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N2 - 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 mm Hg. Standard CCO by thermodilution (Baxter Vigilance, Irvine, CA) was compared with NICO (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 PaO2/F1O2 (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 (r2 = 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.

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