Comparison of pulmonary artery and transpulmonary thermodilution cardiac output measurements in unsedated newborn calves. (16th February 2015)

• Record Type: Journal Article
• Authors: Kutter, Annette PN; Jud Schefer, Rahel S; Bircher, Barbara; Bleul, Uli; Bettschart‐Wolfensberger, Regula
• Is Part Of: Veterinary anaesthesia and analgesia. Volume 42:Number 6(2015:Nov.)
• Page Start: 614
• Page End: 622
• Publication Date: 2015-02-16
• Subjects: Veterinary anesthesia -- Periodicals; 636.089
• DOI: 10.1111/vaa.12243
• Languages: English
• ISSNs: 1467-2987

Abstract

<abstract abstract-type="main" id="vaa12243-abs-0001"> <title>Abstract</title> <sec id="vaa12243-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare the agreement, repeatability and trending ability of transpulmonary thermodilution (TPTD) and pulmonary artery thermodilution (PATD) cardiac output (<inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pgkv9b71cd" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:14672987:media:vaa12243:vaa12243-math-0001" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover accent="true"><mml:mi mathvariant="normal">Q</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:mi>t</mml:mi></mml:mrow></mml:math></alternatives></inline-formula>) measurements in unsedated newborn calves.</p> </sec> <sec id="vaa12243-sec-0002" sec-type="section"> <title>Study design</title> <p>Prospective experimental trial.</p> </sec> <sec id="vaa12243-sec-0003" sec-type="section"> <title>Animals</title> <p>Eight newborn calves weighing a median (range) of 53 (46–59) kg.</p> </sec> <sec id="vaa12243-sec-0004" sec-type="section"> <title>Methods</title> <p>Pulmonary and femoral artery thermodilution catheters were placed under local anaesthesia. A total of 382 PATD and TPTD <inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pgkv9b71dx" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:14672987:media:vaa12243:vaa12243-math-0002" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover accent="true"><mml:mi mathvariant="normal">Q</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:mi>t</mml:mi></mml:mrow></mml:math></alternatives></inline-formula> measurements were performed simultaneously. Cardiac output was influenced by intravenous doxapram and theophylline in a randomized crossover fashion. Bland–Altman analysis for multiple comparisons, concordance and polar plots were used to assess TPTD against PATD.</p> </sec> <sec id="vaa12243-sec-0005" sec-type="section"> <title>Results</title> <p>Median (range) cardiac index values measured with PATD and TPTD were 197 mL kg<sup>−1</sup> minute<sup>−1</sup> (74–335 mL kg<sup>−1</sup> minute<sup>−1</sup>) and 196 mL kg<sup>−1</sup> minute<sup>−1</sup> (59–395 mL kg<sup>−1</sup> minute<sup>−1</sup>), respec‐tively. A small mean bias of −3 mL kg<sup>−1</sup> minute<sup>−1</sup> with limits of agreement (LOA) of −64 to 58 mL kg<sup>−1</sup> minute<sup>−1</sup> and a percentage error of 31% were found. Eighty‐two mean values were calculated. This reduced the LOA to −50 to 41 mL kg<sup>−1</sup> minute<sup>−1</sup> with a similar small bias and a percentage error of 23%. Mean TPTD tracked changes in <inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pgkv9b71j0" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:14672987:media:vaa12243:vaa12243-math-0003" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover accent="true"><mml:mi mathvariant="normal">Q</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:mi>t</mml:mi></mml:mrow></mml:math></alternatives></inline-formula> compared with mean PATD with 90% concordance, a mean polar angle of 6° and radial LOA of 43°, indicating marginal trending ability. Keeping the femoral artery catheter patent and obtaining acceptable measurements were very challenging because the calves were not used to being restrained. Calf movement had less influence on PATD.</p> </sec> <sec id="vaa12243-sec-0006" sec-type="section"> <title>Conclusions and clinical relevance</title> <p>We recommend that PATD remains the reference method to measure <inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pgkv9b71kh" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:14672987:media:vaa12243:vaa12243-math-0004" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover accent="true"><mml:mi mathvariant="normal">Q</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:mi>t</mml:mi></mml:mrow></mml:math></alternatives></inline-formula> in unsedated newborn calves. However, the robust results of the evaluation of the less invasive TPTD technique warrants further evaluation taking into account the difficulties reported in this study.</p> </sec> </abstract>