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Estimation of Stroke Volume and Stroke Volume Changes by Electrical Impedance Tomography

da Silva Ramos, Fernando José MD*; Hovnanian, André MD, PhD*†; Souza, Rogério MD, PhD; Azevedo, Luciano C. P. MD, PhD*; Amato, Marcelo B. P. MD, PhD; Costa, Eduardo L. V. MD, PhD*†

doi: 10.1213/ANE.0000000000002271
Technology, Computing, and Simulation: Original Laboratory Research Report

BACKGROUND: Electrical impedance tomography (EIT) is a noninvasive imaging method that identifies changes in air and blood volume based on thoracic impedance changes. Recently, there has been growing interest in EIT to measure stroke volume (SV). The objectives of this study are as follows: (1) to evaluate the ability of systolic impedance variations (ΔZsys) to track changes in SV in relation to a baseline condition; (2) to assess the relationship of ΔZsys and SV in experimental subjects; and (3) to identify the influence of body dimensions on the relationship between ΔZsys and SV.

METHODS: Twelve Agroceres pigs were instrumented with transpulmonary thermodilution catheter and EIT and were mechanically ventilated in a random order using different settings of tidal volume (VT) and positive end-expiratory pressure (PEEP): VT 10 mL·kg−1 and PEEP 10 cm H2O, VT 10 mL·kg−1 and PEEP 5 cm H2O, VT 6 mL·kg−1 and PEEP 10 cm H2O, and VT 6 mL·kg−1 and PEEP 5 cm H2O. After baseline data collection, subjects were submitted to hemorrhagic shock and successive fluid challenges.

RESULTS: A total of 204 paired measurements of SV and ΔZsys were obtained. The 4-quadrant plot showed acceptable trending ability with a concordance rate of 91.2%. Changes in ΔZsys after fluid challenges presented an area under the curve of 0.83 (95% confidence interval, 0.74–0.92) to evaluate SV changes. Conversely, the linear association between ΔZsys and SV was poor, with R2 from linear mixed model of 0.35. Adding information on body dimensions improved the linear association between ΔZsys and SV up to R2 from linear mixed model of 0.85.

CONCLUSIONS: EIT showed good trending ability and is a promising hemodynamic monitoring tool. Measurements of absolute SV require that body dimensions be taken into account.

Supplemental Digital Content is available in the text.Published ahead of print July 24, 2017.

From the *Department of Intensive Care and Anesthesiology Research Laboratory, Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil; and Respiratory Intensive Care Unit, University of São Paulo School of Medicine, São Paulo, Brazil.

Published ahead of print July 24, 2017.

Accepted for publication May 9, 2017.

Funding: The experimental protocol was supported by Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) and by the Research and Education Institute, Hospital Sírio-Libanês.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Fernando José da Silva Ramos, MD, Research and Education Institute, Hospital Sírio-Libanês, Rua Cel, Nicolau dos Santos, 69, São Paulo 01308, Brazil. Address e-mail to ramosfjs@gmail.com.

© 2018 International Anesthesia Research Society
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