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Application of ultrasound dilution technology for cardiac output measurement: Cerebral and systemic hemodynamic consequences in a juvenile animal model

de Boode, Willem P. MD; van Heijst, Arno F. J. MD, PhD; Hopman, Jeroen C. W. MSc; Tanke, Ronald B. MD, PhD; van der Hoeven, Hans G. MD, PhD; Liem, K. Djien MD, PhD

Pediatric Critical Care Medicine: September 2010 - Volume 11 - Issue 5 - p 616-623
doi: 10.1097/PCC.0b013e3181c517b3
Laboratory Investigations

Objective: Analysis of cerebral and systemic hemodynamic consequences of ultrasound dilution cardiac output measurements.

Design: Prospective, experimental piglet study.

Setting: Animal laboratory.

Subjects: Nine piglets.

Interventions: Ultrasound dilution cardiac output measurements were performed in ventilated, anesthetized piglets. Interventions that are required for ultrasound dilution cardiac output measurement were evaluated for its effect on cerebral and systemic circulation and oxygenation.

Measurements and Main Results: ΔcHbD and ΔctHb, representing changes in cerebral blood flow and cerebral blood volume, respectively, were measured with near infrared spectrophotometry. Pulmonary artery (QMPA) and left carotid artery (QLCA) blood flow were assessed with transit time flow probes. Starting and/or stopping blood flowing through the arteriovenous loop did not cause relevant hemodynamic changes. Fast injection of isotonic saline caused a biphasic change in ΔcHbD and ΔctHb. After injection of 0.5 mL/kg, the mean (sd) increase in ΔcHbD and ΔctHb was 0.175 (0.213) μmol/L and 0.122 (0.148) μmol/L, respectively, with a subsequent mean decrease of −0.191 (0.299) μmol/L and −0.312 (0.266) μmol/L. Injection of 1.0 mL/kg caused a mean increase in ΔcHbD and ΔctHb of 0.237 (0.203) μmol/L and 0.179 (0.162) followed by a mean decrease of −0.334 (0.407) μmol/L and −0.523 (0.335) μmol/L, respectively. QMPA and QLCA changed shortly with a mean increase of 5.9 (3.0) mL/kg/min and 0.23 (0.10) mL/kg/min after injection of 0.5 mL/kg and with 12.0 (4.2) mL/kg/min and 0.44 (0.18) mL/kg/min after injection of 1.0 mL/kg, respectively. The observed changes were more profound after an injection volume of 1.0 mL/kg compared with 0.5 mL/kg for ΔcHbD (p = .06), ΔctHb (p = .09), QMPA, and QLCA (p < .01). No relevant changes in mean arterial blood pressure or heart rate were detected in response to the indicator injection.

Conclusions: Cardiac output measurement by ultrasound dilution does not cause clinically relevant changes in cerebral and systemic circulation and oxygenation in a piglet model.

From the Departments of Neonatology (WPdB, AFJvH, KJL), Pediatrics (JCWH), Pediatric Cardiology (RBT), and Intensive Care Medicine (HGvdH), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

The equipment for ultrasound dilution cardiac output measurement was put at our disposal by Transonic Systems Inc., Ithaca, NY.

The authors have not disclosed any potential conflicts of interest.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies