Minimally invasive determination of cardiac output by transthoracic bioimpedance, partial carbon dioxide rebreathing, and transesophageal Doppler echocardiography in beagle dogs

Minimally invasive cardiac output was determined using transthoracic bioimpedance (BICO), partial carbon dioxide rebreathing (NICO) and transesophageal Doppler echocardiography (TEECO) and compared to thermodilution (TDCO) in 6 beagle dogs. The dogs were 2 years old, weigh between 9.1-13.0 kg and were anesthetized with nitrous oxide-oxygen-sevoflurane. All dogs were administered a neuromuscular blocking drug and artificially ventilated during anesthesia. Thirty paired measurements of TDCO and each non-invasive method were collected during low, intermediate, and high values of cardiac output achieved by varying the depth of anesthesia and the administration of dobutamine. Cardiac output values ranged from 1.10-2.50 L/min for BICO compared to 0.81-4.88 L/min for TDCO; 0.70-2.60 L/min for NICO compared to 0.89-4.45 L/min for TDCO; and 0.59-4.37 L/min for TEECO compared to 0.57-4.15 L/min for TDCO. The limits of agreement and percentage error were -0.58 +/- 1.56 L/min and +/- 75.4% for BICO, -1.04 +/- 1.08 L/min and +/- 56.0% for NICO, and 0.03 +/- 0.26 L/min and +/- 12.3% for TEECO compared to TDCO. In conclusion, TEECO provided the best agreement to TDCO in sevoflurane anesthetized beagle dogs.     

A comparison of noninvasive cardiac output measurement by partial carbon dioxide rebreathing with the lithium dilution technique in anesthetized foals

Newer techniques for cardiac output (Q) determinations that are minimally invasive remain to be validated in neonatal foals against other accepted techniques such as the lithium technique (LiDCO). This study compares Q determinations using the partial CO₂ rebreathing technique (NICO) with LiDCO in anesthetized neonatal foals. Ten foals were instrumented for NICO and LiDCO determinations. For each foal low, intermediate and high levels of cardiac output were achieved in that order using an end‐tidal isoflurane (ETI) concentration of 1.3 – 2.1% for the lowest rate; an ETI of 0.85–1.4% and a constant‐rate infusion of dobutamine (1–3 ?g/kg/min) for the intermediate rate; and an ETI of 0.83–1% and dobutamine (2–6 ?g/kg/min) for the highest rate. Four foals also received IV intermittent doses (total cumulative dose of 1.1–1.7 mg) of phenylephrine at the highest rate of Q. The measurements were obtained in duplicate or triplicate for each Q technique after achieving a stable hemodynamic plane for at least 15 minutes at each rate of Q. For the lithium technique, all foals received 1.1–1.9 mL (0.16–0.28 mmol) of lithium. A Bland‐Altman analysis was used to compare the bias and precision of the two techniques. Eighty seven comparisons were determined between the two techniques. Eight were excluded due to more than 20% variation between the LiDCO determinations or technical errors at the time of determination. The correlation coefficient between the two methods was 0.67 for all Q determinations. Mean LiDCO and NICO values from 79 measurements were 130 ± 40 mL^–1 kg minute^–1 (range, 68– 237) and 152 ± 31 mL^–1 kg minute^–1 (89 – 209), respectively. The mean ( mL^–1 kg minute^–1) of the differences of LiDCO – NICO was = –0.7248 + 0.8602 NICO. The precision (1.96 SD) of the differences between LiDCO and NICO was 58.9 mL^–1 kg minute^–1 (–80.9–+36.9) with a mean difference of –22 mL^–1 kg minute^–1 (bias; 95% CI – 15.2 to ‐28.7). In conclusion, given the small bias compared to the limits of agreement, the NICO technique for determining Q deserves further consideration for adoption into clinical practice in neonatal foals.     

Comparison of non-invasive cardiac output measurement by partial carbon dioxide rebreathing with the lithium dilution method in anesthetized dogs

Objective: To compare the partial CO₂ rebreathing method (non‐invasive cardiac output [NICO]) and the lithium dilution method (lithium dilution cardiac output [LiDCO]) for cardiac output (CO) measurement in anesthetized dogs. Design: Prospective study. Setting: College of Veterinary Medicine, University of Florida. Animals: Six adult dogs (weight range 22–25.4 kg). Interventions: All animals were instrumented for CO determinations using the LiDCO and NICO methods. Direct blood pressure, heart rate, arterial blood gases, end‐tidal isoflurane (ETI), and CO₂ concentrations were monitored throughout the study. CO was manipulated with dobutamine and isoflurane to allow for intermediate, low, and high CO determinations in that order using LiDCO and NICO. Measurements and main results: A 1.5% ETI produced the intermediate rate of CO, a constant‐rate infusion of dobutamine (1–4 μg/kg/min) and 1.1% ETI, the highest rate, and 2.5–3% ETI, the lowest rate. Measurements were obtained in duplicate or triplicate for the LiDCO and continuously for the NICO method after achieving a stable hemodynamic plane for at least 15 minutes at each level of CO, allowing 5 minutes between measurements. Forty‐seven comparisons were determined. The correlation coefficient (r) between the 2 methods was 0.888 for all determinations. The mean LiDCO and NICO from 47 measurements were 155.9±78.7 mL/kg/min (range, 49.6–303.2) and 146.6±62.9 mL/kg/min (50–290.3), respectively. The bias between LiDCO and NICO estimations was 9.3 (?60.7 to +79.4) mL/kg/min (mean and 95% confidence interval). The mean (mL/kg/min) of the differences of LiDCO–NICO was 1.11 × NICO. The relative error was 2.4±24.7%. As CO increased, the relative difference between the methods also increased. Conclusions: The NICO is a viable non‐invasive method for CO determination in the dog and compares well with the LiDCO.     

Comparison of noninvasive cardiac output measured by use of partial carbon dioxide rebreathing or the lithium dilution method in anesthetized foals

OBJECTIVE: To compare cardiac output (CO) measured by use of the partial carbon dioxide rebreathing method (NICO) or lithium dilution method (LiDCO) in anesthetized foals. SAMPLE POPULATION: Data reported in 2 other studies for 18 neonatal foals that weighed 32 to 61 kg. PROCEDURES: Foals were anesthetized and instrumented to measure direct blood pressure, heart rate, arterial blood gases, end-tidal isoflurane and carbon dioxide concentrations, and CO. Various COs were achieved by administration of dobutamine, norepinephrine, vasopressin, phenylephrine, and isoflurane to allow comparisons between LiDCO and NICO methods. Measurements were obtained in duplicate or triplicate. We allowed 2 minutes between measurements for LiDCO and 3 minutes for NICO after achieving a stable hemodynamic plane for at least 10 to 15 minutes at each CO. RESULTS: 217 comparisons were made. Correlation (r = 0.77) was good between the 2 methods for all determinations. Mean +/- SD measurements of cardiac index for all comparisons with the LiDCO and NICO methods were 138 +/- 62 mL/kg/min (range, 40 to 381 mL/kg/min) and 154 +/- 55 mL/kg/min (range, 54 to 358 mL/kg/min), respectively. Mean difference (bias) between LiDCO and NICO measurements was -17.3 mL/kg/min with a precision (1.96 x SD) of 114 mL/kg/min (range, -131.3 to 96.7). Mean of the differences of LiDCO and NICO measurements was 4.37 + (0.87 x NICO value). CONCLUSIONS AND CLINICAL RELEVANCE: The NICO method is a viable, noninvasive method for determination of CO in neonatal foals with normal respiratory function. It compares well with the more invasive LiDCO method.     

Measurement of cardiac output by transesophageal Doppler ultrasonography in anesthetized dogs: comparison with thermodilution

Thermodilution (TD) is the standard method for cardiac output (CO) monitoring in human medicine. Although called the ‘gold standard’, TD is related to numerous complications and data misinterpretations. Recently, a noninvasive, continuous, ultrasound‐based technique for CO measurement has been developed (Hemosonic 100, Arrow Intl). This study compared transesophageal Doppler ultrasonography (TED) for measuring CO with TD in anesthetized dogs. In this study, ten dogs were used to simultaneously measure CO by TED and TD. All dogs were pre‐medicated with acepromazine at 0.1 mg kg^?1 IM, induced with thiopental at 10 mg kg^?1 IV, and maintained on isoflurane at end‐tidal concentrations of 1.3%. Baseline and four different levels of CO were used for comparison. Low CO levels were induced by caudal vena cava occlusion. High CO levels were induced by the constant IV infusion of dopamine, dobutamine, or norepinephrine. Each level of CO allowed one comparison between TED and TD. Forty‐nine paired comparisons of CO were determined ranging from 0.73 to 10.9 L minute^?1. Simple linear regression was used to determine the correlation between the two techniques. Correlation coefficient (r²) was 0.53. Bland and Altman statistical method was used for assessing agreement between the two methods. The difference between the TD and TED when all data were included was 0.82 (bias) ± 1.63 L minute^?1 (mean ± SD). At low CO levels (baseline and caudal vena cava occlusion), the correlation coefficient was 0.77, bias was 0.35 ± 0.64 L minute^?1. At high CO levels (dopamine, dobutamine, or norepinephrine), the correlation coefficient was 0.39. It was concluded that TED was not a reliable monitoring method in determining CO when positive inotropes were used. TED might have importance in situations of low CO values; however, further investigation is warranted.     

Cardiac output measurement by partial carbon dioxide rebreathing, 2-dimensional echocardiography, and lithium-dilution method in anesthetized neonatal foals

The objective of this study was to assess 2 noninvasive methods of measuring cardiac output (CO) in neonatal foals by comparing results to that of the lithium-dilution method. Ten neonatal foals were anesthetized and CO was manipulated by varying the depth of anesthesia and infusion of dobutamine. Concurrent CO measurements were obtained by lithium dilution (reference method), partial carbon dioxide (CO2) rebreathing, volumetric echocardiography (cubic, Teichholz, Bullet, area-length, and single and biplane modified Simpson formulas), and transthoracic Doppler echocardiography. Thirty pairs of lithium-dilution/noninvasive CO measurements were taken from the 10 foals. For each method, relative bias was calculated as a percentage of the average CO. Lithium determinations of CO ranged between 3.09 and 1 1.1 L/min (mean +/- SD = 6.39 +/- 2.1 L/min), resulting in cardiac indices ranging between 79.0 and 209 mL/kg/min (mean +/- SD = 131 +/- 35.9 mL/kg/min). Relative bias of Doppler echocardiography significantly increased (P < .05), whereas that of partial CO2 rebreathing significantly decreased (P = .03) with increasing CO. Other methods were not influenced by the level of CO. Among methods not influenced by the level of CO, relative bias of the Bullet method (-4.2 +/- 20.9%; limits of agreement -45.2 to 36.7%) was significantly lower (P < .05) than that of each of the other noninvasive methods evaluated. Volumetric echocardiography using the Bullet method provides an accurate and noninvasive estimate of CO in anesthetized neonatal foals and warrants investigation in critically ill conscious foals.     

Cardiac output measured by lithium dilution, thermodilution, and transesophageal Doppler echocardiography in anesthetized horses

OBJECTIVE: To assess the suitability of lithium dilution as a method for measuring cardiac output in anesthetized horses, compared with thermodilution and transesophageal Doppler echocardiography. ANIMALS: 6 horses (3 Thoroughbreds, 3 crossbreeds). PROCEDURE: Cardiac output was measured in 6 anesthetized horses as lithium dilution cardiac output (LiDCO), thermodilution cardiac output (TDCO), and transesophageal Doppler echocardiographic cardiac output (DopplerCO). For the LiDCO measurements, lithium chloride was administered i.v., and cardiac output was derived from the arterial lithium dilution curve. Sodium nitroprusside, phenylephrine hydrochloride, and dobutamine hydrochloride were used to alter cardiac output. Experiments were divided into 4 periods. During each period, 3 LiDCO measurements, 3 DopplerCO measurements, and 3 sets of 3 TDCO measurements were obtained. RESULTS: 70 comparisons were made between LiDCO, DopplerCO, and triplicate TDCO measurements over a range of 10 to 43 L/min. The mean (+/- SD) of the differences of LiDCO - TDCO was -0.86 +/- 2.80 L/min; LiDCO = -1.90 + 1.05 TDCO (r = 0.94). The mean of the differences of DopplerCO - TDCO was 1.82 +/- 2.67 L/min; DopplerCO = 2.36 + 0.98 TDCO (r = 0.94). The mean of the differences of LiDCO - DopplerCO was -2.68 +/- 3.01 L/min; LiDCO = -2.53 + 0.99 DopplerCO (r = 0.93). CONCLUSIONS AND CLINICAL RELEVANCE: These results indicate that lithium dilution is a suitable method for measuring cardiac output in horses. As well as being accurate, it avoids the need for pulmonary artery catheterization and is quick and safe to use. Monitoring cardiac output during anesthesia in horses may help reduce the high anesthetic mortality in this species.     

Comparison of lithium dilution and thermodilution cardiac output measurements in anaesthetised neonatal foals

Knowledge of cardiac output is expected to help guide the treatment of hypotension associated with critical illness and/or anaesthesia in neonatal foals. However, a practical and safe method of measuring cardiac output has not been described for the foal. Lithum dilution, a new method of cardiac output determination not requiring cardiac catheterisation, has recently been reported in mature horses. We compared this method to thermodilution in isoflurane-anaesthetised foals age 30-42 h and found good agreement between the 2 methods in a range of cardiac outputs 5.4-20.4 l/min. The lithium dilution technique is a practical and reliable method of measuring cardiac output in anaesthetised neonatal foals, and warrants investigation in critically ill conscious foals.     

Comparison of cardiac measurements by multi-detector computed tomography angiography and transthoracic echocardiography in English bulldogs

Introduction

Transthoracic echocardiography (TTE) is the primary tool for the assessment of cardiac structure and function in dogs but is challenging in English bulldogs due to dorsoventral compression of the thorax, obesity, and narrow intercostal spaces. Multi-detector computed tomography angiography (CTA) may overcome the conformational obstacles of cardiac imaging in this breed.

Comparison of Fick and thermodilution cardiac output determinations in standing horses

The Fick and thermodilution (TD) methods are two currently popular techniques for determination of cardiac output (CO) in adult horses. To our knowledge, a comparison of these two techniques has not been reported. Six healthy, resting, fit, adult horses of either sex and weighing 516.5+/-33.2 kg (mean+/-SD) were instrumented to enable measurement of cardiac output. Resting CO was determined by the Fick method and by thermodilution while the horses stood quietly in the stocks. Fick and thermodilution CO measurements were repeated under conditions of increased cardiac output achieved with the use of a dobutamine infusion (5 microg kg(-1) min(-1), IV), and again under conditions of decreased CO induced by administration of xylazine (0.5 mg/kg, IV). Fick and thermodilution cardiac outputs were compared using Bland-Altman analysis for repeated measures. The mean of the differences+/-1.96SD (bias and precision) between the two techniques was 1.88+/-24.17 L/min. Variability between measurements with the two techniques was decreased to 3.41+/-46.78 mL kg(-1) min(-1) when CO was normalized for body size by calculation of cardiac index.     

Electrical velocimetry for noninvasive cardiac output and stroke volume variation measurements in dogs undergoing cardiovascular surgery

Objective

To compare electrical velocimetry (EV) noninvasive measures of cardiac output (CO) and stroke volume variation (SVV) in dogs undergoing cardiovascular surgery with those obtained with the conventional thermodilution technique using a pulmonary artery catheter.

Comparison of arterial pressure waveform analysis with the lithium dilution technique to monitor cardiac output in anesthetized dogs

OBJECTIVE: To assess agreement between arterial pressure waveform-derived cardiac output (PCO) and lithium dilution cardiac output (LiDCO) systems in measurements of various levels of cardiac output (CO) induced by changes in anesthetic depth and administration of inotropic drugs in dogs. ANIMALS: 6 healthy dogs. PROCEDURE: Dogs were anesthetized on 2 occasions separated by at least 5 days. Inotropic drug administration (dopamine or dobutamine) was randomly assigned in a crossover manner. Following initial calibration of PCO measurements with a LiDCO measurement, 4 randomly assigned treatments were administered to vary CO; subsequently, concurrent pairs of PCO and LiDCO measurements were obtained. Treatments included a light plane of anesthesia, deep plane of anesthesia, continuous infusion of an inotropic drug (rate adjusted to achieve a mean arterial pressure of 65 to 80 mm Hg), and continuous infusion of an inotropic drug (7 microg/kg/min). RESULTS: Significant differences in PCO and LiDCO measurements were found during deep planes of anesthesia and with dopamine infusions but not during the light plane of anesthesia or with dobutamine infusions. The PCO system provided higher CO measurements than the LiDCO system during deep planes of anesthesia but lower CO measurements during dopamine infusions. CONCLUSIONS AND CLINICAL RELEVANCE: The PCO system tracked changes in CO in a similar direction as the LiDCO system. The PCO system provided better agreement with LiDCO measurements over time when hemodynamic conditions were similar to those during initial calibration. Recalibration of the PCO system is recommended when hemodynamic conditions or pressure waveforms are altered appreciably.     

RESEARCH PAPER: Comparison between two methods for cardiac output measurement in propofol‐anesthetized dogs: thermodilution and Doppler

ObjectiveTo compare cardiac output (CO) measured by Doppler echocardiography and thermodilution techniques in spontaneously breathing dogs during continuous infusion of propofol. To do so, CO was obtained using the thermodilution method (CO_TD) and Doppler evaluation of pulmonary flow (CO_DP) and aortic flow (CO_DA).Study designProspective cohort study.AnimalsEight adult dogs weighing 8.3 ± 2.0 kg.MethodsPropofol was used for induction (7.5 ± 1.9 mg kg^?1 IV) followed by a continuous rate infusion at 0.7 mg kg^?1 minute^?1. The animals were positioned in left lateral recumbency on an echocardiography table that allowed for positioning of the transducer at the 3rd and 5th intercostal spaces of the left hemithorax for Doppler evaluation of pulmonary and aortic valves, respectively. CO_DP and CO_DA were calculated from pulmonary and aortic velocity spectra, respectively. A pulmonary artery catheter was inserted via the jugular vein and positioned inside the lumen of the pulmonary artery in order to evaluate CO_TD. The first measurement of CO_TD, CO_DP and CO_DA was performed 30 minutes after beginning continuous infusion (T0) and then at 15‐minute intervals (T15, T30, T45 and T60). Numeric data were submitted to two‐way anova for repeated measurements, Pearson’s correlation coefficient and Bland &; Altman analysis. Data are presented as mean ± SD.ResultsAt T0, CO_TD was lower than CO_DA. CO_DA was higher than CO_TD and CO_DP at T30, T45 and T60. The difference between the CO_TD and CO_DP, when all data were included, was ?0.04 ± 0.22 L minute^?1 and Pearson’s correlation coefficient (r) was 0.86. The difference between the CO_TD and CO_DA was ?0.87 ± 0.54 L minute^?1 and r = 0.69. For CO_TD and CO_DP, the difference was ?0.82 ± 0.59 L minute^?1 and r = 0.61.ConclusionDoppler evaluation of pulmonary flow was a clinically acceptable method for assessing the CO in propofol‐anesthetized dogs.     

Mitral valve morphology assessed by three-dimensional transthoracic echocardiography in healthy dogs and dogs with myxomatous mitral valve disease

Objective

To assess differences in morphology of the mitral valve (MV) between healthy dogs and dogs affected by myxomatous mitral valve disease (MMVD) using real-time transthoracic three-dimensional echocardiography (RT3DE).

Ability of pulse wave transit time to detect changes in stroke volume and to estimate cardiac output compared to thermodilution technique in isoflurane-anaesthetised dogs

Objective

To evaluate the ability of pulse wave transit time (PWTT) to detect changes in stroke volume (SV) and to estimate cardiac output (CO) compared with the thermodilution technique in isoflurane-anaesthetized dogs.

Evaluation of hemodynamic measurements, including lithium dilution cardiac output, in anesthetized dogs undergoing ovariohysterectomy

OBJECTIVE: To measure cardiac output in healthy female anesthetized dogs by use of lithium dilution cardiac output and determine whether changes in mean arterial pressure were caused by changes in cardiac output or systemic vascular resistance. DESIGN: Prospective clinical study. ANIMALS: 20 healthy female dogs. PROCEDURE: Dogs were anesthetized for ovariohysterectomy. Ten dogs breathed spontaneously throughout anesthesia, and 10 dogs received intermittent positive-pressure ventilation. Cardiovascular and respiratory measurements, including lithium dilution cardiac output, were performed during anesthesia and surgery. RESULTS: Mean arterial pressure and systemic vascular resistance index were low after induction of anesthesia and just prior to surgery and increased significantly after surgery began. Cardiac index (cardiac output indexed to body surface area) did not change significantly throughout anesthesia and surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results provide baseline data for cardiac output and cardiac index measurements during clinical anesthesia and surgery in dogs. Changes in mean arterial pressure do not necessarily reflect corresponding changes in cardiac index.