The significance of non invasive cardiac output monitoring system on evaluating circulatory and respiratory function in pig with acute respiratory distress syndrome
10.3760/cma.j.issn.2095-4352.2014.11.007
- VernacularTitle:无创心排血量监测系统对急性呼吸窘迫综合征猪模型呼吸循环功能的评价意义
- Author:
Weishuai BIAN
;
Yangong CHAO
;
Wei CHEN
;
Lan WANG
;
Liming LI
;
Jian GUAN
;
Bo SHENG
;
Jie ZHEN
;
Lei ZHAO
- Publication Type:Journal Article
- Keywords:
Non invasive cardiac output monitoring;
Acute respiratory distress syndrome;
Optimal positive end-expiratory pressure;
Pulse indicated continuous cardiac output
- From:Chinese Critical Care Medicine
2014;(11):799-803
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effect of non invasive cardiac output monitoring(NICO)system in pig model with acute respiratory distress syndrome(ARDS),and to provide experimental basis for clinical application. Methods Eleven anaesthetized and ventilated ARDS male pig models were induced by intravenously infusing 0.2 mL/kg oleic acid. Lung recruitment was condocted by pressure control ventilation on pigs with ARDS. The optimal positive end-expiratory pressure(PEEP)was determined by optimal dead space fraction〔the ratio of dead space to tidal volume(VD/VT)〕. Cardiac output(CO)was determined by NICO,the respiratory function was monitored, and the VD/VT,dynamic compliance(Cdyn),oxygenation index(PaO2/FiO2),the volume of alveolar ventilation(Valv) and arterial blood oxygen saturation(SaO2)were recorded before infusing oleic acid,after stabilization of ARDS model and at optimal PEEP level,and the intrapulmonary shunt fraction(Qs/Qt)was calculated. CO was also determined by application of pulse indicated continuous cardiac output(PiCCO),and the linear regression analysis between CO determined by NICO and CO determined by PiCCO was conducted. Results Seven experimental ARDS pigs model were successfully established. The optimal PEEP identified by the lowest VD/VT method was(15.71±1.80)cmH2O (1 cmH2O=0.098 kPa). Compared with before infusing oleic acid,VD/VT and Qs/Qt after stabilization of ARDS model were significantly increased〔VD/VT:(72.29±8.58)% vs.(56.00±11.06)%,Qs/Qt:(21.04±15.05)%vs.(2.00±1.32)%,both P<0.05〕,and SaO2 and Valv were significantly decreased〔SaO2:0.888±0.108 vs. 0.999±0.053,Valv(mL):92.06±35.22 vs. 146.11±45.43,both P<0.05〕. VD/VT,Qs/Qt,SaO2 and Cdyn at optimal PEEP level were improved to the levels before infusing oleic acid〔(61.07±9.30)%,(3.21±6.10)%, 0.989±0.025,(117.14±41.14)mL〕. Cdyn and PaO2/FiO2 after stabilization of ARDS model were significantly lowered compared with those before infusing oleic acid〔Cdyn (mL/cmH2O):14.43±5.50 vs. 38.14±6.72, PaO2/FiO2 (mmHg, 1 mmHg=0.133 kPa):78.71±23.22 vs. 564.37±158.85, both P<0.05〕. Cdyn and PaO2/FiO2 at optimal PEEP level〔(19.71±4.86)%,(375.49±141.30)mmHg〕were elevated compared with the levels after stabilization of ARDS model(both P<0.05),but still lower than those before infusing oleic acid(both P<0.05). Compared with the levels after stabilization of ARDS model,CO at optimal PEEP level showed obvious decrease from(4.18±2.46)L/min to(3.95±2.69)L/min without significant difference(P>0.05). There was linear correlation between CO determined by NICO and CO determined by PiCCO(r2=0.925,P<0.001). Conclusions NICO technique provides a useful and accurate non invasive estimation of CO and respiratory function.VD/VT provided by NICO can titrate the optimal PEEP in patients with ARDS.
