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.     

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.     

Comparison of noninvasive cardiac output measurements by transthoracic bioimpedance, partial carbon dioxide rebreathing, and transesophageal echocardiography with the thermodilution technique in beagle dogs

Most methods for determining cardiac output (CO) have limited application in clinical practice due to the invasive techniques required. This study compared the thermodilution technique (TDCO) with three noninvasive methods for determining CO in anesthetized dogs: transthoracic bioimpedance (BICO), partial CO₂ rebreathing (NICO), and transesophageal echocardiography (TEECO). TDCO was compared to BICO, NICO, and TEECO in six adult sevoflurane anesthetized beagle dogs (9.1–13.0 kg). All dogs were administered midazolam [0.3 mg kg^?1, intravenously (IV)] and butorphanol (0.1 mg kg^?1 IV), followed by ketamine (5.0 mg kg^–1 IV) and sevoflurane in nitrous oxide (1 L minute^–1) and oxygen (1 L minute^–1) and mechanically ventilated. Dogs were maintained at 2.2% end‐tidal sevoflurane (ETsev) concentration for instrumentation and baseline measurements. Low (5.0% ETsev), intermediate (3.3% ETsev), and high cardiac output values were achieved by varying the end‐tidal sevoflurane concentration and the administration of dobutamine (3–10 g kg^–1 minute^–1 and 2.2% ETsev). A minimum of thirty data sets was obtained for each comparison. The correlation coefficients when compared to TDCO were 0.684 for BICO (p < 0.0001), 0.883 for NICO (p < 0.0001), and 0.991 for TEECO (p < 0.0001). Cardiac output values ranged 50–444 mL kg^–1 minute^–1 for TDCO, 100–253 mL kg^–1 minute^–1 for BICO, 64–214 mL kg^–1 minute^–1 for NICO, and 52–401 mL kg^–1 minute^–1 for TEECO. The differences when compared to TDCO ranged – 62–235 mL kg^?1minute^?1 for BICO, 18–220 mL kg^?1 minute^?1 for NICO, and – 35–32 mL kg^–1 minute^–1 for TEECO. Differences were maximum at the highest CO in BICO and NICO. In conclusion, this study demonstrated that BICO and NICO underestimate CO in sevoflurane anesthetized dogs. TEECO is a viable noninvasive method for determining CO in sevoflurane anesthetized dogs.     

Evaluation of transpulmonary thermodilution as a method to measure cardiac output in anesthetized cats

The objectives of this study were to evaluate the use of a transpulmonary thermodilution (Trans) technique for the measurement of cardiac output, and to determine the agreement between Trans and conventional thermodilution (TD) in anesthetized cats.     

Lack of agreement between thermodilution and echocardiographic determination of cardiac output during normovolemia and acute hemorrhage in clinically healthy, anesthetized dogs

Objective and hypothesis: To determine whether or not there is agreement between the thermodilution and echocardiographic measurement of cardiac output (CO) during normovolemia and acute hemorrhage. The hypothesis was that there will be agreement between echocardiographic measurement of CO (ECO) and thermodilution measurement of CO (TDCO) during normovolemia and acute hemorrhage. Design: CO was measured by both thermodilution and echocardiography during α‐chloralose anesthesia in dogs before and 15 and 30 minutes following acute arterial hemorrhage. Setting: Laboratory investigation. Animals: Eighteen clinically healthy dogs, weighing 20–25 kg, anesthetized with α‐chloralose. Interventions: Acute arterial hemorrhage of approximately 50% of the total blood volume. CO was measured by thermodilution and echocardiography before and 15 and 30 minutes following hemorrhage. Measurements and main results: Acute hemorrhage resulted in a significant decrease in CO. There was a lack of agreement between the 2 methods to measure CO at each time and at all anatomic points of measurement in the aorta and pulmonary artery. Conclusion: There is a lack of agreement between the 2 methods; thus, determination of CO by echocardiography may not be a clinically useful tool following hemorrhage in dogs.     

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.     

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 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.     

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.     

Evaluation of intracranial pressure by transcranial Doppler ultrasonography in dogs with intracranial hypertension

Transcranial Doppler ultrasonography (TCD) has been used to confirm changes in cerebral hemodynamics. In this study, we investigated whether the parameters for the basilar artery measured by TCD were correlated with the intracranial and cerebral perfusion pressures in extreme intracranial hypertension. An intracranial hypertension model was produced in seven dogs by inflating a balloon inserted into the epidural space. The resistance index was compared with the corresponding intracranial pressure and cerebral perfusion pressure values during intracranial hypertension. A significant correlation was recognized between the resistance index and cerebral perfusion pressure. Therefore, measurement of the basilar artery by TCD in the dog with intracranial hypertension is useful in estimating the intracranial circulation in cases where the measurement of intracranial pressure is not available or not indicated.     

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.     

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.     

Spectral waveform analysis of major arteries in conscious dogs by Doppler ultrasonography

Normal values of arterial blood flow velocity and waveforms in major arteries of 10 healthy conscious Beagle dogs were determined using Doppler ultrasonography. Peak systolic, early diastolic, and end-diastolic velocities of the basilar artery, common carotid artery, abdominal aorta, external iliac artery, femoral artery, and peak ejection velocity of the valvular aorta were evaluated. Pulsatility index (PI) of the basilar artery and blood pressure were recorded. All arteries had a high-resistance flow pattern with triphasic flow velocity except the basilar artery, which had a low-resistance pattern. Mean peak systolic velocities of the basilar artery, common carotid artery, abdominal aorta, external iliac artery, and femoral artery were 72 +/- 19, 115 +/- 17, 121 +/- 24, 105 +/- 25, and 110 +/- 17 cm/s, respectively. The PI of the basilar artery and peak ejection velocity of the valvular aorta were 1.37 +/- 0.13 and 96 +/- 16 cm/s, respectively. Mean systolic and diastolic blood pressures were 137 +/- 13 and 78 +/- 15 mmHg, respectively. Present findings may be used as references in future studies on vascular diseases and hemodynamics in dogs.     

Evaluation of transesophageal echo-Doppler ultrasonography for the measurement of aortic blood flow in anesthetized cats

OBJECTIVE: To evaluate the use of a transesophageal echo-Doppler ultrasonography (TED) technique for measurement of aortic blood flow (ABF) in relation to cardiac output (CO) measured by use of a thermodilution technique in anesthetized cats. ANIMALS: 6 adult cats (mean +/- SD body weight, 5 +/- 0.7 kg). PROCEDURES: Anesthesia was induced and maintained in cats by administration of isoflurane. A thermodilution catheter was placed in a pulmonary artery. The TED probe was positioned in the esophagus in the region where the aorta and esophagus are almost parallel. Five baseline values for ABF and CO were concurrently recorded. Cats were randomly assigned to a high or low CO state (increase or decrease in CO by at least 25% from baseline, respectively). Baseline conditions were restored, and the other CO state was induced, after which baseline conditions were again restored. For each CO state, ABF and CO were measured 5 times at 5-minute intervals. Correlation and agreement between the techniques were determined by use of the Pearson product-moment correlation and Bland-Altman method. RESULTS: CO ranged from 0.16 to 0.75 L/min and ABF from 0.05 to 0.48 L/min. Overall data analysis revealed a high correlation (r = 0.884) between techniques but poor agreement (limits of agreement, -0.277 to 0.028 L/min). During the low CO state, correlation between techniques was low (r = 0.413). CONCLUSIONS AND CLINICAL RELEVANCE: TED did not accurately measure CO. However, it allowed evaluation of CO patterns and may be useful clinically in anesthetized cats.