Abstract
Objective
Transpulmonary ultrasound dilution (TPUD) is a minimally invasive technique to measure
cardiac output (CO) using a 1 mL kg–1 isotonic 37 °C saline injectate indicator. The objective was to evaluate the performance
of TPUD using a room temperature saline injectate.
Study design
Prospective experimental trial.
Animals
A total of seven anesthetized male Yorkshire piglets.
Methods
Piglets aged 1 month and weighing 7.7–9.0 kg were anesthetized with detomidine–ketamine–hydromorphone–isoflurane
and a pulmonary artery flow probe (PAFP) placed via a median sternotomy. The thoracic
cavity remained open during measurement of CO by PAFP and TPUD. The TPUD indicators
of 1 mL kg–1 0.9% saline at 37 °C and 20 °C were compared during infusions of phenylephrine and
dobutamine, blood withdrawal and replacement. Bias, limits of agreement (LoAs) and
percentage error (PE) between each iteration of PAFP and TPUD were measured with Bland–Altman
plots. Trending ability via concordance, angular bias and radial LoA were compared.
Results
Bland–Altman plots showed negligible bias with varying LoAs. PEs of 22% and 38% were
found for 37 °C and 20 °C saline injectates, respectively. In the four-quadrant plots,
the concordance rate was 94% and 100% for measurements obtained with 37 °C and 20
°C saline injectates, respectively. Angular bias for both were < ±5 °, with radial
LoA < ±7 °.
Conclusions
TPUD was accurate when using 1 mL kg–1 of isotonic saline at 37 °C in a range of CO within 0.2–0.8 L minute–1, and it reliably tracked positive and negative changes in CO. Room temperature (20
°C) indicator was less accurate but equally able to track direction of changes in
CO.
Clinical relevance
The use of room temperature injectates allows an easy, readily available clinical
application of TPUD CO monitoring while preserving the trending ability of the monitor.
Keywords
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Article info
Publication history
Published online: November 25, 2022
Accepted:
November 18,
2022
Received in revised form:
November 17,
2022
Received:
January 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
