RESUMEN
BACKGROUND: Estimated continuous cardiac output (esCCOTM) based on pulse wave transit time is one of alternative non-invasive CO measurement techniques. METHODS: Randomized study included 23 scheduled patients operated upon due to cardiovascular diseases. Cardiac index (CI) was measured Comparative analyses of esCCO and others CO measurement methods used intraoperative was carried out. In the first group (n = 9) esCCO was compared with transpulmonary thermodilution (PiCCO-plus); in the second group (n = 8) - with pulmonary artery thermodilution; in the third group (n = 6) - with transoesophageal echocardiography (velocity-time integral). RESULTS: In the 1st group direct correlation was found (r = 0,773, p <0.0001), but overestimation was found in 39% of cases; underestimation in 4%. The 2nd group showed direct correlation (r = 0.586, p <0.0001). The 3d group showed direct relationship (r = 0.68, p = 0.0018), but 66.7% of the measurements were out of reference interval (more than ? 15%). Blend- Altman method showed the dispersion of results in all groups. CONCLUSIONS: 1. Estimated continuous cardiac output measurement technique based on PWTT has a direct correla- tion with prepulmonary thermodilution and transoesophageal echocardiography, medium and high power respectively. 2. esCCO has significant differences with the referential techniques during general anesthesia in cardiac surgery pa- tients. 3. Calibration based on invasive blood pressure and outside cardiac output measurement does not increase the accuracy of measurements. 4. esCCO has a negative diagnostic value and cannot be recommendedfor the cardiac out- put evaluation during cardiac surgery. 5. This method can be useful for analyze general effectiveness of perioperative hemodynamics.
Asunto(s)
Gasto Cardíaco/fisiología , Procedimientos Quirúrgicos Cardíacos , Monitoreo Intraoperatorio/métodos , Análisis de la Onda del Pulso , Anestesia General , Ecocardiografía Transesofágica , Humanos , Monitoreo Fisiológico/métodos , Estudios Prospectivos , Sensibilidad y Especificidad , Termodilución , Factores de TiempoRESUMEN
BACKGROUND: In cardiac surgery, protective lung ventilation and/or preventive brdnchoscopy (PB) are able to decrease lung injury effects of cardiopulmonary bypass (CPB) and mechanical ventilation. OBJECTIVES: define lung complication risks, evaluate the effect ofprotective lung ventilation (PLV) on lung functioning, and investigate the feasibility ofpreventive PB in higher pulmonary risk (PR) patients. MATERIALS AND METHODS: 66 patients participated in prospective randomized research. Allocation was based on PR and intraoperative mechanical ventilation type. PLV includedfollowing parameters: PCK PIP - up to 20 cm H20, Vt - 6 ml/ kg of PBW, PEEP - 5-10 cm H20, IE ratio - 1:1.5-1:1, EtCO2 - 35-42 mm Hg, FiO2 - 45-60%, lung ventilation during CPB, alveolar recruitment. Four groups were formed: A - higher PR plus PLV- B - higher PR plus conventional LV (CLV), C - lower PR plus PLV- D - lower PR plus CLV PIP PEEP dynamic compliance, p/f ratio and intrapulmonary shunt (Qs/Qt) were recorded. Seventeen patients of group A underwent PB. RESULTS: Advanced dynamic compliance, higher p/f ratio and lower Qs/Qt were seen in group A, in comparison with group B (p< 0.05). Lower Qs/Qt was seen in group C, in comparison with group D (p<0.05). Mucus obstruction of subsegmental bronchi was observed in 53.3% of higher PR patients. More than half ofpatients without PB sufferedfrom postoperative lung complications (70.4 vs. 34.2 7%, pAsunto(s)
Procedimientos Quirúrgicos Cardiovasculares
, Lesión Pulmonar/prevención & control
, Respiración Artificial/efectos adversos
, Respiración Artificial/métodos
, Adolescente
, Adulto
, Anciano
, Anestesia General
, Circulación Extracorporea
, Femenino
, Humanos
, Lesión Pulmonar/etiología
, Masculino
, Persona de Mediana Edad
, Complicaciones Posoperatorias
, Estudios Prospectivos
, Adulto Joven