Wide Range Of Hemodynamic Conditions Research Articles

Comparison of Central-Venous to Mixed-Venous Oxygen Saturation During Changes in Oxygen Supply/Demand

Because central venous O2 saturation (superior vena cava, ScvO2) can be monitored with less patient risk than mixed venous O2 saturation (pulmonary artery, SvO2), we examined the correlations between SvO2 and ScvO2 over a broad range of cardiorespiratory conditions, including hypoxia, hemorrhage, and resuscitation in anesthetized dogs. The correlation coefficient (r) between SvO2 and ScvO2 in 179 simultaneously drawn blood samples from 22 dogs was 0.97. In another nine dogs, the two sites were continuously and simultaneously monitored with fiberoptic catheters; r was 0.96 with a mean difference of 3.7 +/- 2.9 percent (SD) saturation. In each dog the changes in ScvO2 closely paralleled the changes in SvO2. Although absolute values of ScvO2 are not sufficiently identical to SvO2 to calculate O2 uptake or pulmonary shunt precisely, close tracking of changes in the two sites across a wide range of hemodynamic conditions warrant further consideration of ScvO2 for patient monitoring of trends in O2 supply/demand.

Measurement of Stroke Volume with Three-dimensional Transesophageal Ultrasonic Scanning

The accuracy of measuring cardiac stroke volume with a new transesophageal phased array ultrasonic probe was investigated in 10 dogs. The method involved scanning the heart to obtain serial images covering the entire left ventricular cavity at end-expiration. An off-line computer analysis of the images was used to form three-dimensional reconstructions of the left ventricular cavity at end-diastole and end-systole, from which stroke volume was determined. Comparison with stroke volume determined by thermodilution during a wide range of hemodynamic conditions gave the following results for least-squares regression on 57 determinations (with the 95% confidence limits in parentheses): slope 0.95 (0.842-1.06), ordinate intercept 2.1 (2.0-2.2) ml, standard error of the estimate 4.1 ml, and correlation coefficient of 0.92 (0.87-0.95). Histologic examination of sections of esophagus surrounding the tip of the probe in nine dogs demonstrated minimal trauma to the esophageal wall, with eight specimens described as normal and one showing mild inflammation. The authors conclude that three-dimensional reconstruction of the left ventricular cavity from multiple transesophageal images offers a safe and accurate, although presently tedious, method for determining stroke volume.

Area of the aortic pressure-flow loop measures energy storage by the proximal arteries.

We show that power measured by the area of the pressure-flow loop (APQ) is directly proportional to reactive power [Im(W)], which measures pulsatile energy storage in the proximal arteries. Analytically, Im(W) differs from APQ by K.2 pi, where K is a postulated constant of proportionality. To determine the value of K, 338 heartbeats obtained from 8 dogs under a wide range of hemodynamic conditions were analyzed. The relationship between APQ and Im(W) remained highly linear (r = 0.98), and the pooled value of K was -1.19 +/- 0.01. For the individual dogs, values of K differed at most by +/- 9% from its average value. There was also a small offset in the relationship between APQ and Im(W), probably caused by truncating the calculation of Im(W) at the 10th harmonic. Ignoring the small differences in the values of K and the offset, we found that APQ still proved to be an excellent predictor of Im(W). We also found that APQ was sensitive to changes in heart rate, left ventricular stroke output, and peripheral resistance. This reflects the dependence of pulsatile energy storage on these variables and indicates that APQ cannot serve as an index for changes in just the reactive properties of the proximal arteries.