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Ability of pulse wave transit time to detect changes in stroke volume and to estimate cardiac output compared to thermodilution technique in isoflurane-anaesthetised dogs

Sano, H., Chambers, J.P.
Veterinary anaesthesia and analgesia 2017 v.44 no.5 pp. 1057-1067
adults, blood pressure, cardiac output, catheters, correlation, dogs, electrocardiography, isoflurane, monitoring, phenylephrine, pulmonary artery, vasoconstriction, vasodilation
To evaluate the ability of pulse wave transit time (PWTT) to detect changes in stroke volume (SV) and to estimate cardiac output (CO) compared with the thermodilution technique in isoflurane-anaesthetized dogs.Prospective, experimental study.Eight adult laboratory dogs.The dogs were anaesthetized with isoflurane and mechanically ventilated. Reference CO (TDCO) was measured via a pulmonary artery catheter using the thermodilution technique and reference SV (TDSV) was calculated. PWTT was calculated as the time from the electrocardiogram R-wave peak to the rise point of the pulse oximeter wave. Estimated CO (esCO) was derived from PWTT after calibration with arterial pulse pressure (both non-invasive and invasive methods) and TDCO. Haemodynamic changes were induced by administration of phenylephrine (vasoconstriction), high isoflurane (vasodilatation and negative inotropy) and dobutamine (vasodilatation and positive inotropy). Trending between percentage change in PWTT and TDSV was assessed using concordance analysis and receiver operator characteristic (ROC) curve. The agreement between esCO and TDCO was evaluated using the Bland–Altman method.The direction of percentage change between consecutive PWTT and the corresponding TDSV showed a concordance rate of 95%, with correlation coefficients of −0.86 (p<0.001). Area under the ROC curve for the change in PWTT to detect 15% change in TDSV was 0.91 (p<0.001). TDCO compared with esCO calibrated with invasive and non-invasive blood pressure showed a bias (precision of agreement) of 0.58 (1.54) and 0.57 (1.59) L minute−1 with a percentage error of ±61% and ±63%, respectively.In isoflurane-anaesthetized dogs, PWTT showed a good trending ability to detect 15% changes in SV. This technique is easy to use, inexpensive, non-invasive and could become routine anaesthetic monitoring. However, the agreement between absolute esCO and TDCO was unacceptable.