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Journal of Clinical Monitoring and Computing

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01-08-2017 | Original Research

A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow

Authors: Caroline Hällsjö Sander, Thorir Sigmundsson, Magnus Hallbäck, Fernando Suarez Sipmann, Mats Wallin, Anders Oldner, Håkan Björne

Published in: Journal of Clinical Monitoring and Computing | Issue 4/2017

Abstract

In a previous study a new capnodynamic method for estimation of effective pulmonary blood flow (CO_EPBF) presented a good trending ability but a poor agreement with a reference cardiac output (CO) measurement at high levels of PEEP. In this study we aimed at evaluating the agreement and trending ability of a modified CO_EPBF algorithm that uses expiratory instead of inspiratory holds during CO and ventilatory manipulations. CO_EPBF was evaluated in a porcine model at different PEEP levels, tidal volumes and CO manipulations (N = 8). An ultrasonic flow probe placed around the pulmonary trunk was used for CO measurement. We tested the CO_EPBF algorithm using a modified breathing pattern that introduces cyclic end-expiratory time pauses. The subsequent changes in mean alveolar fraction of carbon dioxide were integrated into a capnodynamic equation and effective pulmonary blood flow, i.e. non-shunted CO, was calculated continuously breath by breath. The overall agreement between CO_EPBF and the reference method during all interventions was good with bias (limits of agreement) 0.05 (−1.1 to 1.2) L/min and percentage error of 36 %. The overall trending ability as assessed by the four-quadrant and the polar plot methodology was high with a concordance rate of 93 and 94 % respectively. The mean polar angle was 0.4 (95 % CI −3.7 to 4.5)°. A ventilatory pattern recurrently introducing end-expiratory pauses maintains a good agreement between CO_EPBF and the reference CO method while preserving its trending ability during CO and ventilatory alterations.

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Title: A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow
Authors: Caroline Hällsjö Sander
Thorir Sigmundsson
Magnus Hallbäck
Fernando Suarez Sipmann
Mats Wallin
Anders Oldner
Håkan Björne
Publication date: 01-08-2017
Publisher: Springer Netherlands
Published in: Journal of Clinical Monitoring and Computing / Issue 4/2017
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-016-9891-z

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A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow

Abstract

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