Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractili...Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter(PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.展开更多
Background Echocardiography is regarded as a gold standard for measuring hemodynamic values. The ultrasonic cardiac output monitor （USCOM） is a new method for measuring hemodynamics and could provide non-invasive po...Background Echocardiography is regarded as a gold standard for measuring hemodynamic values. The ultrasonic cardiac output monitor （USCOM） is a new method for measuring hemodynamics and could provide non-invasive point of care guidance. So far, there are no published USCOM reference values for neonates, nor has USCOM＇s accuracy been established in this population. We aimed to determine the accuracy and clinical utility of the USCOM in healthy neonates relative to published echocardiographic data, to establish normal hemodynamic parameters that it measures, and to assess the possible role of USCOM as an alternative to echocardiography as a trend monitor. Methods Right and left heart hemodynamics of 90 normal neonates were measured during circulatory adaptation over the first three days of life using the USCOM and automated oscillotonometry. Results Heart rate showed a significant decline from days one to three, from 126 to 120 （P〈0.001）. Systolic, diastolic and mean arterial pressures all increased significantly from 66 to 71 mmHg, 33 to 38 mmHg and 44 to 49 mmHg, respectively （P 〈0.001 in each case）. Right ventricular cardiac index （RV-CI） showed no change with a mean of 5.07 L.minl.m2. Left ventricular cardiac index （LV-CI） declined from 3.43 to 3.00 L.minl.m2 （P 〈0.001）. RV-CI exceeded LV-CI on all three days by a mean of 61%. The systemic vascular resistance index （SVRI）, based on LV-CI, increased significantly over the three days from 1083 to 1403 dyne.sec.cm5.m2 （P 〈0.001）. Conclusions Normal neonatal hemodynamic values, as indicated by USCOM, were established. LV-CI measurement showed excellent agreement with published echocardiographic studies. RV-CI was constant and exceeded LV-CI for all three days of this study. It may be falsely high due to flow velocity measurement errors arising from the pulmonary branch arteries, and may represent a limitation of the USCOM method. The progressive rise of arterial pressure and SVRI despite a declining LV-CI may indicate functional closure of the ductus arteriosus, with the greatest change occurring within the first 24 hours. Evidence of closure of the foramen ovale was not observed.展开更多
文摘Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter(PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.
文摘Background Echocardiography is regarded as a gold standard for measuring hemodynamic values. The ultrasonic cardiac output monitor （USCOM） is a new method for measuring hemodynamics and could provide non-invasive point of care guidance. So far, there are no published USCOM reference values for neonates, nor has USCOM＇s accuracy been established in this population. We aimed to determine the accuracy and clinical utility of the USCOM in healthy neonates relative to published echocardiographic data, to establish normal hemodynamic parameters that it measures, and to assess the possible role of USCOM as an alternative to echocardiography as a trend monitor. Methods Right and left heart hemodynamics of 90 normal neonates were measured during circulatory adaptation over the first three days of life using the USCOM and automated oscillotonometry. Results Heart rate showed a significant decline from days one to three, from 126 to 120 （P〈0.001）. Systolic, diastolic and mean arterial pressures all increased significantly from 66 to 71 mmHg, 33 to 38 mmHg and 44 to 49 mmHg, respectively （P 〈0.001 in each case）. Right ventricular cardiac index （RV-CI） showed no change with a mean of 5.07 L.minl.m2. Left ventricular cardiac index （LV-CI） declined from 3.43 to 3.00 L.minl.m2 （P 〈0.001）. RV-CI exceeded LV-CI on all three days by a mean of 61%. The systemic vascular resistance index （SVRI）, based on LV-CI, increased significantly over the three days from 1083 to 1403 dyne.sec.cm5.m2 （P 〈0.001）. Conclusions Normal neonatal hemodynamic values, as indicated by USCOM, were established. LV-CI measurement showed excellent agreement with published echocardiographic studies. RV-CI was constant and exceeded LV-CI for all three days of this study. It may be falsely high due to flow velocity measurement errors arising from the pulmonary branch arteries, and may represent a limitation of the USCOM method. The progressive rise of arterial pressure and SVRI despite a declining LV-CI may indicate functional closure of the ductus arteriosus, with the greatest change occurring within the first 24 hours. Evidence of closure of the foramen ovale was not observed.
