Clinical monitoring of cardiac output assessed by transoesophageal echocardiography in anaesthetised dogs: a comparison with the thermodilution technique.

BACKGROUND: Cardiac output (CO) is an important haemodynamic parameter to monitor in patients during surgery. However, the majority of the techniques for measuring CO have a limited application in veterinary practice due to their invasive approach and associated complexity and risks. Transoesophageal echocardiography (TEE) is a technique used to monitor cardiac function in human patients during surgical procedures and allows CO to be measured non-invasively. This prospective clinical study aimed to compare the transoesophageal echocardiography using a transgastric view of the left ventricular outflow tract (LVOT) and the thermodilution (TD) technique for the assessment of CO during mean arterial pressure of 65-80 mmHg (normotension) and <65 mmHg (hypotension) in dogs undergoing elective surgery. Eight dogs were pre-medicated with acepromazine (0.05 mg/kg, IM), tramadol (4 mg/kg, IM) and atropine (0.03 mg/kg, IM), followed by anaesthetic induction with propofol (3-5 mg/kg IV) and maintenance with isoflurane associated with a continuous infusion rate of fentanyl (bolus of 3 µg/kg followed by 0.3 µg/kg/min). The CO was measured by TEE (COTEE) and TD (COTD) at the end of expiration during normotension and hypotension (induced by isoflurane). RESULTS: There was a strong positive correlation between COTEE and COTD ​​(r = 0.925; P < 0.0001). The bias between COTD and COTEE was 0.14 ± 0.29 L/min (limits of agreement, -0.44 to 0.72 L/min). The percentage error of CO measured by the two methods was 12.32%. In addition, a strong positive correlation was found between COTEE and COTD during normotension (r = 0.995; P < 0.0001) and hypotension (r = 0.78; P = 0.0223). CONCLUSIONS: The results of this study indicated that the transgastric view of the LVOT by TEE was a minimally invasive alternative to clinically monitoring CO in dogs during anaesthesia. However, during hypotension, the CO obtained by TEE was less reliable, although still acceptable.

Comparison of Transpulmonary Thermodilution and Calibrated Pulse Contour Analysis with Pulmonary Artery Thermodilution Cardiac Output Measurements in Anesthetized Dogs.

BACKGROUND: Transpulmonary thermodilution (TPTDCO ) and calibrated pulse contour analysis (PCACO ) are alternatives to pulmonary artery thermodilution cardiac output (PATDCO ) measurement. HYPOTHESIS: Ten mL of ice-cold thermal indicator (TI10 ) would improve the agreement and trending ability between TPTDCO and PATDCO compared to 5 mL of indicator (TI5 ) (Phase-1). The agreement and TA between PCACO and PATDCO would be poor during changes in systemic vascular resistance (SVR) (Phase-2). ANIMALS: Eight clinically normal dogs (20.8-31.5 kg). METHODS: Prospective, experimental study. Simultaneous TPTDCO and PATDCO (averaged from 3 repetitions) using TI5 and TI10 were obtained during isoflurane anesthesia combined or not with remifentanil or dobutamine (Phase-1). Triplicate PCACO and PATDCO measurements were recorded during phenylephrine-induced vasoconstriction and nitroprusside-induced vasodilation (Phase-2). RESULTS: Mean bias (limits of agreement: LOA) (L/min), percentage bias (PB), and percentage error (PE) were 0.62 (-0.11 to 1.35), 16%, and 19% for TI5 ; and 0.33 (-0.25 to 0.91), 9%, and 16% for TI10 . Mean bias (LOA), PB, and PE were 0.22 (-0.63 to 1.07), 6%, and 23% during phenylephrine; and 2.12 (0.70-3.55), 43%, and 29% during nitroprusside. Mean angular bias (radial LOA) values were 2° (-10° to 14°) and -1° (-9° to 6°) for TI5 and TI10 , respectively (Phase-1), and 38° (5°-71°) (Phase-2). CONCLUSIONS AND CLINICAL IMPORTANCE: Although TI10 slightly improves the agreement and trending ability between TPTDCO and PATDCO in comparison to TI5 , both volumes can be used for TPTDCO in replacement of PATDCO . Vasodilation worsens the agreement between PCACO and PATDCO . Because of PCACO 's poor agreement and trending ability with PATDCO during SVR changes, this method has limited clinical application.

Cardiac index by thermodilution or transthoracic echocardiography in dogs at different hemodynamic states / Índice cardíaco pelos métodos de termodiluição ou ecocardiografia transtorácica em cães sob diferentes situações hemodinâmicas

Proper monitoring of cardiac index (CI) in critically ill patients requires accurate and minimally invasive methods. The aim of this study was to compare the CI values obtained by thermodilution or echocardiography using different methods in dogs in different hemodynamic states. Nine dogs weighing 19.6±1.3kg were anesthetized with isoflurane at 1.4V% (Baseline) and subjected to mechanical ventilation (MV),a hypodynamic state (Hypo) with isoflurane at 3.5V% and hyperdynamic state (hyper) with dobutamine infusion at 5gkg-1min-1. CI analysis was performed by thermodilution (TD) and using the modified Simpson's method, aortic velocity-time integral (A-VTI) method and pulmonary VTI (P-VTI) method. We performed Pearson's correlation and Bland-Altman analysis. The CI values (Lm-2min-1) of the animals in the Baseline, MV, Hypo and Hyper states were 4.3±1, 3.6±0.7, 2.9±0.66 and 6.1±2, for TD; 2.8±0.7, 2.4±0.3, 1.7±0.7 and 4.4±1.2, for Simpson's method; 3.4±0.9, 3.1±0.7, 2.6±3.4, 6.1±1.8 for A-VTI; and 3.6±0.8, 3.6±0.8, 2.7±0.6 and 6.2±1.5, for P-VTI. The CI values using Simpson's method were lower than those obtained by TD in all states, and it was observed a significant correlation in the Hypo (r=0.89) and Hyper (r=0.76) groups. In addition,the percent error in the Hypo group using Simpson's method was 26% relative to TD, which allowed for the identification of the different hemodynamic states. With respect to the other methods and states, there was no agreement or correlation between the methods and TD. We concluded that none of the tested echocardiography methods exhibited acceptable agreement with thermodilution at different hemodynamic states.(AU)

A adequada monitoração do índice cardíaco (IC) em pacientes críticos requer métodos acurados e minimamente invasivos. O objetivo deste estudo foi comparar o IC obtido por termodiluição ou ecocardiografia em cães sob alterações hemodinâmicas. Utilizaram-se nove cães pesando 19,6±1,3kg, os quais foram anestesiados com isofluoranoa1,4V% (Basal) e submetidos à ventilação mecânica (VM) e estados hipodinâmico (Hipo) com isofluoranoa3,5V% e hiperdinâmico (Hiper), com dobutaminaa5µgkg-1min-1. O IC foi obtido por termodiluição (TD) e pelos métodos ecocardiográficos de Simpson modificado, e pela velocidade em tempo integral (VTI) nas valvas aórtica (VTI-A) e pulmonar (VTI-P). Realizou-se a análise de correlação de Pearson e de concordância de Bland-Altman. O IC (Lm-2min-1) nas fases Basal, VM, Hipo e Hiper foi de 4,3±1, 3,6±0,7, 2,9±0,66 e 6,1±2 para TD; 2,8 ±0,7, 2,4±0,3, 1,7±0,7 e 4,4±1,2 para Simpson; 3,4±0,9, 3,1 ±0,7, 2,6±3,4, 6,1±1,8 para VTI-A e 3,6±0,8, 3,6±0,8, 2,7±0,6 e 6,2±1,5 para VTI-P. O método de Simpson foi menor que a TD em todas as fases, mas com correlação significativa nos estados Hipo (r=0,89) e Hiper (r=0,76) e percentagem de erro de 26% no Hipo em relação à TD, identificando os diferentes estados hemodinâmicos. Nos demais, não houve concordância ou correlação com a TD. Conclui-se que nenhum dos métodos testados apresentou concordância aceitável com a termodiluição nos diferentes estados hemodinâmicos.(AU)

Produção científica da Enfermagem sobre promoção de saúde, condição crônica e envelhecimento / Producción científica de Enfermería de promoción de la salud, condición crónica y envejecimiento / Nursing scientific production on health promotion, chronic condition, and aging

RESUMOObjetivo:caracterizar a produção científica dos Programas de Pós-Graduação em Enfermagem do Brasil, sobre promoção da saúde com enfoque nas pessoas idosas em condição crônica, no período de 2006 a 2010.Método:pesquisa integrativa, realizada através da busca de dissertações e teses da base de dados do Centro de Estudos e Pesquisas em Enfermagem da Associação Brasileira de Enfermagem, publicados no período de 2006 a 2010, que focassem a promoção de saúde de idosos em condição crônica.Resultados:emergiram cinco categorias temáticas: "Convívio com a doença"; "Tecnologias de cuidado"; "Potencialidades para o autocuidado" "Dimensão psicoespiritual" e "Família cuidadora".Conclusão:pôde-se identificar a assistência de enfermagem como elemento fundamental para promover a saúde do indivíduo idoso e torná-lo mais independente de cuidados para conviver com suas limitações ou incapacidades, mesmo acometido por doenças crônicas.

RESUMENObjetivo:caracterizar la producción científica de la Postgraduate Nursing Brasil, en la promoción de la salud con especial atención a las personas mayores con enfermedades crónicas en el período 2006-2010.Método:la investigación integral realizada mediante la búsqueda de disertaciones y tesis en la base de datos del Centro de Estudios e Investigación en Enfermería Asociación Brasileña de Enfermería, publicada en el período 2006-2010, que se centrará en la promoción de la salud para las personas mayores con enfermedades crónicas.Resultados:cinco temas emergieron: "La convivencia con la enfermedad", "cuidado Technologies", "potencial para el propio cuidado" "dimensión psico-espiritual" y "cuidador familiar".Conclusión:se pudo identificar el cuidado de enfermería como un elemento clave para promover la salud de las personas mayores y que sea una atención más independiente que vivir con limitaciones o incapacidades, aún afectados por enfermedades crónicas.

ABSTRACTObjective:to characterize the scientific production of Postgraduate Programs Nursing in Brazil on health promotion with a focus on elderly people with chronic conditions in the period from 2006 to 2010.Method:integrative research developed by searching for dissertations and theses in the database of the Center for Nursing Studies and Research of the Brazilian Nursing Association published in the period from 2006 to 2010 and which focused on health promotion for elderly people with chronic conditions.Results:five themes emerged: "Living with the disease"; "Technologies of care", "Potential for self-care" "Psycho-spiritual dimension", and "Family caregiver".Conclusion:it was possible to identify nursing care as a key element to promote the health of elderly people and make them more independent in their care so as to live with their limitations or disabilities, even when affected by chronic diseases.

Comparison between two methods for cardiac output measurement in propofol-anesthetized dogs: thermodilution and Doppler.

OBJECTIVE: To compare cardiac output (CO) measured by Doppler echocardiography and thermodilution techniques in spontaneously breathing dogs during continuous infusion of propofol. To do so, CO was obtained using the thermodilution method (CO(TD)) and Doppler evaluation of pulmonary flow (CO(DP)) and aortic flow (CO(DA)). STUDY DESIGN: Prospective cohort study. ANIMALS: Eight adult dogs weighing 8.3 +/- 2.0 kg. METHODS: Propofol was used for induction (7.5 +/- 1.9 mg kg(-1) IV) followed by a continuous rate infusion at 0.7 mg kg(-1) minute(-1). The animals were positioned in left lateral recumbency on an echocardiography table that allowed for positioning of the transducer at the 3rd and 5th intercostal spaces of the left hemithorax for Doppler evaluation of pulmonary and aortic valves, respectively. CO(DP) and CO(DA) were calculated from pulmonary and aortic velocity spectra, respectively. A pulmonary artery catheter was inserted via the jugular vein and positioned inside the lumen of the pulmonary artery in order to evaluate CO(TD). The first measurement of CO(TD), CO(DP) and CO(DA) was performed 30 minutes after beginning continuous infusion (T0) and then at 15-minute intervals (T15, T30, T45 and T60). Numeric data were submitted to two-way anova for repeated measurements, Pearson's correlation coefficient and Bland & Altman analysis. Data are presented as mean +/- SD. RESULTS: At T0, CO(TD) was lower than CO(DA). CO(DA) was higher than CO(TD) and CO(DP) at T30, T45 and T60. The difference between the CO(TD) and CO(DP), when all data were included, was -0.04 +/- 0.22 L minute(-1) and Pearson's correlation coefficient (r) was 0.86. The difference between the CO(TD) and CO(DA) was -0.87 +/- 0.54 L minute(-1) and r = 0.69. For CO(TD) and CO(DP), the difference was -0.82 +/- 0.59 L minute(-1) and r = 0.61. CONCLUSION: Doppler evaluation of pulmonary flow was a clinically acceptable method for assessing the CO in propofol-anesthetized dogs.