Cardiac output can be measured with the transpulmonary thermodilution method in a pediatric model with a left-to-right shunt

Abstract

Background The transpulmonary thermodilution (TPTD) technique for measuring cardiac output (CO) has never been validated in the presence of a left-to-right shunt. Methods In this experimental, paediatric animal model, nine lambs with a surgically constructed aorta-pulmonary left-to-right shunt were studied under various haemodynamic conditions. CO was measured with closed and open shunt using the TPTD technique (COTPTD) with central venous injections of ice-cold saline. An ultrasound transit time perivascular flow probe around the main pulmonary artery served as the standard reference measurement (COMPA). Results Seven lambs were eligible for further analysis. Mean (SD) weight was 6.6 (1.6) kg. The mean COMPA was 1.21 litre min–1 (range 0.61–2.06 l min–1) with closed shunt and 0.93 litre min−1 (range 0.48–1.45 litre min−1) with open shunt. The open shunt resulted in a mean Qp/Qs ratio of 1.8 (range 1.6–2.4). The bias between the two CO methods was 0.17 litre min−1 [limits of agreement (LOA) of 0.27 litre min−1] with closed shunt and 0.14 litre min–1 (LOA of 0.32 litre min−1) with open shunt. The percentage errors were 22% with closed shunt and 34% with open shunt. The correlation (r) between the two methods was 0.93 (P Conclusions The TPTD technique is a feasible method of measuring CO in paediatric animals with a left-to-right shunt.