Abstract
Purpose
Monitoring using transpulmonary thermodilution (TPTD) via a single thermal indicator technique allows measurement of cardiac output, extravascular lung water (EVLW) and volumetric variables.
Methods and results
This report describes two cases of systemic-venous circulation shunt generating early recirculation of thermal indicator with overestimation of EVLW.
Conclusion
In the case of recirculation of thermal indicator, the observed overestimated EVLW in absence of gas exchanges abnormality could be an indicator suggesting the search for a circulatory shunt.
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Abbreviations
- CO:
-
Cardiac output
- CI:
-
Cardiac index
- GEDVI:
-
Global end diastolic volume indexed
- ITBVI:
-
Intrathoracic blood volume indexed
- EVLWI:
-
Extravascular lung water indexed
- ITTV:
-
Intrathoracic thermal volume
- PTV:
-
Pulmonary thermal volume
- MTt:
-
Mean transit time
- DSt:
-
Down slope time
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134_2010_1876_MOESM1_ESM.docx
Contrast-enhanced CT showing the aortic aneurysm and the fistula between the aneurysm and the inferior vena cava. Notably, the aorta and dilated vena cava show simultaneous contrast enhancement (DOCX 59 kb)
Appendix
Appendix
The mathematical formulation derived from haemodynamic parameters of case one (Fig. 1) that supports our explanations is based on the following equation: GEDV = ITTV – PTV = CO (MTt − DSt); MTt – DSt = GEDV/CO. GEDVI before surgery was 685 ml/m2 (ITBVI/1.25 = 857/1.25) and after surgery it was 1,067 ml/m2 (1,334/1.25). Thereafter, the GEDVI (and ITBVI) increased by 56% [(1,067 − 685)/685] after septal closure while CI increased by only 19% [(3.16 − 2.66)/2.66]. Accordingly the (MTt − DSt) value was 16 s (GEDVI/CI) before surgery and 20 s (GEDVI/CI) after septal closure. Thus (MTt − DSt) increased after septal closure (while the absolute total time curve decreased, as observed in Fig. 1). These results demonstrate that DSt decreased more than MTt after shunt correction.
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Giraud, R., Siegenthaler, N., Park, C. et al. Transpulmonary thermodilution curves for detection of shunt. Intensive Care Med 36, 1083–1086 (2010). https://doi.org/10.1007/s00134-010-1876-7
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DOI: https://doi.org/10.1007/s00134-010-1876-7