2003, Number 3
Rev Mex Anest 2003; 26 (3)
Monitoreo Hemodinámico Transanestésico: Evaluación del Flujo Sanguíneo Aórtico por Ultrasonido Eco Modo-M/Doppler Transesofágico vs Catéter de Flotación en la Arteria Pulmonar
Olivares GRJ, Molina FJ, Pastor Luna OP, Espinosa RER, Sánchez VLD, Hurtado RC , Bermudez OG, Alba VKL
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ABSTRACTIntroduction: A critical and/or high risk surgical patient requires more extensive transoperative hemodynamic monitory. Monitoring these patients with a pulmonary catheter is considered standard, however this invasive technique is not without complications. The ultrasound echo M-mode/esophageal Doppler measures aortic diameter as well as aortic blood flow, which allows cardiac output to be calculated. Objective: To determine the correlation and agreement of the hemodynamic profile obtained by thermodilution (T) and esophageal Doppler (D). Material and methods: Clinical Study, prospective and comparative. Twelve patients were included, age 54 ± 12 years, weight 62 ± 8 kg, body mass index 26 ± 3 and an ASA class II-III with diagnostic of surgery of coronary bypass graft (8), abdominal sepsis (2), pancreatitis + acute respiratory distress syndrome (1) and head trauma + acute lung injury (1). Patients without pulmonary catheter had one placed in the operating room as well as an esophageal Doppler M-mode transducer to carry out 6 paired determinations (1 prior to surgery, 2 transoperatively, 2 at the end of surgery and 1 before leaving operating room) to each patient of cardiac output (CO), stroke volume (SV), systemic vascular resistances (SVR) and aortic blood flow (ABF). Statistical Analysis: Student´s t paired, agreement for the method of Bland-Altman and correlation of Pearson proves. It was considered significance a value of p ‹ 0.05. Results: For thermodilution and Doppler the CO was of 4.2 ± 0.5 and 4.0 ± 0.5 l/mim, SV of 49 ± 8 and 47.5 ± 8.8 ml, SVR of 1,265 ± 152 and 1,316 ± 162 din/cm/sec5, respectively. There was not significant difference between both techniques. For thermodilution and Doppler there was good correlation between CO/ABF (r = 0.98; r2 = 0.97), COT/COD (r = 0.98; r2 = 0.97), SVRT/SVRD (r = 0.97; r2 = 0.95) and SVT/SVD (r = 0.99; r2 = 0.99). The grade of agreement had a bias with it limits inferior and superior of the COT with ABF was of 0.95 (0.75- 0.82 and 1.07-1.14 l/min) and of the COT with COD was of 0.16 (-0.01-0.05 and 0.27-0.33 l/min). Conclusion: The ultrasound echo M-mode/esophageal Doppler can be an alternative technique for transoperative monitoring in high risk surgical patient.
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