Analysis of actual accuracy in cardiac output measurements by means of thermodilution

The essential examination in hemodynamic monitoring of the patient is the cardiac output (CO) measurement. Nowadays, in clinical practice the most popular method is indicator dilution, particularly thermodilution. It is realized by applying the Swan-Ganz catheter and observing changes of the indicator concentration. This method is sensitive to many factors and the obtained results should be treated cautiously. The paper presents theoretical and experimental studies of metrological phenomena in CO measurements by means of thermodilution, paying special attention to medical aspects of the measurements. It has been pointed out that the actual unreliability of the mentioned method reaches values from 20% to 45%, which is in opposition to the technical data of patient’s monitors (typical accuracy about 5%).

Model-free numerical deconvolution of recirculating indicator concentration curves

This paper investigates two model-free methods for numerical deconvolution of recirculating indicator concentration curves. The two methods, damped least squares and discrete orthogonal polynomial deconvolution, are applied to simulated data to verify the reliability of the algorithms. Both deconvolution methods provide damping that results in estimated transport functions that are smooth and reasonable estimates of the actual simulated transport function. On convolution with the simulated input curve, the estimated transport functions provide good fits to the simulated output curve. In addition, methods for identifying an optimal solution and for truncating the artifactually long oscillatory tails of the estimated transport functions are proposed, which appear to allow for reasonably accurate estimation of the mean transit times and variances of the transport functions as well. When either method was applied to indicator dilution data obtained from the pulmonary artery and left atrium, it was computationally stable while producing transport functions that when convolved with the input concentration curves provided good fits to the output concentration curves. The combined simulation and experimental results suggest that the proposed methods should be useful for estimating circulation transport functions from indicator dilution data.

Comparison of arsenazo III optical signals in intact and cut frog twitch fibers.

The Ca indicator arsenazo III was introduced into cut frog twitch fibers by diffusion from end-pool segments rendered permeable by saponin. After 2-3 h, the arsenazo III concentration at the optical recording site in the center of a fiber reached two to three times that in the end-pool solutions. Thus, arsenazo III was bound to or taken up by intracellular constituents. The time course of indicator appearance was fitted by equations for diffusion plus linear reversible binding; on average, 0.73 of the indicator was bound and the free diffusion constant was 0.86 x 10(-6) cm2/s at 18 degrees C. When the indicator was removed from the end pools, it failed to diffuse away from the optical site as rapidly as it had diffused in. The wavelength dependence of resting arsenazo III absorbance was the same in cut fibers and injected intact fibers. After action potential stimulation, the active Ca and dichroic signals were similar in the two preparations, which indicates that arsenazo III undergoes the same changes in absorbance and orientation in both cut and intact fibers. Ca transients in freshly prepared cut fibers appeared to be similar to those in intact fibers. As a cut fiber experiment progressed, however, the Ca signal changed. With action potential stimulation, the half-width of the signal gradually increased, regardless of whether the indicator concentration was increasing or decreasing. This increase was usually not accompanied by any change in the amplitude of the Ca signal at a given indicator concentration or by any obvious deterioration in the electrical condition of the fiber. In voltage-clamp experiments near threshold, the relation between peak [Ca] and voltage usually became less steep with time and shifted to more negative potentials. All these changes were also observed in cut fibers containing antipyrylazo III (Maylie, J., M. Irving, N. L. Sizto, and W. K. Chandler. 1987. Journal of General Physiology. 89:83-143). They are considered to represent a progressive change in the physiological state of a cut fiber during the time course of an experiment.