Abstract
Piglets (1-3 wks; n=12) were anaesthetized, intubated, and ventilated. Blood pressure (BP), pulmonary artery pressure (PAP), left atrial pressure (LAP), central venous pressure (CVP), and CO were measured directly. Arterial and mixed venous (PA) blood samples were obtained to determine QO2, O2 consumption (VO2), and O2 extraction. Six piglets (GENT) received 6% Gentran/0.9% NaCl to elevate LAP from approximately 5 to 15 mm Pig over 30 minutes. Six additional piglets (SAL) received 0.9% NaCl for 30 minutes.
Cardiac index (CI) rose during GENT in each piglet, reaching a plateau (+54.2 +/- 38.5 (S.D.) cc/kg/min; p .01) at LAP between 12 - 15 mm Hg. CI fell at the highest LAP reading in 4/6 piglets. GENT raised LAP, PAP, and CVP equivalently (7.3 +/- 1-4, 7.2 +/- 2.6, 5.6 +/- 1.2 mm Hg; all p.01 vs SAL), but had no effect on BP or HR. Hb fell during GENT from 10.4 +/- 1.8 to 7.4 +/- 1.9 gm/dl (p .01) so that QO2 was not enhanced after GENT (17.6 +/- 1.5 vs 17.9 +/- 2.3 cc O2/kg/min) despite the rise in CO. VO2, O2 extraction, pH, and base excess did not change after GENT.
Conclusions: 1. CO consistently rises with increased LAP from 5-12 mm Hg. At higher LAP, CO may fall. 2. QO2 does not rise and O2 extraction does not fall during GENT, as increased CO is opposed by hemodilution, 3. To the extent that improved QO2, not CO, is the endpoint of hemodynamic resuscitation, volume infusion without concurrent blood transfusion may be of little benefit.
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Meadow, W., Rudinsky, B., Komar, K. et al. VOLUME EXPANSION INCREASES CARDIAC OUTPUT (CO) BUT NOT OXYGEN DELIVERY (QO2) IN PIGLETS. Pediatr Res 21 (Suppl 4), 204 (1987). https://doi.org/10.1203/00006450-198704010-00225
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DOI: https://doi.org/10.1203/00006450-198704010-00225