Key result
Transoesophageal echocardiography using a transgastric view of the left ventricular outflow tract showed a strong positive correlation (r = 0.925) and a bias of 0.14 L/min compared to thermodilution for measuring cardiac output in anaesthetised dogs.
Why the study?
Does transoesophageal echocardiography accurately measure cardiac output compared to thermodilution in anaesthetised dogs?
Observational (n=8)
Single-blind
No
Does transoesophageal echocardiography accurately measure cardiac output compared to thermodilution in anaesthetised dogs?
Transoesophageal echocardiography using a transgastric view of the LVOT provides a reliable, minimally invasive alternative to thermodilution for monitoring cardiac output in anaesthetised dogs, though it is slightly less reliable during hypotension.
May support transgastric TEE for cardiac output monitoring in anaesthetised dogs; leaves open prospective validation in larger cohorts.
Cardiac output (CO) is an important haemodynamic parameter to monitor in patients during surgery. However, the majority of the techniques for measuring CO have a limited application in veterinary practice due to their invasive approach and associated complexity and risks. Transoesophageal echocardiography (TEE) is a technique used to monitor cardiac function in human patients during surgical procedures and allows CO to be measured non-invasively. This prospective clinical study aimed to compare the transoesophageal echocardiography using a transgastric view of the left ventricular outflow tract (LVOT) and the thermodilution (TD) technique for the assessment of CO during mean arterial pressure of 65–80 mmHg (normotension) and <65 mmHg (hypotension) in dogs undergoing elective surgery. Eight dogs were pre-medicated with acepromazine (0.05 mg/kg, IM), tramadol (4 mg/kg, IM) and atropine (0.03 mg/kg, IM), followed by anaesthetic induction with propofol (3–5 mg/kg IV) and maintenance with isoflurane associated with a continuous infusion rate of fentanyl (bolus of 3 μg/kg followed by 0.3 μg/kg/min). The CO was measured by TEE (COTEE) and TD (COTD) at the end of expiration during normotension and hypotension (induced by isoflurane). There was a strong positive correlation between COTEE and COTD (r = 0.925; P < 0.0001). The bias between COTD and COTEE was 0.14 ± 0.29 L/min (limits of agreement, −0.44 to 0.72 L/min). The percentage error of CO measured by the two methods was 12.32%. In addition, a strong positive correlation was found between COTEE and COTD during normotension (r = 0.995; P < 0.0001) and hypotension (r = 0.78; P = 0.0223). The results of this study indicated that the transgastric view of the LVOT by TEE was a minimally invasive alternative to clinically monitoring CO in dogs during anaesthesia. However, during hypotension, the CO obtained by TEE was less reliable, although still acceptable.
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Mantovani et al. (2017) conducted an observational in Dogs undergoing elective surgery (n=8). Transoesophageal echocardiography (TEE) using transgastric view of LVOT vs. Thermodilution (TD) technique was evaluated on Cardiac output measurement agreement and correlation between TEE and TD (r = 0.925, 95% CI -0.44 to 0.72, p=<0.0001). Transoesophageal echocardiography using a transgastric view of the left ventricular outflow tract showed a strong positive correlation (r = 0.925) and a bias of 0.14 L/min compared to thermodilution for measuring cardiac output in anaesthetised dogs.
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