Noninvasive Beat-To-Beat Stroke Volume Measurements to Determine Preload Responsiveness During Mini-Fluid Challenge in a Swine Model: A Preliminary Study

Abstract

Cardiac output (CO) is an important parameter in fluid management decisions for treating hemodynamically-unstable patients in ICU. The gold standard for CO measurements is the thermodilution method, which is an invasive procedure with intermittent results. Recently, electrical impedance tomography (EIT) has emerged as a new method for noninvasive measurements of stroke volume (SV). The objectives of this paper are to (1) compare EIT with an invasive pulse contour analysis (PCA) method in measuring SV during mini-fluid challenge in animals and (2) determine preload responsiveness with EIT. Five pigs were anesthetized and mechanically ventilated. After removing 25∼30% of the total blood from each animal, multiple fluid injections were conducted. The EIT device successfully tracked changes in SV beat-to-beat during varying volume states, i.e., from hypovolemia and preload responsiveness to target volume and volume overload. From a total of 50 100-ml fluid injections on five pigs (10 injections per pig), the preload responsiveness value was as large as 32.3% in the preload responsiveness state while in the volume overload state it was as low as −4.9%. The bias of the measured SV data using EIT and PCA was 0 ml, and the limits of agreement were ±3.6 ml in the range of 17.6 to 51.0 ml. The results of the animal experiments suggested that EIT is capable of measuring beat-to-beat SV changes during mini-fluid challenge and determine preload responsiveness. Further animal and clinical studies will be needed to demonstrate the feasibility of the EIT method as a new tool for fluid management.