Application of the method of thermodilution to assess the hemodynamics of patients with pulmonary hypertension

Л.В. Сазыкина; Д.Ш. Газизова; Н.А. Нишонов; С.Н. Маковеев; И. Кофранек; Г.В. Шевченко

doi:10.18127/j15604136-202005-01

Application of the method of thermodilution to assess the hemodynamics of patients with pulmonary hypertension

Л.В. Сазыкина¹, Д.Ш. Газизова², Н.А. Нишонов³, С.Н. Маковеев⁴, И. Кофранек⁵, Г.В. Шевченко⁶

research article UDC 616.1 Pages: 5-17 doi.org/10.18127/j15604136-202005-01

¹ к.б.н., вед. науч. сотрудник, лаборатория математического моделирования и мониторинга, ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А. Н. Бакулева» МЗ РФ (Москва)
² д.м.н., академик Медико-технической академии, гл. науч. сотрудник, лаборатория математического моделирования и мониторинга ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А. Н. Бакулева» МЗ РФ (Москва)
³ врач, сердечно-сосудистый хирург, отделение хирургического лечения заболеваний сердца с прогрессирующей легочной гипертензией, ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А. Н. Бакулева» МЗ РФ (Москва)
⁴ директор, ТОГБУ «Компьютерный центр» (г. Тамбов)
⁵ профессор, Карлов Университет, Институт патофизиологии, Лаборатория биокибернетики (Прага, Чехия)
⁶ коммерческий директор, ООО «Открытые Технологии» (Москва)

Keywords: Thermodilution method Swan-Ganz catheter pulmonary hypertension the pulmonary vasoreactivity testing mathematical model of the cardiovascular system

Abstract

To evaluate hemodynamic parameters such as cardiac and stroke index, pumping ability of the heart, vascular resistance of systemic and pulmonary circulation, etc., it is necessary to measure the volumetric blood flow velocity (cardiac output). Since the 70s of the last century, from the existing methods for evaluating cardiac output as invasive, requiring cardiac catheterization (direct Fick method, Stuart-Hamilton method, thermodilution, etc.) and non-invasive (echocardiographic, rheographic, photoplethysmographic, etc.), the thermodilution method has become the most widespread. At the same time, the method has limitations in use, for example, in children with heart septum defects.

The aim of the work was to determine the advantages and disadvantages of using the thermodilution method to assess the hemodynamics of patients with pulmonary hypertension when performing the pulmonary vasoreactivity testing.

Material and methods of hemodynamic research. The hemodynamics of 96 patients with pulmonary hypertension of various etiology was studied. All patients underwent the pulmonary vasoreactivity testing and underwent complete computer monitoring and analysis using mathematical models and statistics.

Results. The article describes the thermodilution method. An analysis of its applicability and limitations is carried out. It has been established that the measurement of cardiac output by the method of thermodilution is influenced by methodological reasons, such as instability of blood flow, the influence of a respiratory wave, stress, etc., physiological, associated with defects of the heart septum and tricuspid valve, cardiac arrhythmias, disorders associated with catheterization, injection of a solution, etc.

Clinical examples of the application of the method using a mathematical model of the cardiovascular system are given.

Conclusion. The thermodilution method and the equipment for its implementation continue to develop. Half a century of experience in using the thermodilution method in the clinic has determined the boundaries of its application, possible complications and the necessary skills of the specialists using it.

The use of this method is recommended when conducting a test for vasoreactivity in patients with pulmonary hypertension to clarify the diagnosis and choice of therapy. Also, hemodynamic control by the thermodilution method is necessary when prescribing potent drugs to patients with acute heart failure before, during and after cardiac surgery, during resuscitation measures, the selection of surgical tactics for cardiomyopathy and other pathologies, determining indications for heart transplantation, etc.

How to cite

Сазыкина Л.В., Газизова Д.Ш., Нишонов Н.А., Маковеев С.Н., Кофранек И., Шевченко Г.В. Применение метода термодилюции для оценки гемодинамики больных с легочной гипертензией // Биомедицинская радиоэлектроника. 2020. № 5. С. 5–17. DOI: https://doi.org/10.18127/j15604136-202005-01

References

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Gorbachevskij S.V., SHmal'c A.A., Plotnikova L.R. Legochnaya gipertenziya u detej s vrozhdennymi porokami serdca. M.: OOO «Kedr». 2018. 91 s. (In Russian).
Mazhidov U.A., Gorbachevskij S.V., Belkina M.V., Grenaderov M.A., Gorchakova A.I. Primenenie invazivnogo monitoringa davleniya v legochnoj arterii dlya opredeleniya taktiki operativnogo lecheniya bol'nyh s polnoj formoj atrioventrikulyarnogo kanala s sindromom Ejzenmengera. Byulleten' NCSSKH im. A. N. Bakuleva RAMN. Ser. Serdechno-sosudistye zabolevaniya. 2015. № 16(3). S. 15 (In Russian).
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Hamilton W.F., Riley R.L., Attyah A.M., Cournand A., Fowell D.M., Himmelstein A., Noble R.P., Remington J.W., Richards D.W., Wheeler N.C., Witham A.C. Comparison of the Fick and dye injection methods of measuring the cardiac output in Man. Am. J. Physiol. 1948. V. 153. P. 309–321.
Headley J. Invasive Hemodynamic Monitoring: Physiological Principles and Clinical Applications. 2002: Irvine, CA: Edwards LifeSciences. P. 19–20.
Johnson R.W., Normann, R.A. Signal processing strategies for enhancement of signal-to-noise ratio of thermodilution measurements. Ann Biomed Eng. 1988. V. 16. P. 265–278. https://doi.org/10.1007/BF02368003/.
Normann R.A., Johnson R.W., Messinger J.E., Sohrab B. A continuous cardiac output computer based on thermodilution principles. Ann Biomed Eng. 1989. V. 17. P. 61–73. https://doi.org/10.1007/BF02364273.
Lochner W. Studies on the imperfect composition of blood in the right side of the heart with the aid of temperature measurement. Pflugers Arch Gesamte Physiol Menschen Tiere. 1953. V. 256(4). P. 296–303.
Fegler G. Measurement of cardiac output in anaesthetized animals by a thermodilution method. Q. J. Exp. Physiol. Cogn. Med. Sci. 1954. V. 39(3). P. 153–164.
Ganz W., Swan H.J.C. Measurement of blood flow by thermodilution. Am. J. Cardiol. 1972. V. 29. P. 241–246.
Hensli-ml. F.A., Martin D.E., Grevli G.P. Prakticheskaya kardioanesteziologiya. M.: Medicinskoe informacionnoe agentstvo. 2017. 1084 s. (In Russian).
Chessa M. Cardiac Catheterization. In: Pulmonary Hypertension in adult congenital heart disease. Springer. 2017. P. 215–228.
Jansen J.R.C., Schreuder J.J., Settels J.J., Kornet L., Penn O.C.K.M., Mulder P.G.H., Versprille A., Wesseling K.H. Single Injection Thermodilution: A Flow-corrected Method. Anesthesiology. 1996. V. 85(9). P. 481–490.
Norris S.L., King E.G., Grace M., Weir B. Thermodilution cardiac output – an in vitro model of low flow states. Crit Care Med. 1986. V. 14. P. 57–59.
Kubo S.H., Burchenal J.E., Cody R.J. Comparison of direct Fick and thermodilution cardiac output techniques at high flow rates. Am J. Cardiol. 1987. V. 59. P. 384–386.
Hamilton M.A., Stevenson L.W., Woo M., Child J.S., Tillisch J.H. Effect of tricuspid regurgitation on the reliability of the thermodilution cardiac output technique in congestive heart failure. Am J. Cardiol. 1989. V. 64. P. 945–948.
Beyer J., Lamberti J.J., Replogle R.L. Validity of thermodilution cardiac output determination: experimental studies with and without pulmonary insufficiency. J. Surg. Res. 1976. V. 21. P. 313–317.
Anesteziologiya. Kak izbezhat' oshibok. Markuchchi K. (red.): Per. s angl. pod red. V.M. Mizikova. M.: GEOTAR-Media. 2011. 1072 s. (In Russian).
Dadabaev G.M. Rentgenendovaskulyarnoe lechenie oslozhnenij posle operacii gemodinamicheskoj korrekcii po metodu Fontena u pacientov so slozhnymi vrozhdennymi porokami serdca: Diss. … kand. med nauk. M.: NCSSKH im. A.N. Bakuleva. 2015. 167 s. (In Russian).
Dupuis M., Noel-Savina E., Prévot G., Tétu L., Pillard F., Riviere D., Didier A. Determination of Cardiac Output in Pulmonary Hypertension Using Impedance Cardiography. Respiration. 2018. V. 96: 500–506. https://doi.org/10.1159/000486423.
Hsu S., Brusca B., Rhodes P.S., Kolb T.M., Mathai S.C., Tedford R.J. Use of thermodilution cardiac output overestimates diagnoses of exerciseinduced pulmonary hypertension. Pulm Circ. 2017. V. 7(1). P. 253–255.
Alvarez M., Rumbak M., Schwartz S., Cao K., SriAroon C., Clum S., Calero K., Restrepo R. Comparison of cardiac output by Fick formula vs. thermodilution, following vasodilator challenge in pulmonary hypertension. Pulm. Crit. Care Med. 2017. V. 2(3). P. 1–4.
Bokeriya L.A., Gazizova D.SH., Gorbachevskij S.V., Lishchuk V.A., Sazykina L.V. Issledovanie vozmozhnostej regulyacii serdechno-sosudistoj sistemy dlya kompensacii legochnoj gipertenzii. Byulleten' NCSSKH im. A.N. Bakuleva. 2016. № 17(6). S. 23 (In Russian).
Gorbachevskij S.V., SHmal'c A.A., Belkina M.V., Grenaderov M.A., Baryshnikova I.YU., Pursanov M.G., Sazykina L.V., Gorchakova A.I. Algoritm diagnostiki gipertenzionnoj sosudistoj bolezni legkih, associirovannoj s vrozhdennymi porokami serdca. Byulleten' NCSSKH im. A.N. Bakuleva RAMN. 2015. № 16(3). S. 12 (In Russian).
Gorbachevskij S.V., Rahmonov K.H. Kompleksnoe lechenie pri hronicheskoj tromboembolicheskoj legochnoj gipertenzii. Grudnaya i serdechnososudistaya hirurgiya. 2020. № 62 (1). S. 7–13. DOI: 10.24022/0236-2791-2020-62-1-7-13 (In Russian).
Gazizova D.SH., Lishchuk V.A. Tekhnologiya individual'noj terapii – metod. V kn.: Lishchuk V.A., Gazizova D.SH. (red.) Tekhnologiya individual'noj terapii. M.: OOO «PRINT PRO». 2016. S. 127–172 (In Russian).
Chatterjee K. The Swan-Ganz Catheters: Past, Present, and Future. A Viewpoint. Circulation. 2009. № 119. P. 147–152.
McKenzie S.C., Chan W., Brown M.R., Platts D., Javorsky G. Reliability of thermodilution derived cardiac output with different operator characteristics. Journal of Clinical Monitoring and Computing. 2018. V. 32. P. 227–234.

[1] Argueta E.E., Paniagua D. Thermodilution Cardiac Output: A Concept Over 250 Years in the Making. Cardiol Rev. 2019. May/June. V. 27(3). P. 138–144. DOI: 10.1097/CRD.0000000000000223.

[2] Gorbachevskij S.V., SHmal'c A.A., Plotnikova L.R. Legochnaya gipertenziya u detej s vrozhdennymi porokami serdca. M.: OOO «Kedr». 2018. 91 s. (In Russian).

[3] Mazhidov U.A., Gorbachevskij S.V., Belkina M.V., Grenaderov M.A., Gorchakova A.I. Primenenie invazivnogo monitoringa davleniya v legochnoj arterii dlya opredeleniya taktiki operativnogo lecheniya bol'nyh s polnoj formoj atrioventrikulyarnogo kanala s sindromom Ejzenmengera. Byulleten' NCSSKH im. A. N. Bakuleva RAMN. Ser. Serdechno-sosudistye zabolevaniya. 2015. № 16(3). S. 15 (In Russian).

[4] Hamilton W.F., Moore J.W., Kinsman J.M., Spurling R.G. Simultaneous determination of the pulmonary and systemic circulation times in man and of a figure related to the cardiac output. Am. J. of Physiol. 1928. № 84. P. 334–338.

[5] Hamilton W.F., Riley R.L., Attyah A.M., Cournand A., Fowell D.M., Himmelstein A., Noble R.P., Remington J.W., Richards D.W., Wheeler N.C., Witham A.C. Comparison of the Fick and dye injection methods of measuring the cardiac output in Man. Am. J. Physiol. 1948. V. 153. P. 309–321.

[6] Headley J. Invasive Hemodynamic Monitoring: Physiological Principles and Clinical Applications. 2002: Irvine, CA: Edwards LifeSciences. P. 19–20.

[7] Johnson R.W., Normann, R.A. Signal processing strategies for enhancement of signal-to-noise ratio of thermodilution measurements. Ann Biomed Eng. 1988. V. 16. P. 265–278. https://doi.org/10.1007/BF02368003/.

[8] Normann R.A., Johnson R.W., Messinger J.E., Sohrab B. A continuous cardiac output computer based on thermodilution principles. Ann Biomed Eng. 1989. V. 17. P. 61–73. https://doi.org/10.1007/BF02364273.

[9] Lochner W. Studies on the imperfect composition of blood in the right side of the heart with the aid of temperature measurement. Pflugers Arch Gesamte Physiol Menschen Tiere. 1953. V. 256(4). P. 296–303.

[10] Fegler G. Measurement of cardiac output in anaesthetized animals by a thermodilution method. Q. J. Exp. Physiol. Cogn. Med. Sci. 1954. V. 39(3). P. 153–164.

[11] Ganz W., Swan H.J.C. Measurement of blood flow by thermodilution. Am. J. Cardiol. 1972. V. 29. P. 241–246.

[12] Hensli-ml. F.A., Martin D.E., Grevli G.P. Prakticheskaya kardioanesteziologiya. M.: Medicinskoe informacionnoe agentstvo. 2017. 1084 s. (In Russian).

[13] Chessa M. Cardiac Catheterization. In: Pulmonary Hypertension in adult congenital heart disease. Springer. 2017. P. 215–228.

[14] Jansen J.R.C., Schreuder J.J., Settels J.J., Kornet L., Penn O.C.K.M., Mulder P.G.H., Versprille A., Wesseling K.H. Single Injection Thermodilution: A Flow-corrected Method. Anesthesiology. 1996. V. 85(9). P. 481–490.

[15] Norris S.L., King E.G., Grace M., Weir B. Thermodilution cardiac output – an in vitro model of low flow states. Crit Care Med. 1986. V. 14. P. 57–59.

[16] Kubo S.H., Burchenal J.E., Cody R.J. Comparison of direct Fick and thermodilution cardiac output techniques at high flow rates. Am J. Cardiol. 1987. V. 59. P. 384–386.

[17] Hamilton M.A., Stevenson L.W., Woo M., Child J.S., Tillisch J.H. Effect of tricuspid regurgitation on the reliability of the thermodilution cardiac output technique in congestive heart failure. Am J. Cardiol. 1989. V. 64. P. 945–948.

[18] Beyer J., Lamberti J.J., Replogle R.L. Validity of thermodilution cardiac output determination: experimental studies with and without pulmonary insufficiency. J. Surg. Res. 1976. V. 21. P. 313–317.

[19] Anesteziologiya. Kak izbezhat' oshibok. Markuchchi K. (red.): Per. s angl. pod red. V.M. Mizikova. M.: GEOTAR-Media. 2011. 1072 s. (In Russian).

[20] Dadabaev G.M. Rentgenendovaskulyarnoe lechenie oslozhnenij posle operacii gemodinamicheskoj korrekcii po metodu Fontena u pacientov so slozhnymi vrozhdennymi porokami serdca: Diss. … kand. med nauk. M.: NCSSKH im. A.N. Bakuleva. 2015. 167 s. (In Russian).

[21] Dupuis M., Noel-Savina E., Prévot G., Tétu L., Pillard F., Riviere D., Didier A. Determination of Cardiac Output in Pulmonary Hypertension Using Impedance Cardiography. Respiration. 2018. V. 96: 500–506. https://doi.org/10.1159/000486423.

[22] Hsu S., Brusca B., Rhodes P.S., Kolb T.M., Mathai S.C., Tedford R.J. Use of thermodilution cardiac output overestimates diagnoses of exerciseinduced pulmonary hypertension. Pulm Circ. 2017. V. 7(1). P. 253–255.

[23] Alvarez M., Rumbak M., Schwartz S., Cao K., SriAroon C., Clum S., Calero K., Restrepo R. Comparison of cardiac output by Fick formula vs. thermodilution, following vasodilator challenge in pulmonary hypertension. Pulm. Crit. Care Med. 2017. V. 2(3). P. 1–4.

[24] Bokeriya L.A., Gazizova D.SH., Gorbachevskij S.V., Lishchuk V.A., Sazykina L.V. Issledovanie vozmozhnostej regulyacii serdechno-sosudistoj sistemy dlya kompensacii legochnoj gipertenzii. Byulleten' NCSSKH im. A.N. Bakuleva. 2016. № 17(6). S. 23 (In Russian).

[25] Gorbachevskij S.V., SHmal'c A.A., Belkina M.V., Grenaderov M.A., Baryshnikova I.YU., Pursanov M.G., Sazykina L.V., Gorchakova A.I. Algoritm diagnostiki gipertenzionnoj sosudistoj bolezni legkih, associirovannoj s vrozhdennymi porokami serdca. Byulleten' NCSSKH im. A.N. Bakuleva RAMN. 2015. № 16(3). S. 12 (In Russian).

[26] Gorbachevskij S.V., Rahmonov K.H. Kompleksnoe lechenie pri hronicheskoj tromboembolicheskoj legochnoj gipertenzii. Grudnaya i serdechnososudistaya hirurgiya. 2020. № 62 (1). S. 7–13. DOI: 10.24022/0236-2791-2020-62-1-7-13 (In Russian).

[27] Gazizova D.SH., Lishchuk V.A. Tekhnologiya individual'noj terapii – metod. V kn.: Lishchuk V.A., Gazizova D.SH. (red.) Tekhnologiya individual'noj terapii. M.: OOO «PRINT PRO». 2016. S. 127–172 (In Russian).

[28] Chatterjee K. The Swan-Ganz Catheters: Past, Present, and Future. A Viewpoint. Circulation. 2009. № 119. P. 147–152.

[29] McKenzie S.C., Chan W., Brown M.R., Platts D., Javorsky G. Reliability of thermodilution derived cardiac output with different operator characteristics. Journal of Clinical Monitoring and Computing. 2018. V. 32. P. 227–234.

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