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Detection and quantification of left-to-right shunting using transpulmonary ultrasound dilution (TPUD): a validation study in neonatal lambs

  • Sabine L. Vrancken EMAIL logo , Arno F. van Heijst , Jeroen C. Hopman , Kian D. Liem , Johannes G. van der Hoeven and Willem P. de Boode
Published/Copyright: May 9, 2016

Abstract

Objectives:

We investigated the accuracy of left-to-right shunt detection using transpulmonary ultrasound dilution (TPUD) and compared the agreement between pulmonary over systemic blood flow (Qp/Qs) ratio measured by TPUD [Qp/Qs(tpud)] and ultrasonic flow probes [Qp/Qs(ufp)].

Methods:

Seven newborn lambs under general anesthesia were connected to the TPUD monitor (COstatus™) after insertion of arterial and central venous catheters. A Gore-Tex® shunt, inserted between the descending aorta and left pulmonary artery, was intermittently opened and closed while cardiac output was varied by blood withdrawals. Flow probes were placed around the main pulmonary artery (Qufp) and the descending aorta proximal (Qpre) and distal (Qpost) to the shunt insertion. Qp/Qs(ufp) was calculated as (Qufp+Qpre–Qpost)/Qufp.

Results:

Seventy-two paired measurement sessions were analyzed. Shunts were detected by TPUD with a positive predictive value of 86%, a negative predictive value of 100%, a sensitivity of 100% and a specificity of 83%. The Bland-Altman analysis comparing Qp/Qs(tpud) and Qp/Qs(ufp) showed an overall mean bias (SD) of 0.1 (0.3), limits of agreement (LOA) of ±0.6 and a percentage error of 34.8%.

Conclusions:

The qualitative diagnostic accuracy of TPUD for shunt detection is high. Modification of the algorithm seems required as shunt quantification by TPUD is accurate, but not yet very precise.

Acknowledgments

We would like to thank J.J.M. Menssen, Laboratory of Clinical Physics of the Department of Pediatrics, Radboud University Nijmegen Medical Centre; A.E.J. Hanssen, Animal Laboratory of the Radboud University Nijmegen and A.F.J. de Haan, MSc, Department of Epidemiology, Statistics and Health Technology Assessment of the Radboud University Nijmegen for their outstanding support. Our research group received financial support for the technical realization of this experiment from Transonic Systems Inc., Ithaca, NY, USA and Pulsion Medical Systems, Munich, Germany.

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  1. The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2015-9-6
Accepted: 2016-3-31
Published Online: 2016-5-9
Published in Print: 2016-11-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

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