Cardiac output and mixed venous oxygen content measurements by a tracer bolus method: theory

Clark, Justin S., Yuxiang J. Lin, Michael J. Criddle,Antonio G. Cutillo, Adelbert H. Bigler, Fred L. Farr, and Attilio D. Renzetti, Jr. Cardiac output and mixed venous oxygen content measurements by a tracer bolus method: theory. J. Appl.Physiol. 83(3): 884-896, 1997.We present a bolus method ofinert-gas delivery to the lungs that facilitates application ofmultiple inert gases and the multiple inert-gas-exchange technique(MIGET) model to noninvasive measurements of cardiac output (CO) andcentral mixed venous oxygen contentReduction in recirculation error is made possible by 1)replacement of sinusoidal input functions with impulse inputs and2) replacement of steady-state analyses with transientanalyses. Recirculation error reduction increases the inert-gasselection to include common gases without unusually high (and difficultto find) tissue-to-blood partition coefficients for maximizing thesystemic filtering efficiency. This paper also presents a practicalmethod for determining the recirculation contributions to inert expiredprofiles in animals and determining their specific contributions toerrors in the calculations of CO and from simulationsapplied to published ventilation-perfusion ratio(/) profiles.Recirculation errors from common gases were found to be reducible tothe order of 5% or less for both CO and whereassimulation studies indicate that measurement bias contributions fromrecirculation, / mismatch, andthe / extractionprocess can be limited to 15% for subjects with severe/ mismatch and high inspiredoxygen fraction levels. These studies demonstrate a decreasinginfluence of / mismatch onparameter extraction bias as the number of inert gases are increased.However, the influence of measurement uncertainty on parameterextraction error limits improvement to six gases.