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Park CI, Roffi M, Bendjelid K, Bonvini RF. Percutaneous noncoronary interventions during continuous mechanical chest compression with the LUCAS-2 device. Am J Emerg Med 2012; 31:456.e1-3. [PMID: 22980369 DOI: 10.1016/j.ajem.2012.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 11/19/2022] [Imported: 08/29/2023] Open
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Keller R, Goettel N, Bendjelid K. Transpulmonary thermodilution curve and the cross-talk phenomenon. Med Intensiva 2012; 36:446-8. [DOI: 10.1016/j.medin.2011.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 10/14/2022] [Imported: 08/29/2023]
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Bendjelid K, Viale JP, Duperret S, Colling J, Piriou V, Merlani P, Jacques D. Impact of intra-abdominal pressure on retrohepatic vena cava shape and flow in mechanically ventilated pigs. Physiol Meas 2012; 33:615-27. [PMID: 22418601 DOI: 10.1088/0967-3334/33/4/615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] [Imported: 08/29/2023]
Abstract
Conflicting results have been found regarding correlations between right atrial pressure (RAP) and inferior vena cava (IVC) diameter in mechanically ventilated patients. This finding could be related to an increase in intra-abdominal pressure (IAP). This study was designed to clarify whether variations in IVC flow rate caused by positive pressure ventilation are associated with changes in the retrohepatic IVC cross-section (ΔIVC) during major changes in volume status and IAP. Nine pigs were anesthetized, mechanically ventilated and equipped. IAP was set at 0, 15 and 30 mmHg during two conditions, i.e. normovolemia and hypovolemia, generated by blood removal to obtain a mean arterial pressure value lower than 60 mmHg. At each IAP increment, cardiac output, IVC flow and surface area were respectively assessed by flowmeters and transesophageal echocardiography. At normal IAP, even in presence of respiratory changes in IVC flows, no ΔIVC were observed during the two conditions. At high IAP, neither ΔIVC nor modulations of IVC flow were observed whatever the volemic status. The majority of animals with an IVC area of less than 0.65 cm(2) showed evidence of IAP greater than RAP values. Negative RAP-IAP pressure gradients were found to occur with an IVC area of less than 0.65 cm(2), suggesting that IVC dimensions determined using standard ultrasound techniques may indicate the direction of the RAP-IAP gradient. The clinical relevance of the present findings is that volume status should not be estimated from retrohepatic IVC dimensions in cases of high IAP.
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Giraud R, Siegenthaler N, Bendjelid K. Transpulmonary thermodilution assessments: precise measurements require a precise procedure. Crit Care 2011; 15:195. [PMID: 21995848 PMCID: PMC3334767 DOI: 10.1186/cc10459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] [Imported: 08/29/2023] Open
Abstract
When incorporating the values of a hemodynamic parameter into the care of patients, the precision of the measurement method should always be considered. A prospective analysis in the previous issue of Critical Care showed that the precision of transpulmonary thermodilution (TPTD) allows for reliable mean values if a standardised procedure is used. The present finding has a physiological basis, as TPTD requires a more prolonged transit time, which in turn reduces the effects that airway pressure and arrhythmia have on venous return-cardiac output steady states. Moreover, this result suggests that the current accepted threshold value of a 15% increase in cardiac output to identify a positive response to a fluid challenge could be reduced in the future. Indeed, this value is mainly related to the precision of the pulmonary artery catheter.
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Bendjelid K. Monitoring intra-cardiac shunts correction with transpulmonary thermodilution curve: the best is yet to come! J Clin Monit Comput 2011; 25:89-90. [PMID: 21630053 DOI: 10.1007/s10877-011-9286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 05/19/2011] [Indexed: 12/14/2022] [Imported: 08/29/2023]
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Giraud R, Siegenthaler N, Bendjelid K. Pulse pressure variation, stroke volume variation and dynamic arterial elastance. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:414. [PMID: 21457494 PMCID: PMC3219348 DOI: 10.1186/cc10088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] [Imported: 08/29/2023]
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Impact of shunt on the transpulmonary thermodilution curve. Intensive Care Med 2010. [DOI: 10.1007/s00134-010-2108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] [Imported: 08/29/2023]
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Bendjelid K, Giraud R, Siegenthaler N, Michard F. Validation of a new transpulmonary thermodilution system to assess global end-diastolic volume and extravascular lung water. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R209. [PMID: 21092252 PMCID: PMC3220030 DOI: 10.1186/cc9332] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 10/08/2010] [Accepted: 11/23/2010] [Indexed: 12/20/2022] [Imported: 08/29/2023]
Abstract
Introduction A new system has been developed to assess global end-diastolic volume (GEDV), a volumetric marker of cardiac preload, and extravascular lung water (EVLW) from a transpulmonary thermodilution curve. Our goal was to compare this new system with the system currently in clinical use. Methods Eleven anesthetized and mechanically ventilated pigs were instrumented with a central venous catheter and a right (PulsioCath; Pulsion, Munich, Germany) and a left (VolumeView™; Edwards Lifesciences, Irvine, CA, USA) thermistor-tipped femoral arterial catheter. The right femoral catheter was used to measure GEDV and EVLW using the PiCCO2™ (Pulsion) method (GEDV1 and EVLW1, respectively). The left femoral catheter was used to measure the same parameters using the new VolumeView™ (Edwards Lifesciences) method (GEDV2 and EVLW2, respectively). Measurements were made during inotropic stimulation (dobutamine), during hypovolemia (bleeding), during hypervolemia (fluid overload), and after inducing acute lung injury (intravenous oleic acid). Results One hundred and thirty-seven paired measurements were analyzed. GEDV1 and GEDV2 ranged from 701 to 1,629 ml and from 774 to 1,645 ml, respectively. GEDV1 and GEDV2 were closely correlated (r2 = 0.79), with mean bias of -11 ± 80 ml and percentage error of 14%. EVLW1 and EVLW2 ranged from 507 to 2,379 ml and from 495 to 2,222 ml, respectively. EVLW1 and EVLW2 were closely correlated (r2 = 0.97), with mean bias of -5 ± 72 ml and percentage error of 15%. Conclusions In animals, and over a very wide range of values, a good agreement was found between the new VolumeView™ system and the PiCCO™ system to assess GEDV and EVLW.
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Influence of tidal volume on pulse pressure variations in hypovolemic ventilated pigs with acute respiratory distress-like syndrome. Anesthesiology 2010; 113:630-8. [PMID: 20693877 DOI: 10.1097/aln.0b013e3181e908f6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND Sensitivity and specificity of respiratory change in pulse pressure (DeltaPP) to predict preload dependency has been questioned at small tidal volumes (VT) in critically ill patients suffering from acute respiratory distress syndrome (ARDS). We studied DeltaPP in pigs with ARDS-like syndrome during reversible hemorrhagic shock. METHODS Prospective, observational animal study in a Laboratory Investigation Unit. Sixteen deeply sedated mechanically ventilated pigs were successively ventilated with VT of 10 ml/kg at a respiratory rate of 15 breaths/min (RR15) and VT of 6 ml/kg at RR15 and RR25. ARDS-like syndrome was produced by lung lavage in eight pigs (ARDS group). Severe hemorrhagic shock was induced by removal of 40% of total blood volume followed by restoration. RESULTS After bleeding, in the control group ventilated with a VT of 10 ml/kg, DeltaPP increased from 8.5 (95% confidence interval [CI], 7.1 to 9.9%) to 18.5% (CI, 15.3 to 21.7%; P<0.05). In the ARDS group, this index increased similarly, from 7.1% (95% CI, 5.3 to 9.0%) to 20.1% (CI, 15.3 to 24.9%; P<0.05). In control lungs, reduction in VT from 10 to 6 ml/kg reduced the DeltaPP reaction by 40%, although it remained a statistically valid indicator of hypovolemia regardless of the RR value. In contrast, in the ARDS group, DeltaPP was an unreliable hypovolemia marker at low VT ventilation, regardless of the RR value (p=not statistically significant). CONCLUSIONS The present study suggests that DeltaPP is a reliable indicator of severe hypovolemia in pigs with healthy lungs regardless of VT or RR. In contrast, in pigs with ARDS-like syndrome ventilated with small VT, DeltaPP is not a good indicator of severe hemorrhage. However, in this setting, indexing DeltaPP to respiratory changes in transpulmonary pressure allows this marker to significantly indicate the occurrence of hypovolemia.
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Giraud R, Siegenthaler N, Park C, Beutler S, Bendjelid K. Transpulmonary thermodilution curves for detection of shunt. Intensive Care Med 2010; 36:1083-6. [PMID: 20397008 DOI: 10.1007/s00134-010-1876-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 03/04/2010] [Indexed: 10/19/2022] [Imported: 08/29/2023]
Abstract
PURPOSE Monitoring using transpulmonary thermodilution (TPTD) via a single thermal indicator technique allows measurement of cardiac output, extravascular lung water (EVLW) and volumetric variables. METHODS AND RESULTS This report describes two cases of systemic-venous circulation shunt generating early recirculation of thermal indicator with overestimation of EVLW. CONCLUSION In the case of recirculation of thermal indicator, the observed overestimated EVLW in absence of gas exchanges abnormality could be an indicator suggesting the search for a circulatory shunt.
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Abstract
PURPOSE OF REVIEW To evaluate the recent literature on the utility of the pulse oximetry plethysmographic curve to assess macrocirculation and microcirculation monitoring in intensive care patients. RECENT FINDINGS In patients with sinus rhythm who are hypotensive, deeply sedated, mechanically ventilated, critically ill and in the operation room, plethysmographic pulse variation related to mechanical breath is a recent noninvasive indicator of preload dependency. SUMMARY A growing number of recent clinical studies demonstrated that plethysmographic dynamic indices are useful methods to assess fluid responsiveness. Any alternating signal processing of the raw data curves, however, may be detrimental for this purpose, as significant clinically relevant information could be lost after perpetual adjustment of filtering. Hence, time will tell if the pulse oximetry plethysmographic curve will succeed other methods as a noninvasive approach to monitor haemodynamics of critically ill patients.
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Bendjelid K. [Non-invasive methods to measure cardiac output]. REVUE MEDICALE SUISSE 2007; 3:2822-2826. [PMID: 18225838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] [Imported: 08/29/2023]
Abstract
In clinical practice of intensive care, no method of measure of cardiac output lacks limitations. Consequently, no one of them showed her superiority in regard to another one. Although the classic thermodilution was the reference in the twentieth century, recently, the measure of cardiac output by non invasive techniques was widely developed. The present article reviews the recent developments in this area.
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Bendjelid K, Romand JA. Interdépendance cœur–poumons chez le patient ventilé par pression positive. ACTA ACUST UNITED AC 2007; 26:211-7. [PMID: 17236745 DOI: 10.1016/j.annfar.2006.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 10/23/2006] [Indexed: 11/26/2022] [Imported: 08/29/2023]
Abstract
Heart-lung interactions during positive-pressure ventilation are characterized by an extreme sensibility to the patient's intravascular volume status. Indeed, a fall in cardiac output due to decreased ventricular preload can be observed when initiating positive-pressure ventilation. This phenomenon is due to the close anatomic-functional association between heart and lungs, and to the fact that pulmonary volume and intrathoracic pressure variations cyclically modify heart-lung interactions. The present review address the questions of the physiological and physiopathological effects of positive-pressure ventilation on the right and left venous returns, and on pulmonary and systemic vascular resistances.
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Bendjelid K, Schütz N, Suter PM, Romand JA. Continuous cardiac output monitoring after cardiopulmonary bypass: a comparison with bolus thermodilution measurement. Intensive Care Med 2006; 32:919-22. [PMID: 16601960 DOI: 10.1007/s00134-006-0161-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 03/15/2006] [Indexed: 10/24/2022] [Imported: 08/29/2023]
Abstract
OBJECTIVE The interchangeability of continuous measurement of cardiac output (CO) with the traditional bolus method in patients after cardiopulmonary bypass (CPB) is uncertain. DESIGN Prospective observational clinical study. SETTING A 20-bed surgical ICU at a university hospital. PATIENTS Fourteen deeply sedated, ventilated, post-cardiac surgery patients, all equipped with a pulmonary artery catheter. INTERVENTIONS Six hours after the end of the CPB, 56 simultaneous bolus and continuous measurements were compared by a linear regression analysis and Bland-Altman analysis. Bolus CO was estimated by averaging triplicate injections of 10 ml room-temperature NaCl 0.9%, delivered randomly during the respiratory cycle. A stringent maximum difference of 0.55 l min(-1) (about 10% of the mean bolus measured) was considered as a clinically acceptable agreement between the two types of measurements. To be interchangeable the limits of agreement (+/-2 SD of the mean difference between the two methods) should not exceed the chosen acceptable difference. MEASUREMENTS AND RESULTS Continuous was correlated with bolus CO, with a correlation coefficient of r(2)=0.68. (p<0.01). The Bland-Altman analysis demonstrated an objective mean bias of 0.33+/-0.6 l min(-1) (confidence interval of -0.87-1.58) with 34% of measured values falling outside of the clinically acceptable limits. CONCLUSION Our results suggest that, in the first 6 h after CPB, continuous and bolus CO determinations are not interchangeable; one third of the values obtained by continuous CO fell outside the strict limits of clinically useful precision.
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Abstract
According to the concept of Guyton, cardiac output is largely controlled by venous return, which is determined by the difference between mean systemic venous pressure and right atrial pressure. In the analysis of the venous return curve, other authors have suggested that right atrial pressure is the dependent variable and venous return is the independent variable (right atrial pressure decreased because cardiac output increased). The present report analyzes this historical debate, which has already lasted > 50 years.
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Abstract
Post-acute myocardial infarction (AMI) syndrome was first described by Dressler in 1956. Its incidence has decreased in the reperfusion era, most likely because of the extensive use of thrombolysis and coronary balloon angioplasty, therapies that dramatically decreased the size of myocardial necrosis. The authors suggest that drugs that have been prescribed in previous decades as the post-AMI "standard-of-care," such as angiotensin-converting enzyme inhibitors, beta-blockers, and statins, may also play an important role in the disappearance of Dressler syndrome due to their immunomodulatory effects.
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Bendjelid K, Suter PM, Romand JA. The respiratory change in preejection period: a new method to predict fluid responsiveness. J Appl Physiol (1985) 2004; 96:337-42. [PMID: 14660495 DOI: 10.1152/japplphysiol.00435.2003] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] [Imported: 08/29/2023] Open
Abstract
The accuracy and clinical utility of preload indexes as bedside indicators of fluid responsiveness in patients after cardiac surgery is controversial. This study evaluates whether respiratory changes (Delta) in the preejection period (PEP; DeltaPEP) predict fluid responsiveness in mechanically ventilated patients. Sixteen postcoronary artery bypass surgery patients, deeply sedated under mechanical ventilation, were enrolled. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the radial arterial pressure. DeltaPEP (%) was defined as the difference between expiratory and inspiratory PEP measured over one respiratory cycle. We also measured cardiac output, stroke volume index, right atrial pressure, pulmonary arterial occlusion pressure, respiratory change in pulse pressure, systolic pressure variation, and the Deltadown component of SPV. Data were measured without positive end-expiratory pressure (PEEP) and after application of a PEEP of 10 cmH2O (PEEP10). When PEEP10 induced a decrease of >15% in mean arterial pressure value, then measurements were re-performed before and after volume expansion. Volume loading was done in eight patients. Right atrial pressure and pulmonary arterial occlusion pressure before volume expansion did not correlate with the change in stroke volume index after the fluid challenge. Systolic pressure variation, DeltaPEP, Deltadown, and change in pulse pressure before volume expansion correlated with stroke volume index change after fluid challenge (r2 = 0.52, 0.57, 0.68, and 0.83, respectively). In deeply sedated, mechanically ventilated patients after cardiac surgery, DeltaPEP, a new method, can be used to predict fluid responsiveness and hemodynamic response to PEEP10.
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Bendjelid K, Schutz N, Suter PM, Romand JA. Après circulation extra-corporelle, la mesure continue de la Svo2 et la co-oxymétrie du sang mêlé ne sont pas interchangeables. Can J Anaesth 2004; 51:610-5. [PMID: 15197124 DOI: 10.1007/bf03018404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] [Imported: 08/29/2023] Open
Abstract
OBJECTIVE To determine the accuracy of continuous (in vivo) measurement of mixed venous oxygen saturation (SvO(2)), using a fibreoptic catheter, in patients having had cardiopulmonary bypass (CPB). METHODS Using a pulmonary arterial catheter, we prospectively studied 14 patients (age 64 +/- 8) having had cardiopulmonary bypass. Mean hematocrit was 30 +/- 4%. The catheter was calibrated in vitro and in vivo, according to the manufacturer's instructions. Fifty-six simultaneous measurements of continuous SvO(2) (CSvO(2)) and measured SvO(2) (MSvO(2)) were taken with a co-oxymeter and the paired values were analyzed by the linear regression method. To make the two sets of measurements interchangeable, we established, a priori, a maximum limit of 3% (approximately 5% of the measurement), as being an acceptable difference between the two types of measurements. RESULTS All the measurements were obtained within four hours of the placement of the catheter. CSvO(2) was weakly correlated with MSvO(2), with a correlation coefficient of r(2) = 0.49 (P < 0.001). The Bland-Altman analysis demonstrates an objective mean bias of 0.8 +/- 3%, with 36% of the values measured falling outside clinically acceptable limits. For values of CSvO(2) <or= 65%, the measurements were not correlated (P = NS). The bias was -2 +/- 7%, and 56% of the values measured fell outside clinically acceptable limits. CONCLUSIONS Our results demonstrate that, in the immediate aftermath of cardiopulmonary bypass, the continuous measurement of SvO(2) and the co-oxymetry determination of mixed blood is not inter-changeable. Other studies will be necessary to confirm these results and enable us to understand the pathophysiological phenomena accounting for the lack of agreement between the two methods.
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Bendjelid K, Treggiari MM, Romand JA. Transpulmonary lactate gradient after hypothermic cardiopulmonary bypass. Intensive Care Med 2004; 30:817-21. [PMID: 14985958 DOI: 10.1007/s00134-004-2179-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/24/2003] [Accepted: 01/06/2004] [Indexed: 11/26/2022] [Imported: 08/29/2023]
Abstract
OBJECTIVE Several studies demonstrated that the lungs could produce lactate in patients with acute lung injury (ALI). Because after cardiopulmonary bypass (CPB) some patients develop ALI, the effect of CPB on pulmonary lactate release was investigated. DESIGN Prospective observational clinical study. SETTING Twenty-beds, surgical ICU at a university hospital. PATIENTS Sixteen deeply sedated, ventilated and post-cardiac surgery patients, all equipped with a pulmonary artery catheter. MEASUREMENTS AND RESULTS Lactate concentration was measured using a lactate analyser in simultaneously drawn arterial (A) and mixed venous (V) blood samples. Three measurements per patients were taken at 30-min interval, after body temperature reached 37 degrees C. Concomitantly, measurements of cardiac output were also obtained. Pulmonary lactate release was calculated as the product of transpulmonary A-V lactate and cardiac index. The mean cardiopulmonary bypass duration was 100+/-44 min (SD), and the aortic cross-clamping time was 71+/-33 min. After CPB, lactate release was 0.136+/-0.210 mmol/min m(-2). These values were not correlated with cardiopulmonary bypass duration. CONCLUSION The present study shows that in patients receiving mechanical ventilation after CPB, the lung is a source of lactate production. This pulmonary release was not dependent on cardiopulmonary bypass duration.
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Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 2003; 29:352-60. [PMID: 12536268 DOI: 10.1007/s00134-002-1615-9] [Citation(s) in RCA: 198] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2002] [Accepted: 11/21/2002] [Indexed: 01/22/2023] [Imported: 08/29/2023]
Abstract
OBJECTIVE In mechanically ventilated patients the indices which assess preload are used with increasing frequency to predict the hemodynamic response to volume expansion. We discuss the clinical utility and accuracy of some indices which were tested as bedside indicators of preload reserve and fluid responsiveness in hypotensive patients under positive pressure ventilation. RESULTS AND CONCLUSIONS Although preload assessment can be obtained with fair accuracy, the clinical utility of volume responsiveness-guided fluid therapy still needs to be demonstrated. Indeed, it is still not clear whether any form of monitoring-guided fluid therapy improves survival.
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Bendjelid K, Poblete B, Baenziger O, Romand JA. The effects of hypothermic cardiopulmonary bypass on Doppler cerebral blood flow during the first 24 postoperative hours. Interact Cardiovasc Thorac Surg 2003; 2:46-52. [PMID: 17669986 DOI: 10.1016/s1569-9293(02)00098-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] [Imported: 08/29/2023] Open
Abstract
To provide understanding of influence of cardiopulmonary bypass (CPB) on cerebral blood flow (CBF), we investigated the effect of CPB on patients' cerebral haemodynamic parameters. Twenty-three patients were prospectively enrolled. CBF was estimated by transcranial Doppler (TCD) to measure blood velocity in the middle cerebral artery (MVMCA), preoperatively T(0) and at four postoperative times (T(1), T(2), T(3), T(4)). At times T(2), T(3) and T(4), MVMCA remained at higher levels than T(0) (P < 0.05). In the multivariate analysis PaCO(2) was independently associated to MVMCA at times T(1) and T(2) (P = 0.03, P = 0.01, respectively) and temperature was independently associated with MVMCA at time T(1) (P = 0.02). Thus, the present study showed an increase in CBF after CPB, that was correlated with raised temperature but not with decrease in haematocrit.
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Bendjelid K, Canet E, Rayan E, Casali C, Revel D, Janier M. Role of glycolysis in the energy production for the non-mechanical myocardial work in isolated pig hearts. Curr Med Res Opin 2003; 19:51-8. [PMID: 12661781 DOI: 10.1185/030079902125001281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND The dissociation of mechanical from non-mechanical energy utilisation can be studied using BDM (2,3-butanedione monoxime), which inhibits the actin-myosin interaction without inhibiting Ca2+ transport. The objective of the present study was to establish if increasing the non-mechanical energy demand of perfused isolated pig hearts by dobutamine stimulation requires glycolysis with increased exogenous glucose uptake. METHODS Five isolated pig hearts (CTRL) were perfused for 90 min at constant flow (1 ml g(-1) min(-1)) with non-recirculating blood containing 30 mM BDM and 26 MBq/l of fluorine-18 2-fluoro-2-deoxyglucose (IFDG). This was compared with five hearts (DOBU) subjected to the same protocol for the first 30 min and then to dobutamine (1.5 microM) for the following 30 min and dobutamine (4 microM) for the last 30 min. Five other isolated hearts were perfused as for the DOBU group but without BDM (CTRLDOBU). Using a clinical PET scanner, glucose uptake was assessed by estimating 18FDG uptake using linear regression. The slope variations were compared using a global test of coincidence. RESULTS Heart rate was at 100 +/- 2 b.p.m. in the CTRL group and at 180 +/- 7 b.p.m. in the DOBU group. 18FDG uptake was homogeneous within the whole myocardium and we observed a linear and regular increase in both the CTRL and DOBU groups (p, NS). In the CTRLDOBU group, 18FDG uptake was also homogeneous within the whole myocardium, but slopes of 18FDG uptake during dobutamine perfusion were higher than without dobutamine. CONCLUSION In blood-perfused isolated pig hearts, exogenous glucose is not necessarily required when non-mechanical energy is increased by dobutamine stimulation. These findings suggest that ATP derived from glycolysis is not necessary to preserve myocardial Ca2+ transport during beta-adrenergic stimulation.
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Bendjelid K, Romand JA, Walder B, Suter PM, Fournier G. Correlation between measured inferior vena cava diameter and right atrial pressure depends on the echocardiographic method used in patients who are mechanically ventilated. J Am Soc Echocardiogr 2002; 15:944-9. [PMID: 12221411 DOI: 10.1067/mje.2002.120701] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] [Imported: 08/29/2023]
Abstract
In patients who are mechanically ventilated, the correlation between inferior vena cava diameter (IVCD) measurements and mean right atrial pressure (RAP) varies in the literature. The purpose of this study was to test if the correlation between IVCD and RAP measurement in patients who are critically ill depends on the transthoracic echocardiography (TTE) methodology used. Twenty patients who were critically ill, sedated, and required respiratory support were prospectively studied by TTE during mechanical ventilation in a controlled mode. The TTE measures of IVCD were made, using methods previously cited. First, IVCD was measured at end-expiration and end-diastole, with ECG synchronization, using the M-mode, on short-axis view 2 cm below the right atrium. Second, IVCD was assessed at end-expiration, without ECG synchronization, using the 2-dimensional long-axis view at the same location. RAP was measured simultaneously by using a central venous catheter positioned in the superior vena cava. All measurements were taken in the supine position. IVCD at end-expiration and end-diastole, with ECG synchronization, using the M-mode, and IVCD at end-expiration, without ECG synchronization, using the 2-dimensional long-axis view, correlate linearly with RAP (0.81, P <.0001 and 0.71, P =.0004). Mean bias between the 2 TTE methods (Bland-Altman analysis) was 1.6 mm (SD +/- 2.03 mm). In conclusion, this study confirms that variation of correlation between TTE IVCD measurement and RAP depends on the ultrasonographic methodology used and the timing of measurement during the cardiac cycle. IVCD at end-expiration and end-diastole, with ECG synchronization, using the M-mode (IVCD-MM) correlates more satisfactory with RAP than with IVCD at end-expiration, without ECG synchronization, using the 2-dimensional long-axis view, in patients during mechanical ventilation.
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Abstract
INTRODUCTION Systemic elastorrhexis or Grönblad-Strandberg-Touraine syndrome is a rare inherited disease characterized by a generalized elastic tissue dysplasia and polymorphic clinical features, with the main tissues affected being cutaneous, ocular and arterial. CURRENT KNOWLEDGE AND KEY POINTS Usual cardiovascular complications of this entity include ischemic heart disease, renovascular hypertension and atherosclerotic peripheral vascular disease. Some cases of restrictive cardiomyopathies and valvular disease have been reported. Coronary artery disease, often with early onset, is seen in approximately 20% of cases. FUTURE PROSPECTS AND PROJECTS This review of the literature concerning a rare cause of cardiopathy underlines the need to search for underlying elastorrhexis in the clinical setting of early onset and severe coronary artery disease or arteriopathy, especially in the absence of vascular risk factors. This hereditary disease has been traced to chromosome 16p13.1 and may in the future be easily diagnosed, bypassing the need for cutaneous biopsy.
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