1
|
Donati PA, Rabelo RC, Araos J, Tunesi M, Mouly J, Londoño L, Jensen M, Dubin A. Retrospective evaluation of jugular venous blood variables and mortality in critically ill hospitalized cats. J Vet Emerg Crit Care (San Antonio) 2022; 32:777-783. [DOI: 10.1111/vec.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Pablo A. Donati
- Facultad de Ciencias Veterinarias Universidad de Buenos Aires Buenos Aires Argentina
- Cooperative Veterinary Intensive Care Unit (UCICOOP) Buenos Aires Argentina
| | | | - Joaquin Araos
- Department of Clinical Sciences College of Veterinary Medicine Cornell University Ithaca New York USA
| | - Marcela Tunesi
- Cooperative Veterinary Intensive Care Unit (UCICOOP) Buenos Aires Argentina
| | - Javier Mouly
- Clínica Veterinaria del Sol, Provincia de Buenos Aires
| | - Leonel Londoño
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Mario Jensen
- Cooperative Veterinary Intensive Care Unit (UCICOOP) Buenos Aires Argentina
| | - Arnaldo Dubin
- Faculty of Medical Sciences National University of La Plata La Plata Argentina
| |
Collapse
|
2
|
Chan L, Zhang H, Meyring-Wösten A, Campos I, Fuertinger D, Thijssen S, Kotanko P. Intradialytic Central Venous Oxygen Saturation is Associated with Clinical Outcomes in Hemodialysis Patients. Sci Rep 2017; 7:8581. [PMID: 28819317 PMCID: PMC5561134 DOI: 10.1038/s41598-017-09233-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 07/17/2017] [Indexed: 01/20/2023] Open
Abstract
Central venous oxygen saturation (ScvO2) in the superior vena cava is predominantly determined by cardiac output, arterial oxygen content, and oxygen consumption by the upper body. While abnormal ScvO2 levels are associated with morbidity and mortality in non-uremic populations, ScvO2 has received little attention in hemodialysis patients. From 1/2012 to 8/2015, 232 chronic hemodialysis patients with central venous catheters as vascular access had their ScvO2 monitored during a 6-month baseline period and followed for up to 36 months. Patients were stratified into upper and lower two tertiles by a ScvO2 of 61.1%. Survival analysis employed Kaplan-Meier curves and adjusted Cox proportional hazards models. Patients in the lower tertiles of ScvO2 were older, had longer hemodialysis vintage, lower systolic blood pressure, lower ultrafiltration rates, higher leukocyte counts and neutrophil-to-lymphocyte ratios. Kaplan-Meier analysis indicated a shorter survival time in the lower tertiles of ScvO2 (P = 0.005, log-rank test). In adjusted Cox analysis, a 1 percent point decrease in mean ScvO2 was associated with a 4% increase in mortality (HR 1.04 [95% CI 1.01-1.08], P = 0.044), indicating that low ScvO2 is associated with poor outcomes. Research on the relative contributions of cardiac output and other factors is warranted to further elucidate the pathophysiology underlying this novel finding.
Collapse
Affiliation(s)
- Lili Chan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Peter Kotanko
- Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Renal Research Institute, New York, NY, USA.
| |
Collapse
|
3
|
Influence of central venous oxygen saturation on in-hospital mortality of surgical patients. Rev Bras Anestesiol 2011; 60:593-602, 329-34. [PMID: 21146055 DOI: 10.1016/s0034-7094(10)70074-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 06/28/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Low central venous oxygen saturation (ScvO₂) indicates an imbalance between cellular oxygen supply and consumption and, consequently, worse prognosis for critical patients. However, it is not clear what the value of this marker in surgical patients. The objective of the present study was to evaluate whether low perioperative ScvO₂ determines a worse prognosis. METHODS This is a 6-month observational study carried on in a tertiary hospital. Patients who needed to be in the intensive care unit (ICU) postoperatively, with age ≥ 18 years, who underwent large surgeries, were included. Patients who underwent palliative surgeries and those with severe heart failure were excluded. Levels of ScvO₂ were measured before the surgery, during the procedure, and after the surgery in the ICU. RESULTS Sixty-six patients were included in this study, but 25.8% of them did not survive. Mean ScvO₂ levels were higher intraoperatively, 84.7 ± 8.3%, than preoperatively and in the ICU, 74.1 ± 7.6% and 76.0 ± 10.5% (p = 0.0001), respectively. However, only preoperative SvcO₂ levels of non-surviving patients were significantly lower than those who survived. By logistic regression, preoperative ScvO₂, OR = 0.85 (95% CI 0.74-0.98) (p = 0.02), was an independent factor of in-hospital mortality. Patients with preoperative ScvO₂ < 70% had greater need of intraoperative blood transfusion (80.0% versus 37.0%, p = 0.001) and volume replacement, 8,000.0 (6,500.0-9,225.0) mL versus 6,000.0 (4,500.0-8,500.0) mL (p = 0.04), with greater chances of postoperative complications (75% versus 45.7%, p = 0.02) and longer time in the ICU, 4.0 (20.0-5.0) days versus 3.0 (1.7-4.0) days (p = 0.02). CONCLUSIONS Intraoperative ScvO₂ levels are higher than those both in the pre- and postoperative period. However, low preoperative ScvO₂ determines worse prognosis.
Collapse
|
4
|
Smetkin AA, Kirov MY, Kuzkov VV, Lenkin AI, Eremeev AV, Slastilin VY, Borodin VV, Bjertnaes LJ. Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery. Acta Anaesthesiol Scand 2009; 53:505-14. [PMID: 19183113 DOI: 10.1111/j.1399-6576.2008.01855.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Off-pump coronary artery bypass grafting (OPCAB) requires thorough monitoring of hemodynamics and oxygen transport. Our aim was to find out whether therapeutic guidance during and after OPCAB, using an algorithm based on advanced monitoring, influences perioperative hemodynamic and fluid management as well as the length of post-operative ICU and hospital stay. METHODS Patients were randomized into two groups of hemodynamic monitoring: the conventional monitoring (CM) group (n=20) and the advanced monitoring (AM) group (n=20). In the CM group, therapy was guided by central venous pressure, mean arterial pressure (MAP) and heart rate (HR), and in the AM group by the intrathoracic blood volume index, MAP, HR, central venous oxygen saturation (ScvO(2)) and cardiac index (CI). The measurements were performed before and during surgery, and at 2, 4 and 6 h post-operatively. RESULTS In the AM group, colloids and dobutamine were given more frequently and were accompanied by increments in ScvO(2), CI and oxygen delivery compared with baseline. The percentage of ephedrine administration was higher in the CM group. The algorithm guided by AM decreased time until achieving the status of 'fit for ICU discharge' and post-operative hospital stay by 15% and 25%, respectively. CONCLUSIONS A goal-directed algorithm based on advanced hemodynamic monitoring and continuous measurement of ScvO(2) facilitates early detection and correction of hemodynamic changes and influences the strategy for fluid therapy that can improve the course of post-operative period after coronary artery bypass grafting on the beating heart.
Collapse
Affiliation(s)
- A A Smetkin
- Department of Anaesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky avenue 51, Arkhangelsk, Russian Federation
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Yazigi A, Abou-Zeid H, Madi-Jebara S, Haddad F, Hayek G, Jabbour K. Correlation between central venous oxygen saturation and oxygen delivery changes following fluid therapy. Acta Anaesthesiol Scand 2008; 52:1213-7. [PMID: 18823459 DOI: 10.1111/j.1399-6576.2008.01761.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The rationale for using central venous oxygen saturation (ScvO(2)) in various clinical scenarios is that it reflects the balance between oxygen delivery (DO(2)) and demands. In this study, we evaluated the correlation between ScvO(2) and DO(2) changes (Delta Do(2), DeltaScvO(2)) in patients receiving fluid therapy following coronary surgery. We also correlated the changes of mean arterial pressure (Delta MAP) and central venous pressure (Delta CVP), with Delta DO(2). METHODS Sixty consecutive sedated and mechanically ventilated adult patients, with cardiac index <or=2.3 L/min/m(2) and a pulmonary artery occlusion pressure <or=12 mmHg following coronary surgery, were included. Concomitant hemodynamic parameters, arterial and venous blood gases were measured before (T0) and after (T1) administration of a 500 ml bolus of an isotonic crystalloid solution over 30 min. The correlations between Delta DO(2) and DeltaScvO(2), Delta MAP or Delta CVP were evaluated by linear regression analysis and Pearson test. RESULTS Cardiac index (1.9+/-0.2 vs 2.3+/-0.5 ml/min/m(2)), MAP (83+/-11 vs 94+/-13 mm Hg) and CVP (5.7+/-3 vs 7.1+/-3 mmHg) were significantly higher at T1 compared with T0. The correlation of Delta DO(2) with DeltaScvO(2) was positive, significant (r=0.41; P=0.004) and superior to its correlation with Delta MAP (r=0.30; P=0.01) or Delta CVP (r=0.03; P=0.78). CONCLUSION A significant correlation between ScvO(2) and DO(2) changes was found in patients receiving fluid therapy following coronary surgery. ScvO(2) could be used as an indicator to track DO(2) and to guide volume loading.
Collapse
Affiliation(s)
- A Yazigi
- Department of Anesthesia and Surgical Intensive Care, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
| | | | | | | | | | | |
Collapse
|
6
|
Caille V, Squara P. Oxygen uptake-to-delivery relationship: a way to assess adequate flow. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10 Suppl 3:S4. [PMID: 17164016 PMCID: PMC3226126 DOI: 10.1186/cc4831] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Invasive and noninvasive monitoring facilitates clinical evaluation when resuscitating patients with complex haemodynamic disorders. If the macrocirculation is to be stable, then it must adapt to blood flow or blood flow must be optimized. The objective of flow monitoring is to assist with matching observed oxygen consumption (VO2) to pathophysiological needs. If an adequate balance cannot be maintained then dysoxia occurs. In this review we propose a simple schema for global reasoning; we discuss the limitations of VO2 and arterial oxygen delivery (DaO2) assessment; and we address concerns about increasing DaO2 to supranormal values or targeting pre-established levels of DaO2, cardiac output, or mixed venous oxygen saturation. All of these haemodynamic variables are interrelated and limited by physiological and/or pathological processes. A unique global challenge, and one that is of great prognostic interest, is to achieve rapid matching between observed and needed VO2--no more and no less. However, measuring or calculating these two variables at the bedside remains difficult. In practice, we propose a distinction between three situations. Clinical and blood lactate clearance improvements can limit investigations in simple cases. Intermediate cases may be managed by continuous monitoring of VO2-related variables such as DaO2, cardiac output, or mixed venous oxygen saturation. In more complex cases, three methods can help to estimate the needed VO2 level: comparison with expected values from past physiological studies; analysis of the relationship between VO2 and oxygen delivery; and use of computer software to integrate the preceding two methods.
Collapse
Affiliation(s)
- Vincent Caille
- Service de Chirurgie Cardio-vasculaire, Hôpital Foch, Suresnes, France
| | - Pierre Squara
- Ceric, Clinique Ambroise Pare, Neuilly-Sur-Seine, France
| |
Collapse
|
7
|
Multicentre study on peri- and postoperative central venous oxygen saturation in high-risk surgical patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10:R158. [PMID: 17101038 PMCID: PMC1794462 DOI: 10.1186/cc5094] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 08/30/2006] [Accepted: 11/13/2006] [Indexed: 01/20/2023]
Abstract
Introduction Low central venous oxygen saturation (ScvO2) has been associated with increased risk of postoperative complications in high-risk surgery. Whether this association is centre-specific or more generalisable is not known. The aim of this study was to assess the association between peri- and postoperative ScvO2 and outcome in high-risk surgical patients in a multicentre setting. Methods Three large European university hospitals (two in Finland, one in Switzerland) participated. In 60 patients with intra-abdominal surgery lasting more than 90 minutes, the presence of at least two of Shoemaker's criteria, and ASA (American Society of Anesthesiologists) class greater than 2, ScvO2 was determined preoperatively and at two hour intervals during the operation until 12 hours postoperatively. Hospital length of stay (LOS) mortality, and predefined postoperative complications were recorded. Results The age of the patients was 72 ± 10 years (mean ± standard deviation), and simplified acute physiology score (SAPS II) was 32 ± 12. Hospital LOS was 10.5 (8 to 14) days, and 28-day hospital mortality was 10.0%. Preoperative ScvO2 decreased from 77% ± 10% to 70% ± 11% (p < 0.001) immediately after surgery and remained unchanged 12 hours later. A total of 67 postoperative complications were recorded in 32 patients. After multivariate analysis, mean ScvO2 value (odds ratio [OR] 1.23 [95% confidence interval (CI) 1.01 to 1.50], p = 0.037), hospital LOS (OR 0.75 [95% CI 0.59 to 0.94], p = 0.012), and SAPS II (OR 0.90 [95% CI 0.82 to 0.99], p = 0.029) were independently associated with postoperative complications. The optimal value of mean ScvO2 to discriminate between patients who did or did not develop complications was 73% (sensitivity 72%, specificity 61%). Conclusion Low ScvO2 perioperatively is related to increased risk of postoperative complications in high-risk surgery. This warrants trials with goal-directed therapy using ScvO2 as a target in high-risk surgery patients.
Collapse
|
8
|
Varpula M, Karlsson S, Ruokonen E, Pettilä V. Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock. Intensive Care Med 2006; 32:1336-43. [PMID: 16826387 DOI: 10.1007/s00134-006-0270-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Accepted: 06/08/2006] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Central venous oxygen saturation (ScvO2) in initial resuscitation is included in the Surviving Sepsis Campaign guidelines. ScvO2 monitoring has also been suggested to be comparable to mixed venous oxygen saturation (SvO2) for clinical purposes. The aim of our study was to assess the correlation and agreement of ScvO2 and SvO2 and compare ScvO2-SvO2 difference to lactate, oxygen-derived and hemodynamic parameters in early septic shock in ICU after initial resuscitation. DESIGN AND SETTING Prospective clinical study with 16 patients with septic shock at two university hospital ICUs. A dose of norepinephrine over 0.1 microg/kg/min was required for inclusion. MEASUREMENTS AND RESULTS Five paired ScvO2 and SvO2 samples at 6-h intervals, altogether 72 samples, were collected during 24 h. The mean SvO2 was below the mean ScvO2 at all time points. Bias of difference was 4.2% and 95% limits of agreement ranged from -8.1% to 16.5%. The difference correlated significantly to CI and DO2. CONCLUSIONS The difference between paired ScvO2 and SvO2 varies highly. Therefore, SvO2 may not be estimated on the basis of ScvO2 in treatment of septic shock after resuscitation period in ICU.
Collapse
Affiliation(s)
- Marjut Varpula
- Helsinki University Hospital, POB 340, 00029 HUS, Helsinki, Finland.
| | | | | | | |
Collapse
|
9
|
|
10
|
Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Changes in central venous saturation after major surgery, and association with outcome. Crit Care 2005; 9:R694-9. [PMID: 16356220 PMCID: PMC1414025 DOI: 10.1186/cc3888] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 09/30/2005] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Despite recent interest in measurement of central venous oxygen saturation (ScvO2), there are no published data describing the pattern of ScvO2 changes after major general surgery or any relationship with outcome. METHODS ScvO2 and other biochemical, physiological and demographic data were prospectively measured for 8 hours after major surgery. Complications and deaths occurring within 28 days of enrollment were included in the data analysis. Independent predictors of complications were identified with the use of logistic regression analysis. Optimum cutoffs for ScvO2 were identified by receiver operator characteristic analysis. RESULTS Data from 118 patients was analysed; 123 morbidity episodes occurred in 64 these patients. There were 12 deaths (10.2%). The mean +/- SD age was 66.8 +/- 11.4 years. Twenty patients (17%) underwent emergency surgery and 77 patients (66%) were male. The mean +/- SD P-POSSUM (Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity) score was 38.6 +/- 7.7, with a predicted mortality of 16.7 +/- 17.6%. After multivariate analysis, the lowest cardiac index value (odds ratio (OR) 0.58 (95% confidence intervals 0.37 to 0.9); p = 0.018), lowest ScvO2 value (OR 0.94 (0.89 to 0.98); p = 0.007) and P-POSSUM score (OR 1.09 (1.02 to 1.15); p = 0.008) were independently associated with post-operative complications. The optimal ScvO2 cutoff value for morbidity prediction was 64.4%. In the first hour after surgery, significant reductions in ScvO2 were observed, but there were no significant changes in CI or oxygen delivery index during the same period. CONCLUSION Significant fluctuations in ScvO2 occur in the immediate post-operative period. These fluctuations are not always associated with changes in oxygen delivery, suggesting that oxygen consumption is also an important determinant of ScvO2. Reductions in ScvO2 are independently associated with post-operative complications.
Collapse
Affiliation(s)
- Rupert Pearse
- Adult Intensive Care Unit, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
| | | | | | | | | | | |
Collapse
|
11
|
Krantz T, Warberg J, Secher NH. Venous oxygen saturation during normovolaemic haemodilution in the pig. Acta Anaesthesiol Scand 2005; 49:1149-56. [PMID: 16095457 DOI: 10.1111/j.1399-6576.2005.00778.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hypovolaemia may be considered to represent a volume-restricted cardiac output (CO), but CO varies inversely with the haemoglobin concentration (Hb) and a maximal mixed venous oxygen saturation (SvO2) may be a better target for volume administration than a maximal CO. METHODS In 10 anaesthetized pigs, volume loading with 6% hydroxyethyl starch was performed to obtain a maximal SvO2 followed by normovolaemic haemodilution with 6% hydroxyethyl starch. RESULTS Volume loading increased SvO2 from 55.0+/-5.2% to 64.8+/-9.0% (mean+/-SD) associated with an increase in CO (2.3+/-0.4 to 3.5+/-0.9 l/min) and central venous oxygen saturation (ScvO2; 68.2+/-9.3% to 79.4+/-7.2%; P<0.05). Heart rate (HR), mean arterial (MAP), central venous (CVP), pulmonary arterial mean (PAMP), and occlusion pressures (PAOP) increased as well (P<0.05). In contrast, during progressive haemodilution, SvO2 and ScvO2 remained statistically unchanged until the haemoglobin concentration had decreased from 5.5+/-0.4 to 2.9+/-0.2 mM, while CO and HR increased at a haemoglobin value of 4.4+/-0.4 and 4.0+/-0.4 mM and CVP and PAOP decreased at a haemoglobin of 4.0+/-0.4 and 2.9+/-0.2 mM, respectively (P<0.05) leaving MAP unaffected. CONCLUSION This study found that volume loading increased cardiac output and mixed and central venous oxygen saturations in parallel, but during normovolaemic haemodilution an increase in cardiac output left mixed and central venous oxygen saturations statistically unchanged until haemoglobin concentration was reduced by approximately 50%. Accordingly, volume therapy should be directed to maintain a high venous oxygen saturation rather than a change in cardiac output.
Collapse
Affiliation(s)
- T Krantz
- Copenhagen Muscle Research Center, Department of Anesthesia, Rigshospitalet, Denmark.
| | | | | |
Collapse
|
12
|
Klaus S, Eichler W, Heringlake M, Schmucker P, Bahlmann L. Assessment of fluid balance by measurement of skin tissue thickness during clinical anaesthesia. Clin Physiol Funct Imaging 2002; 22:197-201. [PMID: 12076345 DOI: 10.1046/j.1475-097x.2002.00417.x] [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: 11/20/2022]
Abstract
STUDY OBJECTIVE To determine if measuring skin tissue thickness by a recently developed 10 MHz ultrasound scan may be used as a valuable parameter to guide fluid therapy and detect fluid shifts to the extravascular space during surgical procedures in addition to central venous pressure (CVP). STUDY DESIGN Prospective, clinical and observational study. SETTING An operation theatre of the Ear Nose Throat (ENT) department of an university hospital. PATIENTS Following approval by the local ethics committee 12 otherwise healthy male patients undergoing ENT surgery for oropharyngeal carcinoma were involved in this study. The patients stayed nil per os for 10 h before induction of anaesthesia. INTERVENTIONS/MEASUREMENTS: Crystalline fluids (Ringer's solution) were supplied at a constant rate of 10 ml kg-1 bw h-1. Patients were kept in the supine position during surgery, no further interventions were performed. Additional to routine monitoring, tissue thickness (TT) of proximal pre-tibial skin and CVP were measured every 30 min, haematocrit was determined hourly for 5 h starting at t0. MAIN RESULTS Haematocrit constantly declined during the observation period, showing a significant difference in t0 after 120 min. The increase in TT was strongly correlated with intraoperative positive fluid balance (r=0.96), while the course of CVP did not reflect the amount of fluid application comparably. CONCLUSIONS Non-invasive determinations of skin tissue thickness by the presented ultrasonic device appears to give additional information on fluid intake and distribution during clinical anaesthesia.
Collapse
Affiliation(s)
- Stephan Klaus
- Department of Anaesthesiology, Medical University of Luebeck, Germany.
| | | | | | | | | |
Collapse
|
13
|
Rivers EP, Ander DS, Powell D. Central venous oxygen saturation monitoring in the critically ill patient. Curr Opin Crit Care 2001; 7:204-11. [PMID: 11436529 DOI: 10.1097/00075198-200106000-00011] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the initial treatment of a critically ill patient, blood pressure, heart rate, urine output, and central venous pressure guide resuscitative efforts. Despite normalization of these variables, global tissue hypoxia may still persist and has been implicated in the development of multiorgan failure and increased mortality. Definitive management includes intensive care unit admission, pulmonary artery catheterization using mixed venous oxygen saturation (SvO2), and hemodynamic optimization. In the absence of or before definitive management, hemodynamic optimization can be performed using central venous oxygen saturation (ScvO2) as a surrogate. The physiology, technology, clinical uses, and rationale for ScvO2 monitoring are reviewed, including issues regarding physiologic equivalence to SvO2. The clinical use of ScvO2 monitoring, evidence-based outcome implications, and limitations of ScvO2 monitoring will also be examined.
Collapse
Affiliation(s)
- E P Rivers
- Department of Emergency Medicine, Henry Ford Health System, Case Western Reserve University, Detroit, Michigan, USA
| | | | | |
Collapse
|
14
|
Ener BK. Dorsal pedal venous oximetry as an outcome index of lower extremity revascularizations. VASCULAR SURGERY 2001; 35:37-41. [PMID: 11668367 DOI: 10.1177/153857440103500107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dorsal pedal venous blood gas analysis was performed in 24 patients with arterial occlusive disease requiring revascularizations of the lower extremities. After the reconstructive surgical procedure, measurements were repeated. It has been observed that this method is useful before surgery since it proves the severity of tissue hypoxia due to perfusion impairment of the foot. Postoperative measurements have detected the effectiveness of the vascular restorations. The results of the trial showed a mean increase in partial pressure of venous blood oxygen (PVO2) and pH of 30.3% and 13.7% (p<0.05), respectively and a mean decrease in partial pressure of arterial carbon dioxide (PCO2) of 12.9% (p<0.05) between initial and postsurgical measurements in involved legs. In the healthy, unoperated on side, there was no significant (p>0.05) change in response to arterial reconstructions. Symptoms decreased markedly in direct proportion to the increase in dorsal pedal venous PO2 induced by changes in blood flow. This method can be reliably used for assessing the treatment to ensure adequate oxygen delivery to the foot as a result of improved pedal perfusion.
Collapse
Affiliation(s)
- B K Ener
- Department of Vascular Surgery, Canakkale State Hospital, Canakkale, Turkey
| |
Collapse
|
15
|
Krantz T, Cai Y, Lauritsen T, Warberg J, Secher NH. Accurate monitoring of blood loss: thoracic electrical impedance during hemorrhage in the pig. Acta Anaesthesiol Scand 2000; 44:598-604. [PMID: 10786749 DOI: 10.1034/j.1399-6576.2000.00519.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiovascular variables are closely regulated in that they remain relatively stable during minor hemorrhage. We considered that such stability would make these variables less accurate for monitoring a blood loss. In contrast, thoracic electrical impedance would be unlikely to be a regulated variable and could serve as a non-invasive monitor of a volume deficit. METHODS In 10 pigs bled (0-24 ml kg(-1)) and retransfused (to 28 ml kg(-1)) during halothane anesthesia, the magnitude of the electrical impedance, cardiovascular, blood gas and temperature variables, atrial natriuretic peptide and near infrared spectroscopy of the leg muscles were recorded. RESULTS During hemorrhage and retransfusion, the median correlations between changes in the magnitude of the thoracic impedance and the external blood loss ranged from 0.97 to 0.98 with an individual range from 0.80 to 1.0. These correlation coefficients were higher and their ranges were lower than correlations established for any other measured parameter. CONCLUSION During hemorrhage and retransfusion in the halothane anesthetized pig, a change in the magnitude of thoracic electrical impedance appears to be an accurate and also non-invasive monitor of a blood volume deficit.
Collapse
Affiliation(s)
- T Krantz
- Department of Anesthesia, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
16
|
Trittenwein G, Pansi H, Graf B, Golej J, Burda G, Hermon M, Marx M, Wollenek G, Trittenwein H, Pollak A. Proposed entry criteria for postoperative cardiac extracorporeal membrane oxygenation after pediatric open heart surgery. Artif Organs 1999; 23:1010-4. [PMID: 10564307 DOI: 10.1046/j.1525-1594.1999.06457.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria based on parameters readily available, children were examined at postoperative pediatric intensive care unit (PICU) admission. Using hospital mortality as the primary outcome, univariate and multiple logistic regressions were performed to estimate the predictive value of clinical (age, weight, and diagnosis) and laboratory (arterial blood pressure, pH, lactate, creatine kinase, and arterial and central venous oxygen saturation [ScvO2]) variables. Data from 218 children over a 2 year period were analyzed retrospectively. Univariate regression demonstrated that age, weight, diagnosis, blood pressure, venous and arterial saturation, and lactate were significantly associated with postoperative mortality (p < 0.05). In multiple regression, ScvO2 and lactate level were found to be independent predictors and were used in a predictive model (ScvO2 odds ratio: 2.03-828.6, p = 0.016) (lactate odds ratio: 1.58 -4.20, p = 0.0002) (R2 = 0.70). Applying an 80% risk of mortality to establish entry criteria as in neonatal ECMO, PICU admission values of lactate > 70 mg/dl if ScvO2 < 60% or lactate >163 mg/dl if ScvO2 > 60% are proposed to serve as postoperative ECMO entry criteria if bypass weaning has been possible but is followed by low cardiac output.
Collapse
Affiliation(s)
- G Trittenwein
- Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Vienna, Austria
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Perko G, Schmidt JF, Warberg J, Secher NH. Pharmacological manipulation of cardiovascular responses to lower body negative pressure. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1996; 73:459-64. [PMID: 8803507 DOI: 10.1007/bf00334424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To evaluate influences on blood volume distribution, atrial natriuretic peptide concentrations (ANP) and thoracic and leg electrical impedance at 2.5 (TI2.5 and LI2.5, respectively) and 100 kHz (TI100 and LI100, respectively) were monitored during administration of ketanserin, noradrenaline and trimetaphan combined with lower body negative pressure (LBNP) in 12 subjects. Administration of clinically relevant doses of ketanserin alone did not induce changes in mean arterial pressure (MAP) or in the central blood volume, as electrical impedance and ANP concentrations did not change. During continued infusion of ketanserin an increase in MAP from a mean of 90 (range 83-108) to 113 (range 98-138) mmHg was induced by noradrenaline, but TI2.5 [mean 45.6 (range 39.3-54.2)] and TI100 [mean 33.8 (range 27.5-38.5) omega] remainded stable until ganglionic blockade and LBNP were applied, when they increased by a mean of 3.1 (range 2.0-6.1) and 2.7 (range 1.1-4.2) omega, respectively (P < 0.05). Conversely, LI2.5 [mean 79.6 (range 74.1-89.4)] and LI100 [mean 56.7 (range 52.4-63.3) omega] decreased by a mean of 3.2 (range 1.2-8.0) and 2.3 (range 0.9-3.9) omega, ANP from a mean of 27.7 (range 10.2-62.7) to 12.7 (range 7.1-27.5) pmol.l-1 and MAP fell to a mean of 62 (range 42-70) mmHg (P < 0.05). The heart rate was a mean of 75 (range 69-77) beats.min-1 and did not change until LBNP, when it increased to a mean of 102 (range 78-104) beats.min-1, as presyncopal symptoms appeared. The data indicated that serotonergic blockade by ketanserin and alpha-sympathetic stimulation by noradrenaline did not affect blood volume distribution in normal humans, but that ganglionic blockade combined with LBNP reduced the central blood volume as leg volume increased; during central hypovolaemia tachycardia induced by ganglionic blockade did not prevent the fall in MAP, and thereby the appearance of presyncopal symptoms.
Collapse
Affiliation(s)
- G Perko
- Copenhagen Muscle Research Centre, Department of Anaesthesia, Rigshospitalet Blegdamsvej 9, Denmark
| | | | | | | |
Collapse
|
18
|
Doblar DD. Cerebral blood flow velocity and liver transplantation. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1996; 16:97-101. [PMID: 8964136 DOI: 10.1111/j.1475-097x.1996.tb00559.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
19
|
Larsen PN, Moesgaard F, Madsen P, Pedersen M, Secher NH. Subcutaneous oxygen and carbon dioxide tensions during head-up tilt-induced central hypovolaemia in humans. Scand J Clin Lab Invest 1996; 56:17-24. [PMID: 8850168 DOI: 10.3109/00365519609088583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The effect of hypovolaemic shock on subcutaneous oxygen and carbon dioxide tensions was studied in man. Subcutaneous oxygen (Psc,O2) and carbon dioxide (Psc,CO2) tensions were monitored, during 50 degrees head-up tilt (anti-Trendelenburg's position)-induced central hypovolaemia, in two females and eight males, using a silicone tonometer on the lateral upper aspect of the right arm. All cardiovascular variables remained stable at rest. Incremental tilting to 50 degrees increased heart rate (HR) and mean arterial pressure (MAP) (p < 0.01), while stroke volume (SV), cardiac output (CO) and central venous saturation (SvO2) decreased (p < 0.05). Presyncopal symptoms appeared after 28 (8-48) min (mean and range) as HR decreased from 82 (63-108) to 52 (36-70) beats min-1 (p < 0.05), MAP from 88 (61-106) to 46 (37-54) mmHg and SvO2 from 0.68 (0.56-0.76) to 0.58 (0.39-0.70) (p < 0.01). On return of the tilt table to the horizontal position HR, MAP, SV, CO and SvO2 immediately re-established resting values. The Psc,O2 was 83 (72-102) mmHg at rest and during tilting it increased to 89 (82-111) mmHg followed by a decrease to 72 (58-97) mmHg (p < 0.01) at the appearance of presyncopal symptoms. Psc,O2 returned to the pretilt level over 45 (30-60) min of recovery. Arterial oxygen, carbon dioxide and Psc,CO2 did not change significantly. Subcutaneous oxygen tension decreases during marked central hypovolaemia and it returns slowly to the resting level during recovery. Psc,O2 is a more sensitive marker of impaired tissue oxygenation than arterial oxygen pressure.
Collapse
Affiliation(s)
- P N Larsen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- B Oberg
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | | |
Collapse
|
21
|
Pedersen M, Madsen P, Klokker M, Olesen HL, Secher NH. Sympathetic influence on cardiovascular responses to sustained head-up tilt in humans. ACTA PHYSIOLOGICA SCANDINAVICA 1995; 155:435-44. [PMID: 8719263 DOI: 10.1111/j.1748-1716.1995.tb09993.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Sympathetic beta-adrenergic influences on cardiovascular responses to 50 degrees head-up tilt were evaluated with metoprolol (beta 1-blockade; 0.29 mg kg-1) and propranolol (beta 1 and beta 2-blockade; 0.28 mg kg-1) in eight males. A normotensive-tachycardic phase was followed by a hypotensive-bradycardic episode associated with presyncopal symptoms after 23 +/- 3 min (control, mean +/- SE). Head-up tilt made thoracic electrical impedance (3.0 +/- 1.0 omega), mean arterial pressure (MAP, 86 +/- 4-93 +/- 4 mmHg), heart rate (HR, 63 +/- 3-99 +/- 10 beats min-1) and total peripheral resistance (TPR, 15 +/- 1-28 +/- 4 mmHg min L-1) increase, while central venous oxygen saturation (74 +/- 2-58 +/- 4%), cardiac output (5.7 +/- 0.1-3.1 +/- 0.3 L min-1), stroke volume (95 +/- 6-41 +/- 5 mL) and pulse pressure (55 +/- 4-49 +/- 4 mmHg) decreased (P < 0.05). Central venous pressure decreased during head-up tilt (7 +/- 2-0 +/- 1 mmHg), but it remained stable during the sustained tilt. At the appearance of presyncopal symptoms MAP (49 +/- 3 mmHg), HR (66 +/- 4 beats min-1) and TPR (15 +/- 3 mmHg min L-1) decreased (P < 0.05). Neither metoprolol or propranolol changed tilt tolerance or cardiovascular variables, except for HR that remained at 57 +/- 2 (metoprolol) and 55 +/- 3 beats min-1 (propranolol), and MAP that remained at 87 +/- 5 mmHg during the first phase with metoprolol. In conclusion, sympathetic activation was crucial for the heart rate elevation during normotensive head-up tilt, but not for tilt tolerance or for the associated hypotension and bradycardia.
Collapse
Affiliation(s)
- M Pedersen
- Department of Anaesthesia, University of Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
22
|
Madsen P, Lyck F, Pedersen M, Olesen HL, Nielsen H, Secher NH. Brain and muscle oxygen saturation during head-up-tilt-induced central hypovolaemia in humans. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1995; 15:523-33. [PMID: 8846672 DOI: 10.1111/j.1475-097x.1995.tb00541.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Near-infrared spectrophotometry-determined cerebral (ScO2) and muscle oxygen saturations (SmO2) were followed in 15 volunteers during passive 50 degrees head-up-tilt-induced central hypovolaemia, and in nine volunteers during ventilatory manoeuvres affecting arterial carbon dioxide tension. During head-up tilt, mean arterial pressure [MAP, 88 (77-118) to 97 (80-136) mmHg, median and range] and heart rate [HR; 66 (49-77) to 87 (42-132) beats min-1 P < 0.01] increased, but after 22 (1-45) min they declined [to 61 (40-91) mmHg and 69 (38-109) beats min-1, respectively, P = 0.001] and pre-syncopal symptoms developed. Central hypovolaemia was indicated by an increased thoracic electrical impedance, and a decreased cardiac output and central venous oxygen saturation. The arterial oxygen saturation, pulmonal oxygen uptake and skin temperatures remained constant. The ScO2 remained stable at 72 (62-77)% until the pre-syncopal incidence, when it decreased to 62 (31-73)% (P = 0.001), and tilt down made it increase to 75 (36-87)% (P < 0.05) before the recovery value was established. In contrast, SmO2 decreased during tilting [75(70-87) to 65 (53-70)%], and recovered to 70 (53-83)%, P < 0.01) during the hypotensive episode. The end-tidal CO2 tension decreased only during tilt-up. The ScO2 decreased, and SmO2 increased during hyperventilation, and ScO2 increased during breathing of 5% carbon dioxide. Rebreathing from a bag made SmO2 decrease and resulted in a biphasic ScO2 response: it first increased and subsequently decreased. Cardiovascular changes during tilt were not reflected in skin temperature. The ScO2 reflected the maintained autoregulation of cerebral blood flow until the perfusion pressure decreased markedly. In contrast, SmO2 mirrored muscle vasoconstriction early during tilt, and vasodilatation when pre-syncopal symptoms appeared.
Collapse
Affiliation(s)
- P Madsen
- Copenhagen Muscle Research Centre, Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
23
|
Jenstrup M, Ejlersen E, Mogensen T, Secher NH. A maximal central venous oxygen saturation (SvO2max) for the surgical patient. ACTA ANAESTHESIOLOGICA SCANDINAVICA. SUPPLEMENTUM 1995; 107:29-32. [PMID: 8599293 DOI: 10.1111/j.1399-6576.1995.tb04326.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Before induction of anaesthesia, 23 patients scheduled for major abdominal surgery had blood samples drawn from a central venous catheter for oxygen saturation (SvO2) after graded infusion of isotonic saline. The infusion of saline was continued until further administration resulted in a stable SvO2 (SvO2max). The SvO2 increased from 69 (53-83) to 72 (66-83) % (median and range; P < 0.0001), when the patients received 10 (0-26) mL.kg-1, average 500 mL, of saline. At the same time central venous haematocrit decreased from 38 (32-47) to 36 (23-47) % which suggests that the intravascular volume was expanded by 420 (180-3070) mL or by 72 (18-174) % of the administered volume. The results demonstrate that volume expansion by saline can establish a maximal venous oxygen saturation in the surgical patient.
Collapse
Affiliation(s)
- M Jenstrup
- Department of Anaesthesia, Righospitalet, University of Copenhagen, Denmark
| | | | | | | |
Collapse
|
24
|
Jónsson F, Madsen P, Jørgensen LG, Lunding M, Secher NH. Thoracic electrical impedance and fluid balance during aortic surgery. Acta Anaesthesiol Scand 1995; 39:513-7. [PMID: 7676789 DOI: 10.1111/j.1399-6576.1995.tb04110.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Indices of fluid balance were evaluated during and after aortic surgery in 16 consecutive patients. Thoracic electrical impedance (TI), heart rate (HR), central venous (CVP), pulmonary artery mean (PAMP), pulmonary wedge (PWP) and mean arterial (MAP) pressure as well as fourteen arterial and venous blood gas variables were followed. Consistent with a reduction of T1 by 4.2 (-5.2 to 9.2) Ohm (median and range) during the operation, fluid balance was in excess of 1.8 (-0.1 to 3.3) 1 when evaporation was not taken into account, and it remained elevated by 1.3 (0.0 to 5.4) 1 on the first postoperative morning. The HR, MAP and PWP remained stable, while CVP and PAMP decreased by 6 (-2 to 13) and 6 (-1 to 22) mmHg, respectively. Of the determined variables only TI revealed a meaningful correlation to fluid balance (rho = -0.41; P < 0.01). Haemoglobin concentrations increased in proportion to the administered packed erythrocytes, while arterial oxygen saturation, pH and base excess decreased in proportion to the excess fluid. The results indicate that while central venous and pulmonary artery mean pressures gave the impression of a volume deficit, the positive fluid balance was mirrored by thoracic electrical impedance, and that even a minor increase of fluid balance may affect pulmonary function in patients subjected to aortic surgery.
Collapse
Affiliation(s)
- F Jónsson
- Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
25
|
Pott F, Larsen FS, Ejlersen E, Linkis P, Jørgensen LG, Secher NH. Cerebral perfusion during human liver transplantation. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1995; 15:119-30. [PMID: 7600732 DOI: 10.1111/j.1475-097x.1995.tb00436.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
During transplantation of the liver cerebral perfusion was monitored by transcranial Doppler determined middle cerebral artery mean flow velocity (Vmean) and pulsatility index (PI) in six fulminant hepatic failure patients and 11 patients with chronic liver disease. In both groups of patients Vmean, PI and central haemodynamic variables were recorded during (1) the last preanhepatic hour; (2) the anhepatic phase; (3) the first 15 min of reperfusion; and (4) for the following 45 min of reperfusion. No significant differences were detected between the two groups of patients with respect to changes of variables with time. The Vmean (40 +/- 13 cm s-1 [mean +/- SD]), thoracic electrical impedance (TI) (30 +/- 7 Ohm), heart rate (97 +/- 19 beats min-1), mean arterial pressure (84 +/- 9 mmHg) and arterial carbon dioxide tension (PaCO2, 4.5 +/- 0.4 kPa) remained stable in the anhepatic phase, while cardiac output (CO, 7.6 +/- 2.7 to 5.4 +/- 1.41 min-1), stroke volume (SV, 79 +/- 26 to 56 +/- 15 ml) and PI (1.2 +/- 0.3 to 0.9 +/- 0.2) decreased (P < 0.05). During reperfusion, CO (9.9 +/- 4.01 min-1), SV (105 +/- 40 ml), PaCO2 (5.5 +/- 0.6 kPa), Vmean (57 +/- 17 cm s-1) and PI (1.2 +/- 0.2) became elevated. Taken together, during the anhepatic phase of the liver transplantation a maintained central blood volume as indicated by the constant TI served for a stable blood pressure and in turn cerebral perfusion, whereas revascularization of the graft increased cerebral perfusion concomitant with an elevated carbon dioxide tension.
Collapse
Affiliation(s)
- F Pott
- Copenhagen Muscle Research Centre, Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
26
|
Madsen P, Klokker M, Olesen HL, Secher NH. Naloxone-provoked vaso-vagal response to head-up tilt in men. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1995; 70:246-51. [PMID: 7607200 DOI: 10.1007/bf00238571] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A double-blind paired protocol was used to evaluate, in eight male volunteers, the effects of the endogenous opiate antagonist naloxone (NAL; 0.05 mg.kg-1) on cardiovascular responses to 50 degrees head-up tilt-induced central hypovolaemia. Progressive central hypovolaemia was characterized by a phase of normotensive-tachycardia followed by an episode of hypotensive-bradycardia. The NAL shortened the former from 20 (8-40) to 5 (3-10) min (median and range; P < 0.02). Control head-up tilt increased the means of thoracic electrical impedance [from 35.8 (SEM 2.1) to 40.0 (SEM 1.8) omega; P < 0.01] of heart rate [HR; from 67 (SEM 5) to 96 (SEM 8) beats.min-1, P < 0.02], of total peripheral resistance [TPR; from 25.5 (SEM 3.2) to 50.4 (SEM 10.5)mmHg.min.1-1, P < 0.05] and of mean arterial pressure [MAP; from 96 (SEM 2) to 101 (SEM 2)mmHg, P < 0.02]. Decreases were observed in stroke volume [from 65 (SEM 12) to 38 (SEM 9) ml, P < 0.01], in cardiac output [from 3.7 (SEM 0.7) to 2.5 (SEM 0.5) 1.min-1, P < 0.01], in pulse pressure [from 55 (SEM 4) to 37 (SEM 3)mmHg, P < 0.01] and in central venous oxygen saturation [from 73 (SEM 2) to 59 (SEM 4)%, P < 0.01]. During NAL, mean HR increased from 70 (SEM 3); n.s. compared to control) to only 86 (SEM 9) beats.min-1 (P < 0.02 compared to control) and MAP remained stable.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P Madsen
- Copenhagen Muscle Research Centre, Department of Anaesthesia, Rigshospitalet 2034, University of Copenhagen, Denmark
| | | | | | | |
Collapse
|
27
|
Iversen HK, Madsen P, Matzen S, Secher NH. Arterial diameter during central volume depletion in humans. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1995; 72:165-9. [PMID: 8789588 DOI: 10.1007/bf00964132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The luminal diameter of the radial artery was followed by high frequency ultrasound during 50 degrees head-up tilt-induced central volume depletion in ten healthy subjects of whom six were tilted twice and pretreated with the serotonin receptor antagonist methysergide or placebo following a double-blind randomized design. Eight subjects without active treatment experienced presyncopal symptoms after 16-45 (mean 32 min). Central volume depletion was indicated by an increase in mean thoracic electrical impedance [from 31.5 (SEM 1.6) to 33.4 (SEM 1.7) omega; P < 0.05]. Cardiac output decreased [from 4.1 (SEM 0.3) to 2.2 (SEM 0.3) 1.min-1] and heart rate [HR, from 64 (SEM 3) to 100 (SEM 7) beats.min-1], mean arterial pressure (MAP, from 77 (SEM 4) to 89 (SEM 2) mmHg [10.3 (SEM 0.53 to 11.9 (SEM 0.27) kPa]) and total peripheral resistance (TPR, from 19 (SEM 2) to 34 (SEM 4) mmHg.min.1-1 [2.5 (SEM 0.27) to 4.5 (SEM 0.53) kPa.min.1-1]) increased; but with the appearance of presyncopal symptoms, HR, MAP and TPR were reduced to 65 (SEM 8) beats.min-1, 46 (SEM 4) mmHg [6.1 (SEM 0.53) kPa] and 18 (SEM 3) mmHg.min.1-1 [2.4 (SEM 0.4) kPa.min-1.1-1], respectively (P < 0.05). Vascular resistance was reflected in the arterial diameter which decreased from 2.42 (SEM 0.17) to 2.27 (SEM 0.14) mm during head-up tilt and increased to 2.71 (SEM 0.14) mm with the appearance of presyncopal symptoms (P < 0.05). Methysergide reduced the resting radial (15 +/- 2%) and temporal artery diameters (10 +/- 3%) (P < 0.05); however, it affected neither tilt-tolerance nor the central cardiovascular response to tilt. The results suggested a serotonergic influence on arterial tone at rest, and demonstrated that vessels as large as the radial artery participated in vascular control during central volume depletion independent of such a serotonergic influence.
Collapse
Affiliation(s)
- H K Iversen
- Department of Neurology, University of Copenhagen, Denmark
| | | | | | | |
Collapse
|
28
|
Perko G, Payne G, Linkis P, Jørgensen LG, Landow L, Warberg J, Secher NH. Thoracic impedance and pulmonary atrial natriuretic peptide during head-up tilt induced hypovolaemic shock in humans. ACTA PHYSIOLOGICA SCANDINAVICA 1994; 150:449-54. [PMID: 8036913 DOI: 10.1111/j.1748-1716.1994.tb09710.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Head up and down tilts were used for manipulating the central blood volume in eight volunteers. During head-up tilt thoracic electrical impedance (TI) increased from 36.7 (33.9-52.1) ohm (mean and range) to 41.9 (36.9-59.2) ohm, heart rate from 60 (49-72) to 80 (65-90) beats min-1 (P < 0.05) and decreased again to 57 (48-67) beats min-1 accompanying a fall in mean arterial pressure from 86 (76-97) to 54 (41-79) mmHg and in cardiac output from 9.2 (5.9-12.1) to 6.9 (3.4-8.8) 1 min-1 (n = 7, P < 0.07). Central venous pressure did not change significantly. Pulmonary arterial mean, 6 (3-12) mmHg, and wedge pressures, 4 (1-9) mmHg, decreased to 4 (1-11) and 1 (0-7) mmHg, respectively, and mixed, 78 (77-79%), and central venous oxygen saturations, 72 (71-73)%, fell to 62 (46-75) and 54 (44-58)%, respectively (P < 0.05). Atrial natriuretic peptide (ANP) was determined from blood of the superior vena cava and pulmonary and brachial arteries. Pulmonary artery ANP, 18.4 (7.5-30.7) pmol l-1, was higher than in vena cava, 13.3 (5.2-20.9) pmol l-1 (P < 0.05). At the time of presyncope, pulmonary artery ANP decreased from 20.8 (37.4-10.1) to 13.7 (19.7-5.7) pmol l-1, in vena cava from 13.8 (23.1-7.1) to 10.2 (17.9-6.7) pmol l-1 and in the brachial artery from 16.9 (34.1-5.2) to 11.3 (18.5-5.1) pmol l-1 (P < 0.05). Head-down tilt did not affect the recorded variables significantly. Thoracic electrical impedance, pulmonary artery pressure and venous oxygen saturations were sensitive indices of the central blood volume as reflected in the release of atrial natriuretic peptide from the right side of the heart.
Collapse
Affiliation(s)
- G Perko
- Department of Anaesthesia, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | | | | |
Collapse
|
29
|
Madsen P, Olesen HL, Klokker M, Secher NH. Peripheral venous oxygen saturation during head-up tilt induced hypovolaemic shock in humans. Scand J Clin Lab Invest 1993; 53:411-6. [PMID: 8378745 DOI: 10.3109/00365519309086634] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We followed central, median cubital and dorsal metacarpal venous oxygen saturations (SvO2) during 50 degrees head-up tilt (anti-Trendelenburg's position) induced central hypovolaemia in eight males. Head-up tilt resulted in slight tachycardia of 101 (60-120) beats min-1 (median with range) and a stable mean arterial pressure (MAP) of 100 (88-114) mmHg. After 13 (6-23) min presyncopal symptoms appeared, accompanied by decreases in heart rate to 75 (51-97) beats min-1 and in MAP to 59 (49-76) mmHg (p < 0.01). Cardiac output decreased 0.9 (0.3-1.6) 1 min-1 while thoracic electrical impedance increased 3.4 (-1.2-5.9) Ohm (p < 0.01). Tilt-up decreased central venous pressure, but during sustained tilt it remained unchanged. Arterial oxygen saturation did not change. Head-up tilt decreased central SvO2 by 12 (5-24)% (p < 0.01). Median cubital SvO2 decreased 8 (-5-25)% (p < 0.02) during tilting, and it remained at this level during sustained tilt. Only five of eight samples from the dorsal metacarpal vein could be obtained. In these samples SvO2 was lowered by 15 (7-26)% (p = 0.01) at the onset of presyncopal symptoms. The results indicate that loss of central blood volume is reflected in central as well as peripheral SvO2. However, for reliable monitoring of blood volume changes, central SvO2 is the most useful variable, as this SvO2 changed consistently with the central blood volume, and blood samples could be obtained readily from the central venous catheter.
Collapse
Affiliation(s)
- P Madsen
- Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | |
Collapse
|