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Levy D, Saura O, Lucenteforte M, Collado Lledó E, Demondion P, Hammoudi N, Assouline B, Petit M, Gautier M, Le Fevre L, Pineton de Chambrun M, Coutance G, Berg E, Chommeloux J, Schmidt M, Luyt CE, Lebreton G, Leprince P, Hékimian G, Combes A. Isoproterenol improves hemodynamics and right ventricle-pulmonary artery coupling after heart transplantation. Am J Physiol Heart Circ Physiol 2024; 327:H131-H137. [PMID: 38700470 DOI: 10.1152/ajpheart.00200.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/05/2024]
Abstract
Right ventricular failure (RVF) is a major cause of early mortality after heart transplantation (HT). Isoproterenol (Iso) has chronotropic, inotropic, and vasodilatory properties, which might improve right ventricle function in this setting. We aimed to investigate the hemodynamic effects of isoproterenol on patients with post-HT RVF. We conducted a 1-yr retrospective observational study including patients receiving isoproterenol (Iso) and dobutamine for early RVF after HT. A comprehensive multiparametric hemodynamic evaluation was performed successively three times: no isoproterenol, low doses: 0.025 µg/kg/min, and high doses: 0.05 µg/kg/min (henceforth, respectively, called no Iso, low Iso, and high Iso). From June 2022 to June 2023, 25 patients, median [interquartile range (IQR) 25-75] age 54 [38-61] yr, were included. Before isoproterenol was introduced, all patients received dobutamine, and 15 (60%) were on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Isoproterenol significantly increased heart rate from 84 [77-99] (no Iso) to 91 [88-106] (low Iso) and 102 [90-122] beats/min (high Iso, P < 0.001). Similarly, cardiac index rose from 2.3 [1.4-3.1] to 2.7 [1.8-3.4] and 3 [1.9-3.7] L/min/m2 (P < 0.001) with a concomitant increase in indexed stroke volume (28 [17-34] to 31 [20-34] and 33 [23-35] mL/m2, P < 0.05). Effective pulmonary arterial elastance and pressures were not modified by isoproterenol. Pulmonary vascular resistance (PVR) tended to decrease from 2.9 [1.4-3.6] to 2.3 [1.3-3.5] wood units (WU), P = 0.06. Right ventricular ejection fraction/systolic pulmonary artery pressure (sPAP) evaluating right ventricle-pulmonary artery (RV-PA) coupling increased after isoproterenol from 0.8 to 0.9 and 1%·mmHg-1 (P = 0.001). In conclusion, in post-HT RVF, isoproterenol exhibits chronotropic and inotropic effects, thereby improving RV-PA coupling and resulting in a clinically relevant increase in the cardiac index.NEW & NOTEWORTHY This study offers a detailed and comprehensive hemodynamic investigation at the bedside, illustrating the favorable impact of isoproterenol on right ventricular-pulmonary arterial coupling and global hemodynamics. It elucidates the physiological effects of an underused inotropic strategy in a critical clinical scenario. By enhancing cardiac hemodynamics, isoproterenol has the potential to expedite right ventricular recovery and mitigate primary graft dysfunction, thereby reducing the duration of mechanical support and intensive care unit stay posttransplantation.
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Affiliation(s)
- David Levy
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ouriel Saura
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Manuela Lucenteforte
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Department of Health Sciences, University of Milan, Milano, Italy
| | - Elena Collado Lledó
- Acute Cardiovascular Care Unit, Department of Cardiology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Pierre Demondion
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166 and Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Boulevard de l'hôpital, Paris, France
| | - Benjamin Assouline
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Intensive Care Medicine Unit, Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Matthieu Petit
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Melchior Gautier
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lucie Le Fevre
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marc Pineton de Chambrun
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Service de Médecine Interne 2, Centre de Référence Lupus Systémique, SAPL et Autres Maladies Auto-immunes et Systémiques Rares, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Guillaume Coutance
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Elodie Berg
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Juliette Chommeloux
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Charles-Edouard Luyt
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Leprince
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Hékimian
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
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Silverton NA, Gebhardt BR, Maslow A. The Intraoperative Assessment of Right Ventricular Function During Cardiac Surgery. J Cardiothorac Vasc Anesth 2022; 36:3904-3915. [DOI: 10.1053/j.jvca.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/14/2022] [Accepted: 05/21/2022] [Indexed: 11/11/2022]
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The contemporary pulmonary artery catheter. Part 2: measurements, limitations, and clinical applications. J Clin Monit Comput 2021; 36:17-31. [PMID: 33646499 PMCID: PMC7917533 DOI: 10.1007/s10877-021-00673-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/08/2021] [Indexed: 12/25/2022]
Abstract
Nowadays, the classical pulmonary artery catheter (PAC) has an almost 50-year-old history of its clinical use for hemodynamic monitoring. In recent years, the PAC evolved from a device that enabled intermittent cardiac output measurements in combination with static pressures to a monitoring tool that provides continuous data on cardiac output, oxygen supply and-demand balance, as well as right ventricular performance. In this review, which consists of two parts, we will introduce the difference between intermittent pulmonary artery thermodilution using bolus injections, and the contemporary PAC enabling continuous measurements by using a thermal filament which heats up the blood. In this second part, we will discuss in detail the measurements of the contemporary PAC, including continuous cardiac output measurement, right ventricular ejection fraction, end-diastolic volume index, and mixed venous oxygen saturation. Limitations of all of these measurements are highlighted as well. We conclude that thorough understanding of measurements obtained from the PAC is the first step in successful application of the PAC in daily clinical practice.
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Bootsma IT, Scheeren TWL, de Lange F, Jainandunsing JS, Boerma EC. The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General Right Ventricular Performance During Aortic Valve Replacement: An Explorative Study. J Cardiothorac Vasc Anesth 2020; 34:2140-2147. [PMID: 32139346 DOI: 10.1053/j.jvca.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to identify whether the decrease of longitudinal parameters after cardiothoracic surgery (ie, tricuspid annular systolic plane excursion [TAPSE] and systolic excursion velocity [S']) is accompanied by a reduction in global right ventricular (RV) performance. DESIGN Prospective, observational study. SETTING Single-center explorative study in a tertiary teaching hospital. PARTICIPANTS The study comprised 20 patients who underwent aortic valve replacement with or without coronary artery bypass grafting. INTERVENTIONS During cardiac surgery, simultaneous measurements of RV function were performed with a pulmonary artery catheter and transesophageal echocardiography. MEASUREMENTS AND MAIN RESULTS TAPSE and S' were reduced significantly directly after surgery compared with the time before surgery (TAPSE from 20.8 [16.6-23.4] mm to 9.1 [5.6-15.5] mm; p < 0.001 and S' from 8.7 [7.9-10.7] cm/s to 7.2 [5.7-8.6] cm/s; p = 0.041). However, the reduction in TAPSE and S' was not accompanied by a reduction in RV performance, as assessed with the TEE-derived myocardial performance index (MPI) and pulmonary artery catheter-derived RV ejection fraction (RVEF). Both remained statistically unaltered before and after the procedure (MPI from 0.52 [0.43-0.58] to 0.50 [0.42-0.88]; p = 0.278 and RVEF from 27% [22%-32%] to 26% [22%-28%]; p = 0.294). CONCLUSIONS In the direct postoperative phase, the reduction of echocardiographic parameters of longitudinal RV contractility (TAPSE and S') were not accompanied by a reduction in global RV performance, expressed as MPI and RVEF. Solely relying on a single RV parameter as a marker for global RV performance may not be adequate to assess the complex adaptation of the right ventricle to aortic valve replacement.
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Affiliation(s)
- Inge T Bootsma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Thomas W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fellery de Lange
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Jayant S Jainandunsing
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Hård af Segerstad M, Olsen F, Houltz E, Nellgård B, Ricksten S. Inhaled prostacyclin for the prevention of increased pulmonary vascular resistance in cemented hip hemiarthroplasty-A randomised trial. Acta Anaesthesiol Scand 2019; 63:1152-1161. [PMID: 31270800 DOI: 10.1111/aas.13423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bone cementation may cause pulmonary vasoconstriction and ventilation/perfusion abnormalities in patients undergoing cemented hip hemiarthroplasty. In this randomised trial, we tested the hypothesis that intra-operative inhalation of prostacyclin could attenuate the increase in pulmonary vascular resistance index (PVRI, primary endpoint) when compared to inhaled saline in this group of patients. METHODS Twenty-two patients with displaced femoral neck fractures were allocated to receive inhaled aerosolised prostacyclin (20 ng/kg/min) (n = 11) or inhaled saline (NaCl, 9 mg/mL) (n = 11). All patients received total intravenous anaesthesia and were catheterised with radial and pulmonary artery fast response thermodilution catheters, for measurements of arterial and pulmonary arterial pressures, cardiac output, right ventricular ejection fraction and effective pulmonary arterial elastance. Haemodynamic measurements were performed after induction of anaesthesia, during surgery before and immediately after bone cementation and prosthesis insertion, 10 and 20 min after insertion and during skin closure. RESULTS During the surgical procedure, PVRI increased both in the saline (44%, P < 0.001) and the prostacyclin (36%, P = 0.019) groups, with a less pronounced increase in the prostacyclin group (P = 0.031). Effective pulmonary arterial elastance increased both in the saline (44%, P < 0.001) and the prostacyclin groups (29%, P = 0.032), with a trend for a less pronounced increase in the prostacyclin group (P = 0.084). Right ventricular ejection fraction decreased significantly in both groups with no difference between the groups. CONCLUSION Inhalation of prostacyclin attenuates the increase in pulmonary vascular resistance in patients undergoing cemented hip hemiarthroplasty and could potentially attenuate/prevent haemodynamic instability induced by an increase in right ventricular afterload seen in this procedure.
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Affiliation(s)
- Mathias Hård af Segerstad
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Fredrik Olsen
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Erik Houltz
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Sven‐Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
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Barthélémy R, Roy X, Javanainen T, Mebazaa A, Chousterman BG. Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:312. [PMID: 31519203 PMCID: PMC6743193 DOI: 10.1186/s13054-019-2582-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
Background Though echocardiographic evaluation assesses the right ventricular systolic function, which of the existing parameters best reflects the right ventricular ejection fraction (RVEF) in the critically ill patients is still uncertain. We aimed to determine the relationship between echocardiographic indices of right ventricular systolic function and RVEF. Methods Prospective observational study was conducted in a mixed Surgical Intensive Care Unit (Hôpital Lariboisière, Paris, France) from November 2017 to November 2018. All critically ill patients monitored with a pulmonary artery catheter were assessed. We collected echocardiographic indices of right ventricular function (tricuspid annular plane systolic excursion, TAPSE; peak systolic velocity of pulsed tissue Doppler at lateral tricuspid annulus, S′; fractional area change, FAC; right ventricular index of myocardial performance, RIMP; isovolumic acceleration, IVA; end-diastolic diameter ratio, EDDr) and compared them with the RVEF obtained from continuous volumetric pulmonary artery catheter. Results Twenty-five patients were analyzed. Admission diagnosis was acute heart failure in 11 patients and septic shock in 14 patients. Median age was 70 years [57–80], norepinephrine median dose was 0.29 μg/kg/min [0.14–0.50], median Sequential Organ Failure Assessment score was 12 [10–14], and mortality at day 28 was 56%. When compared to RVEF, TAPSE had the highest correlation coefficient (rho = 0.78, 95% CI 0.52 to 0.89, p < 0.001). S′ was also correlated to RVEF (rho = 0.64, 95% CI 0.60 to 0.80, p = 0.001) whereas FAC, RIMP, IVA, and EDDr did not. TAPSE lower than 16 mm, S′ lower than 11 cm/s, and EDDr higher than 1 were always associated with a reduced RVEF. Conclusions We found that amongst indices of right ventricular systolic function, TAPSE and S′ were well correlated with thermodilution-derived RVEF in critically ill patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2582-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Romain Barthélémy
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France. .,Réanimation Chirurgical Polyvalente, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
| | - Xavier Roy
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France
| | - Tujia Javanainen
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France.,Université de Paris, Paris, France
| | - Benjamin Glenn Chousterman
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France.,Université de Paris, Paris, France
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Segerstad MHA, Olsen F, Patel A, Houltz E, Nellgård B, Ricksten SE. Pulmonary haemodynamics and right ventricular function in cemented vs uncemented total hip arthroplasty-A randomized trial. Acta Anaesthesiol Scand 2019; 63:298-305. [PMID: 30203412 DOI: 10.1111/aas.13262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/10/2018] [Accepted: 08/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is a feared complication in orthopaedic surgery with a huge impact on post-operative morbidity. In this randomized trial, we evaluated the effects of bone cement on pulmonary and systemic haemodynamics in patients receiving either cemented or uncemented hip arthroplasty for isolated femoral neck fracture. METHODS Twenty-two patients were randomized to receive either cemented (n = 10) or uncemented (n = 12) total hip arthroplasty. Surgery was performed under total intravenous anaesthesia in the lateral position. All patients were catheterized with radial- and pulmonary artery catheters, for continuous measurements of mean arterial pressure (MAP), pulmonary arterial pressure (PAP), cardiac output, right ventricular (RV) end-diastolic volume (RVEDV) and RV ejection fraction (RVEF). Haemodynamic measurements and blood gas analyses were performed after induction of anaesthesia, during surgery before and immediately after bone cementation and prosthesis insertion, 10 and 20 minutes after insertion and during skin closure. RESULTS Pulmonary vascular resistance index (PVRI) increased during and after prosthesis insertion by 45% and 20% in the cemented and uncemented group, respectively (P < 0.005). Systolic and mean PAP increased by 18% and 17% in the cemented group, which was not seen in the uncemented group (P < 0.001). There was a trend for a more pronounced fall in RVEF in the cemented group, while there were no differences in cardiac output or stroke volume between groups. CONCLUSION The use of bone cement in total hip arthroplasty increases pulmonary vascular resistance and the afterload of the RV with potentially negative effects on RV performance.
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Affiliation(s)
- Mathias Hård af Segerstad
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Fredrik Olsen
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Arun Patel
- Department of Orthopedic Surgery; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Erik Houltz
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
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8
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Bootsma IT, de Lange F, Koopmans M, Haenen J, Boonstra PW, Symersky T, Boerma EC. Right Ventricular Function After Cardiac Surgery Is a Strong Independent Predictor for Long-Term Mortality. J Cardiothorac Vasc Anesth 2017; 31:1656-1662. [DOI: 10.1053/j.jvca.2017.02.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Indexed: 12/31/2022]
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Grønlykke L, Ravn HB, Gustafsson F, Hassager C, Kjaergaard J, Nilsson JC. Right ventricular dysfunction after cardiac surgery – diagnostic options. SCAND CARDIOVASC J 2016; 51:114-121. [DOI: 10.1080/14017431.2016.1264621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lars Grønlykke
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens C. Nilsson
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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10
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Garcia Gigorro R, Renes Carreño E, Mayordomo S, Marín H, Perez Vela JL, Corres Peiretti MA, Montejo González JC. Evaluation of right ventricular function after cardiac surgery: The importance of tricuspid annular plane systolic excursion and right ventricular ejection fraction. J Thorac Cardiovasc Surg 2016; 152:613-20. [DOI: 10.1016/j.jtcvs.2016.04.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 03/05/2016] [Accepted: 04/12/2016] [Indexed: 11/30/2022]
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De Pietri L, Mocchegiani F, Leuzzi C, Montalti R, Vivarelli M, Agnoletti V. Transoesophageal echocardiography during liver transplantation. World J Hepatol 2015; 7:2432-2448. [PMID: 26483865 PMCID: PMC4606199 DOI: 10.4254/wjh.v7.i23.2432] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/22/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation (LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver transplant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the procedures as a result of both the disease process and the surgery. Transoesophageal echocardiography (TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. Moreover, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure.
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Al Shehri AM, El-Tahan MR, Al Metwally R, Qutub H, El Ghoneimy YF, Regal MA, Zien H. Right Ventricular Function During One-Lung Ventilation: Effects of Pressure-Controlled and Volume-Controlled Ventilation. J Cardiothorac Vasc Anesth 2014; 28:880-4. [DOI: 10.1053/j.jvca.2013.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Indexed: 11/11/2022]
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The comparison between stroke volume variation and filling pressure as an estimate of right ventricular preload in patients undergoing renal transplantation. J Anesth 2014; 29:40-6. [DOI: 10.1007/s00540-014-1870-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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Xu H, Li W, Xu Z, Shi X. Evaluation of the right ventricular ejection fraction during classic orthotopic liver transplantation without venovenous bypass. Clin Transplant 2013; 26:E485-91. [PMID: 23061758 DOI: 10.1111/ctr.12010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Right ventricular (RV) function is sensitive to changes in cardiac loading conditions, and RV dysfunction may contribute to hemodynamic instability during orthotopic liver transplantation (OLT). Thus, we evaluated RV function and its role in hemodynamic instability during classic OLT without venovenous bypass (VVB). METHODS Thirty patients undergoing classic OLT without VVB were studied. Right ventricular ejection fraction (RVEF) was measured using a modified pulmonary artery catheter. Hemodynamic data were recorded at pre-determined time points: T0, baseline; T1-T3: 5, 15, and 30 min after clamping; T4-T7: 5, 15, 30, and 120 min after reperfusion; T8 and T9: 24 and 48 h after surgery. RESULTS The baseline RVEF was lower than normal value. RVEF decreased significantly from T1 to T4 and returned to baseline beginning at T5. At 24 and 48 h after surgery, RVEF was higher than baseline value. RVEF was correlated with stroke volume index and post-reperfusion syndrome during OLT. Compared to the low MELDs group, RVEF in the high MELDs group was lower at T1, T2, and T4. CONCLUSIONS Right ventricular function was compromised during the anhepatic and early reperfusion stages in patients undergoing classic OLT without VVB, particularly in the high MELD score patients. Close monitoring of RV function in these patients should be considered.
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Affiliation(s)
- Haitao Xu
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Pérez Vela J, Martín Benítez J, Carrasco González M, De la Cal López M, Hinojosa Pérez R, Sagredo Meneses V, del Nogal Saez F. Guías de práctica clínica para el manejo del síndrome de bajo gasto cardíaco en el postoperatorio de cirugía cardíaca. Med Intensiva 2012; 36:e1-44. [DOI: 10.1016/j.medin.2012.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/07/2012] [Indexed: 01/04/2023]
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Habicher M, Perrino A, Spies CD, von Heymann C, Wittkowski U, Sander M. Contemporary fluid management in cardiac anesthesia. J Cardiothorac Vasc Anesth 2010; 25:1141-53. [PMID: 20947379 DOI: 10.1053/j.jvca.2010.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Marit Habicher
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Mukkamala R, Xu D. Continuous and less invasive central hemodynamic monitoring by blood pressure waveform analysis. Am J Physiol Heart Circ Physiol 2010; 299:H584-99. [PMID: 20622106 PMCID: PMC2944477 DOI: 10.1152/ajpheart.00303.2010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 07/05/2010] [Indexed: 12/24/2022]
Abstract
Blood pressure waveform analysis may permit continuous (i.e., automated) and less invasive (i.e., safer and simpler) central hemodynamic monitoring in the intensive care unit and other clinical settings without requiring any instrumentation beyond what is already in use or available. This practical approach has been a topic of intense investigation for decades and may garner even more interest henceforth due to the evolving demographics as well as recent trends in clinical hemodynamic monitoring. Here, we review techniques that have appeared in the literature for mathematically estimating clinically significant central hemodynamic variables, such as cardiac output, from different blood pressure waveforms. We begin by providing the rationale for pursuing such techniques. We then summarize earlier techniques and thereafter overview recent techniques by our collaborators and us in greater depth while pinpointing both their strengths and weaknesses. We conclude with suggestions for future research directions in the field and a description of some potential clinical applications of the techniques.
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Affiliation(s)
- Ramakrishna Mukkamala
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, Michigan 48824-1226, USA.
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Hein M, Roehl AB, Baumert JH, Rossaint R, Steendijk P. Continuous right ventricular volumetry by fast-response thermodilution during right ventricular ischemia: Head-to-head comparison with conductance catheter measurements*. Crit Care Med 2009; 37:2962-7. [DOI: 10.1097/ccm.0b013e3181b027a5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shim JK, Bang SO, Lee JH, Oh YJ, Yoo KJ, Kwak YL. Effect of intracoronary shunt on right ventricular function during off-pump grafting of dominant right coronary artery with poor collateral. J Korean Med Sci 2008; 23:373-7. [PMID: 18583869 PMCID: PMC2526513 DOI: 10.3346/jkms.2008.23.3.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although numerous studies have validated the efficacy of intracoronary shunt on reducing left ventricular dysfunction during off-pump coronary artery bypass surgery (OPCAB), there is lack of evidence supporting its role on right ventricular (RV) function during right coronary artery (RCA) revascularization. Therefore, we studied the effect of intracoronary shunt during grafting of dominant RCA without visible collateral supply on global RV function using thermodilution method. Forty patients scheduled for multivessel OPCAB with right dominant coronary circulation without collateral supply confirmed by angiography were randomized to RCA revascularization either with a shunt (n=20) or soft snare occlusion (n=20). RV ejection fraction (RVEF) was recorded at baseline, during RCA grafting, and 15 min after reperfusion. Corresponding RV stroke work index (RVSWI) was calculated. RVEF and RVSWI decreased significantly during RCA grafting and returned to baseline values after reperfusion in both groups without any significant differences between the groups. Intracoronary shunt did not exert any beneficial effect on global RV function during RCA grafting, even in the absence of visible collateral supply. Regarding the possibility of graft failure by intracoronary shunt-induced endothelial damage, routine use of intracoronary shunt during RCA grafting is not recommended in patients with preserved biventricular function.
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Affiliation(s)
- Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, Korea
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Gueret G, Kiss G, Khaldi S, Le Jouan R, Le Grand A, Perrament Y, Lefèvre C, Arvieux CC. Comparison of cardiac output measurements between NICO and the pulmonary artery catheter during repeat surgery for total hip replacement. Eur J Anaesthesiol 2007; 24:1028-33. [PMID: 17678573 DOI: 10.1017/s026502150700110x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare cardiac output measurements of the non-invasive cardiac output and the pulmonary artery catheter during repeat surgery for hip replacement. METHODS In this prospective observational study, patients undergoing repeat hip surgery who needed a pulmonary artery catheter were included. A standard protocol was followed for induction, endotracheal intubation and maintenance of anaesthesia (sufentanil, etomidate, sevoflurane, cisatracurium). After endotracheal intubation, the non-invasive cardiac output was connected and a pulmonary artery catheter was inserted. Data were collected every 3 min until patients were extubated. RESULTS Ten patients were included and 2455 points of comparison recorded. Cardiac output from the pulmonary artery catheter varied from 1.7 to 8.9 L min(-1) (mean 4.1 L min(-1)) and the non-invasive cardiac output (using averaging mode) from 1.7 to 8.0 L min(-1) (mean 3.7 L min(-1)). There was a significant correlation between them (P < 0.01; bias 0.3 L min(-1); limits of agreement +1.9 and -2.5 L min(-1)), although these differed between patients. CONCLUSION The perioperative bias was small and the non-invasive cardiac output slightly underestimated cardiac output intraoperatively compared to the pulmonary artery catheter. The bias was smaller when mean cardiac output was below 3 L min(-1). Core temperature between 34.4 degrees C and 37.6 degrees C had no influence on the differences.
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Affiliation(s)
- G Gueret
- University Hospital, Anesthesiology and Critical Care Department, La Cavale Blanche, Brest, France.
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Spöhr F, Hettrich P, Bauer H, Haas U, Martin E, Böttiger BW. Comparison of two methods for enhanced continuous circulatory monitoring in patients with septic shock. Intensive Care Med 2007; 33:1805-10. [PMID: 17549452 DOI: 10.1007/s00134-007-0703-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare a modified pulmonary artery catheter (PAC) and pulse-contour analysis by the PiCCO (Pulsion Medical Systems, Munich, Germany) system for continuous assessment of cardiac output in patients with septic shock. In addition, to assess the relationships between an index of global end-diastolic volume (GEDV) derived by the PiCCO system with traditional PAC-derived indicators of filling: central venous pressure; pulmonary artery occlusion pressure; and right ventricular end-diastolic volume (RVEDV). DESIGN Prospective cohort study. SETTING Surgical intensive care unit of a university hospital. PATIENTS AND PARTICIPANTS 14 patients with septic shock. INTERVENTIONS None. MEASUREMENTS AND RESULTS A significant correlation was found between continuous cardiac output by PAC (CCO(PAC)) and by pulse-contour analysis (r (2) = 0.714, p < 0.0001), accompanied by a bias of 0.1 l min(-1) and a precision of 2.7 l min(-1). The correlation between CCO(PAC) and cardiac output measured by transcardiopulmonary thermodilution was also significant (r (2) = 0.781, p < 0.0001). There was a bias for the two methods of 0.2 l min(-1), and a precision of 2.2 lmin(-1). The GEDV showed no correlation with central venous pressure, pulmonary artery occlusion pressure, or RVEDV. CONCLUSION In patients with septic shock, the averaged bias in continuous measurement of cardiac output by both a modified pulmonary artery catheter and pulse-contour analysis was small, but variability was large. No correlation was found between GEDV and RVEDV. The clinical importance of different cardiac filling parameters needs further investigation.
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Affiliation(s)
- F Spöhr
- Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Gueret G, Kiss G, Rossignol B, Bezon E, Wargnier JP, Miossec A, Corre O, Arvieux CC. Cardiac output measurements in off-pump coronary surgery: comparison between NICO and the Swan-Ganz catheter. Eur J Anaesthesiol 2007; 23:848-54. [PMID: 16953944 DOI: 10.1017/s0265021506000573] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this prospective study was to compare continuous cardiac output measurements of the non-invasive cardiac output system (NICO) with the pulmonary artery catheter during off-pump coronary bypass surgery. METHODS Twenty-two patients enrolled for off-pump coronary surgery received both a pulmonary artery catheter and a non-invasive cardiac output system for measurement of cardiac output. Data were compared by the Bland-Altman method to calculate the degree of agreement and to analyse if a significant difference existed between the two methods of cardiac output measurements. RESULTS Perioperatively, the non-invasive cardiac output underestimated cardiac output, but postoperatively overestimated it. The limits of agreement were larger during surgery compared to the postoperative period (-3.1; +2.5 vs. -1.4; +2.2 L min(-1)). Perioperatively, cardiac output measured with the pulmonary artery catheter varied from 0.5 to 7.5 L min(-1) (mean 3.6 L min(-1)) and with the non-invasive cardiac output from 0.5 to 8.4 L min(-1) (mean 3.9 L min(-1)). Postoperatively, these were 2.5-7.7 L min(-1) (mean 4.5 L min(-1)) and 2.3-8.4 L min(-1) (mean 4.9 L min(-1)), respectively. CONCLUSION During off-pump cardiac surgery, the non-invasive cardiac output reliably measures cardiac output and does it more rapidly than a pulmonary artery catheter and may be more useful in order to detect rapid haemodynamic changes.
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Affiliation(s)
- G Gueret
- University Hospital, Department of Anesthesiology and Surgical Intensive Care Unit, Brest, France.
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Lee JY, Bang SO, Shim JK, Lee JH, Won YJ, Kwak YL. Does Predictors of Preload Measured from Continuous Right Ventricular End-diastolic Volume Index Monitored Pulmonary Artery Catheter Reflect Stroke Volume Index in Off Pump Coronary Artery Bypass? Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.2.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ji Yeon Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sou Ouk Bang
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Yang R, Tibbs BM, Chang B, Nguyen C, Woodall C, Steppacher R, Helling T, Morrison DC, Van Way CW. Effect of DHEA on the Hemodynamic Response to Resuscitation in a Porcine Model of Hemorrhagic Shock. ACTA ACUST UNITED AC 2006; 61:1343-9. [PMID: 17159675 DOI: 10.1097/01.ta.0000222955.14191.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemorrhagic shock is a major cause of death from trauma. Pharmacologic treatment has not been satisfactory. The objective of this study was to use a porcine model of hemorrhagic shock and resuscitation to access the hemodynamic effects of dehydroepiandrosterone (DHEA), an adrenal steroid hormone reported to improve cardiac function in patients. METHODS Hemorrhagic shock was produced in 20- to 30-kg male Yorkshire pigs anesthetized with 2% isoflurane by withdrawing blood through a carotid cannula to a mean arterial pressure (MAP) of 40 to 45 mm Hg and maintaining that level for 60 minutes by further removals of blood. Resuscitation was with 21 mL/kg Ringer's lactate (LR), with (n = 6) or without (n = 6) DHEA (4 mg/kg) dissolved in propylene glycol. The animals were killed after 7 days. Continuous cardiac output (CCO) was recorded using a modified Swan-Ganz catheter system. MAP, heart rate (HR), central venous pressure (CVP), and pulmonary arterial pressure (PAP) were measured every 5 minutes until 60 minutes postresuscitation. From MAP, CCO, HR, and CVP, we calculated total peripheral resistance (TPR), stroke volume (SV), and left ventricular stroke work (SW). RESULTS The MAP, CCO, SV, and SW decreased significantly during hemorrhagic shock, and then gradually increased to baseline levels during and 1 hour after resuscitation. The TPR was increased during hemorrhagic shock, and then gradually decreased to baseline levels during and after resuscitation. DHEA administration was associated with no significant improvement. CONCLUSION DHEA when added to standard fluid resuscitation showed no added benefit as resumed by the hemodynamic response.
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Affiliation(s)
- Rongjie Yang
- Department of Surgery, Shock/Trauma Research Center, University of Missouri Kansas City, Kansas City, MO 64108, USA
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Couchman BA, Wetzig SM, Coyer FM, Wheeler MK. Nursing care of the mechanically ventilated patient: what does the evidence say? Part one. Intensive Crit Care Nurs 2006; 23:4-14. [PMID: 17046259 DOI: 10.1016/j.iccn.2006.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 08/08/2006] [Accepted: 08/08/2006] [Indexed: 11/26/2022]
Abstract
The care of the mechanically ventilated patient is at the core of a nurse's clinical practice in the Intensive Care Unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly. Literature focuses on patient assessment and management strategies for patient stressors, pain and sedation. Yet this literature is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient is explored with specific focus on patient safety: particularly patient and equipment assessment. Part two of the paper examines the evidence related to the mechanically ventilated patient's comfort, the patient/family unit, patient position, hygiene, management of stressors, pain management and sedation.
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Affiliation(s)
- Bronwyn A Couchman
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield St., Brisbane, Qld 4029, Australia
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Abstract
PURPOSE OF REVIEW The evaluation of hemodynamic status in critically ill patients is a leading recommended indication of transesophageal echocardiography in the intensive care unit. Advantages and diagnostic yield of transesophageal echocardiography in this setting are particularly relevant when considering limitations and questioned prognostic impact of pulmonary artery catheterization. RECENT FINDINGS Recent clinical studies have been performed to validate and assess the value of transesophageal echocardiography in determining cardiac output, cardiac preload dependence, right ventricular function, and left ventricular filling pressure. In addition, diagnostic capacity and therapeutic impact of transesophageal echocardiography have been widely reported in various intensive care unit settings. SUMMARY Transesophageal echocardiography appears well suited for the determination of cardiac index and to track its variations after therapeutic interventions. Although repeated measurements of left ventricular end-diastolic dimension allows to accurately track preload variations, a single determination is not reliable to predict fluid responsiveness in intensive care unit patients. Identification of preload dependence in hemodynamically unstable patients currently tends to rely mainly on dynamic parameters that use cardiopulmonary interactions under mechanical ventilation. Transesophageal echocardiography also allows to adequately assess right ventricular function and left ventricular filling pressure using combined Doppler modalities. Adequate education and training of intensivists and anesthesiologists is crucial to further develop the use of transesophageal echocardiography in the intensive care unit setting. Despite the absence of randomized controlled studies documenting transesophageal echocardiography benefits on patient outcome, present evidence and experience strongly recommend a larger use of echocardiography Doppler for a comprehensive functional hemodynamic assessment of critically ill patients with circulatory failure.
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Affiliation(s)
- Philippe Vignon
- Medical-surgical intensive care unit, Dupuytren Teaching Hospital, Limoges, France.
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