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Jiang H, Han Y, Zheng X, Fang Q. Roles of electrical impedance tomography in lung transplantation. Front Physiol 2022; 13:986422. [PMID: 36407002 PMCID: PMC9669435 DOI: 10.3389/fphys.2022.986422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Lung transplantation is the preferred treatment method for patients with end-stage pulmonary disease. However, several factors hinder the progress of lung transplantation, including donor shortages, candidate selection, and various postoperative complications. Electrical impedance tomography (EIT) is a functional imaging tool that can be used to evaluate pulmonary ventilation and perfusion at the bedside. Among patients after lung transplantation, monitoring the graft’s pulmonary function is one of the most concerning issues. The feasible application of EIT in lung transplantation has been reported over the past few years, and this technique has gained increasing interest from multidisciplinary researchers. Nevertheless, physicians still lack knowledge concerning the potential applications of EIT in lung transplantation. We present an updated review of EIT in lung transplantation donors and recipients over the past few years, and discuss the potential use of ventilation- and perfusion-monitoring-based EIT in lung transplantation.
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Affiliation(s)
| | | | - Xia Zheng
- *Correspondence: Xia Zheng, ; Qiang Fang,
| | - Qiang Fang
- *Correspondence: Xia Zheng, ; Qiang Fang,
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Xu M, He H, Long Y. Lung Perfusion Assessment by Bedside Electrical Impedance Tomography in Critically Ill Patients. Front Physiol 2021; 12:748724. [PMID: 34721072 PMCID: PMC8548642 DOI: 10.3389/fphys.2021.748724] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 12/02/2022] Open
Abstract
As a portable, radiation-free imaging modality, electrical impedance tomography (EIT) technology has shown promise in the bedside visual assessment of lung perfusion distribution in critically ill patients. The two main methods of EIT for assessing lung perfusion are the pulsatility and conductivity contrast (saline) bolus method. Increasing attention is being paid to the saline bolus EIT method in the evaluation of regional pulmonary perfusion in clinical practice. This study seeks to provide an overview of experimental and clinical studies with the aim of clarifying the progress made in the use of the saline bolus EIT method. Animal studies revealed that the saline bolus EIT method presented good consistency with single-photon emission CT (SPECT) in the evaluation of lung regional perfusion changes in various pathological conditions. Moreover, the saline bolus EIT method has been applied to assess the lung perfusion in a pulmonary embolism and the effect of positive end-expiratory pressure (PEEP) on regional ventilation/perfusion ratio (V/Q) and acute respiratory distress syndrome (ARDS) in several clinical studies. The implementation of saline boluses, data analyses, precision, and cutoff values varied among different studies, and a consensus must be reached regarding the clinical application of the saline bolus EIT method. Further study is required to validate the impact of the described saline bolus EIT method on decision-making, therapeutic management, and outcomes in critically ill patients.
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Affiliation(s)
- Mengru Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huaiwu He
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Shi Y, Yang Z, Xie F, Ren S, Xu S. The Research Progress of Electrical Impedance Tomography for Lung Monitoring. Front Bioeng Biotechnol 2021; 9:726652. [PMID: 34660553 PMCID: PMC8517404 DOI: 10.3389/fbioe.2021.726652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/09/2021] [Indexed: 01/16/2023] Open
Abstract
Medical imaging can intuitively show people the internal structure, morphological information, and organ functions of the organism, which is one of the most important inspection methods in clinical medical diagnosis. Currently used medical imaging methods can only be applied to some diagnostic occasions after qualitative lesions have been generated, and the general imaging technology is usually accompanied by radiation and other conditions. However, electrical impedance tomography has the advantages of being noninvasive and non-radiative. EIT (Electrical Impedance Tomography) is also widely used in the early diagnosis and treatment of some diseases because of these advantages. At present, EIT is relatively mature and more and more image reconstruction algorithms are used to improve imaging resolution. Hardware technology is also developing rapidly, and the accuracy of data collection and processing is continuously improving. In terms of clinical application, EIT has also been used for pathological treatment of lungs, the brain, and the bladder. In the future, EIT has a good application prospect in the medical field, which can meet the needs of real-time, long-term monitoring and early diagnosis. Aiming at the application of EIT in the treatment of lung pathology, this article reviews the research progress of EIT, image reconstruction algorithms, hardware system design, and clinical applications used in the treatment of lung diseases. Through the research and introduction of several core components of EIT technology, it clarifies the characteristics of EIT system complexity and its solutions, provides research ideas for subsequent research, and once again verifies the broad development prospects of EIT technology in the future.
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Affiliation(s)
- Yan Shi
- The School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - ZhiGuo Yang
- The School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Fei Xie
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Shuai Ren
- The School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, China
| | - ShaoFeng Xu
- The School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
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Hovnanian ALD, Costa ELV, Hoette S, Fernandes CJCS, Jardim CVP, Dias BA, Morinaga LTK, Amato MBP, Souza R. Electrical impedance tomography in pulmonary arterial hypertension. PLoS One 2021; 16:e0248214. [PMID: 33730110 PMCID: PMC7968654 DOI: 10.1371/journal.pone.0248214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
The characterization of pulmonary arterial hypertension (PAH) relies mainly on right heart catheterization (RHC). Electrical impedance tomography (EIT) provides a non-invasive estimation of lung perfusion that could complement the hemodynamic information from RHC. To assess the association between impedance variation of lung perfusion (ΔZQ) and hemodynamic profile, severity, and prognosis, suspected of PAH or worsening PAH patients were submitted simultaneously to RHC and EIT. Measurements of ΔZQ were obtained. Based on the results of the RHC, 35 patients composed the PAH group, and eight patients, the normopressoric (NP) group. PAH patients showed a significantly reduced ΔZQ compared to the NP group. There was a significant correlation between ΔZQ and hemodynamic parameters, particularly with stroke volume (SV) (r = 0.76; P < 0.001). At 60 months, 15 patients died (43%) and 1 received lung transplantation; at baseline they had worse hemodynamics, and reduced ΔZQ when compared to survivors. Patients with low ΔZQ (≤154.6%.Kg) presented significantly worse survival (P = 0.033). ΔZQ is associated with hemodynamic status of PAH patients, with disease severity and survival, demonstrating EIT as a promising tool for monitoring patients with pulmonary vascular disease.
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Affiliation(s)
- André L. D. Hovnanian
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Eduardo L. V. Costa
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Susana Hoette
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Caio J. C. S. Fernandes
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Carlos V. P. Jardim
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Bruno A. Dias
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Luciana T. K. Morinaga
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Marcelo B. P. Amato
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Rogério Souza
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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Ko YF, Cheng KS. Semi-Siamese U-Net for separation of lung and heart bioimpedance images: A simulation study of thorax EIT. PLoS One 2021; 16:e0246071. [PMID: 33529234 PMCID: PMC7853495 DOI: 10.1371/journal.pone.0246071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
Electrical impedance tomography (EIT) is widely used for bedside monitoring of lung ventilation status. Its goal is to reflect the internal conductivity changes and estimate the electrical properties of the tissues in the thorax. However, poor spatial resolution affects EIT image reconstruction to the extent that the heart and lung-related impedance images are barely distinguishable. Several studies have attempted to tackle this problem, and approaches based on decomposition of EIT images using linear transformations have been developed, and recently, U-Net has become a prominent architecture for semantic segmentation. In this paper, we propose a novel semi-Siamese U-Net specifically tailored for EIT application. It is based on the state-of-the-art U-Net, whose structure is modified and extended, forming shared encoder with parallel decoders and has multi-task weighted losses added to adapt to the individual separation tasks. The trained semi-Siamese U-Net model was evaluated with a test dataset, and the results were compared with those of the classical U-Net in terms of Dice similarity coefficient and mean absolute error. Results showed that compared with the classical U-Net, semi-Siamese U-Net exhibited performance improvements of 11.37% and 3.2% in Dice similarity coefficient, and 3.16% and 5.54% in mean absolute error, in terms of heart and lung-impedance image separation, respectively.
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Affiliation(s)
- Yen-Fen Ko
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Sheng Cheng
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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Proença M, Braun F, Lemay M, Solà J, Adler A, Riedel T, Messerli FH, Thiran JP, Rimoldi SF, Rexhaj E. Non-invasive pulmonary artery pressure estimation by electrical impedance tomography in a controlled hypoxemia study in healthy subjects. Sci Rep 2020; 10:21462. [PMID: 33293566 PMCID: PMC7722929 DOI: 10.1038/s41598-020-78535-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
Pulmonary hypertension is a hemodynamic disorder defined by an abnormal elevation of pulmonary artery pressure (PAP). Current options for measuring PAP are limited in clinical practice. The aim of this study was to evaluate if electrical impedance tomography (EIT), a radiation-free and non-invasive monitoring technique, can be used for the continuous, unsupervised and safe monitoring of PAP. In 30 healthy volunteers we induced gradual increases in systolic PAP (SPAP) by exposure to normobaric hypoxemia. At various stages of the protocol, the SPAP of the subjects was estimated by transthoracic echocardiography. In parallel, in the pulmonary vasculature, pulse wave velocity was estimated by EIT and calibrated to pressure units. Within-cohort agreement between both methods on SPAP estimation was assessed through Bland-Altman analysis and at subject level, with Pearson's correlation coefficient. There was good agreement between the two methods (inter-method difference not significant (P > 0.05), bias ± standard deviation of - 0.1 ± 4.5 mmHg) independently of the degree of PAP, from baseline oxygen saturation levels to profound hypoxemia. At subject level, the median per-subject agreement was 0.7 ± 3.8 mmHg and Pearson's correlation coefficient 0.87 (P < 0.05). Our results demonstrate the feasibility of accurately assessing changes in SPAP by EIT in healthy volunteers. If confirmed in a patient population, the non-invasive and unsupervised day-to-day monitoring of SPAP could facilitate the clinical management of patients with pulmonary hypertension.
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Affiliation(s)
- Martin Proença
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland. .,Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Fabian Braun
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland.,Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Mathieu Lemay
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland
| | - Josep Solà
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland
| | - Andy Adler
- Systems and Computer Engineering, Carleton University, Ottawa, Canada
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland.,Department of Paediatrics, Inselspital Bern, University Children's Hospital, Bern, Switzerland
| | - Franz H Messerli
- Department of Cardiology and Clinical Research, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Radiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stefano F Rimoldi
- Department of Cardiology and Clinical Research, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology and Clinical Research, Inselspital Bern, University Hospital, Bern, Switzerland
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Braun F, Proença M, Adler A, Riedel T, Thiran JP, Solà J. Accuracy and reliability of noninvasive stroke volume monitoring via ECG-gated 3D electrical impedance tomography in healthy volunteers. PLoS One 2018; 13:e0191870. [PMID: 29373611 PMCID: PMC5786320 DOI: 10.1371/journal.pone.0191870] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/12/2018] [Indexed: 01/31/2023] Open
Abstract
Cardiac output (CO) and stroke volume (SV) are parameters of key clinical interest. Many techniques exist to measure CO and SV, but are either invasive or insufficiently accurate in clinical settings. Electrical impedance tomography (EIT) has been suggested as a noninvasive measure of SV, but inconsistent results have been reported. Our goal is to determine the accuracy and reliability of EIT-based SV measurements, and whether advanced image reconstruction approaches can help to improve the estimates. Data were collected on ten healthy volunteers undergoing postural changes and exercise. To overcome the sensitivity to heart displacement and thorax morphology reported in previous work, we used a 3D EIT configuration with 2 planes of 16 electrodes and subject-specific reconstruction models. Various EIT-derived SV estimates were compared to reference measurements derived from the oxygen uptake. Results revealed a dramatic impact of posture on the EIT images. Therefore, the analysis was restricted to measurements in supine position under controlled conditions (low noise and stable heart and lung regions). In these measurements, amplitudes of impedance changes in the heart and lung regions could successfully be derived from EIT using ECG gating. However, despite a subject-specific calibration the heart-related estimates showed an error of 0.0 ± 15.2 mL for absolute SV estimation. For trending of relative SV changes, a concordance rate of 80.9% and an angular error of -1.0 ± 23.0° were obtained. These performances are insufficient for most clinical uses. Similar conclusions were derived from lung-related estimates. Our findings indicate that the key difficulty in EIT-based SV monitoring is that purely amplitude-based features are strongly influenced by other factors (such as posture, electrode contact impedance and lung or heart conductivity). All the data of the present study are made publicly available for further investigations.
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Affiliation(s)
- Fabian Braun
- Systems Division, Centre Suisse d’Electronique et de Microtechnique (CSEM), CH-2002 Neuchâtel, Switzerland
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
- * E-mail:
| | - Martin Proença
- Systems Division, Centre Suisse d’Electronique et de Microtechnique (CSEM), CH-2002 Neuchâtel, Switzerland
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Andy Adler
- Systems and Computer Engineering, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Thomas Riedel
- Cantonal Hospital Graubuenden, CH-7000 Chur, Switzerland
- University Children’s Hospital and University of Bern, CH-3010 Bern, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
- Department of Radiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland
| | - Josep Solà
- Systems Division, Centre Suisse d’Electronique et de Microtechnique (CSEM), CH-2002 Neuchâtel, Switzerland
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Noninvasive pulmonary artery pressure monitoring by EIT: a model-based feasibility study. Med Biol Eng Comput 2016; 55:949-963. [DOI: 10.1007/s11517-016-1570-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 09/07/2016] [Indexed: 01/22/2023]
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Proença M, Braun F, Solà J, Adler A, Lemay M, Thiran JP, Rimoldi SF. Non-invasive monitoring of pulmonary artery pressure from timing information by EIT: experimental evaluation during induced hypoxia. Physiol Meas 2016; 37:713-26. [PMID: 27212013 DOI: 10.1088/0967-3334/37/6/713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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10
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Electrical impedance tomography: the holy grail of ventilation and perfusion monitoring? Intensive Care Med 2012; 38:1917-29. [DOI: 10.1007/s00134-012-2684-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/08/2012] [Indexed: 01/08/2023]
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Nguyen DT, Jin C, Thiagalingam A, McEwan AL. A review on electrical impedance tomography for pulmonary perfusion imaging. Physiol Meas 2012; 33:695-706. [DOI: 10.1088/0967-3334/33/5/695] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hovnanian A, Menezes E, Hoette S, Jardim C, Jasinowodolinski D, Souza R. The role of imaging techniques in the assessment of pulmonary circulation. J Bras Pneumol 2011; 37:389-403. [PMID: 21755197 DOI: 10.1590/s1806-37132011000300017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 05/11/2011] [Indexed: 11/22/2022] Open
Abstract
Knowledge of the structure and function of pulmonary circulation has evolved considerably in the last few decades. The use of non-invasive imaging techniques to assess the anatomy and function of the pulmonary vessels and heart has taken on added importance with the recent advent of novel therapies. Imaging findings not only constitute a diagnostic tool but have also proven to be essential for prognosis and treatment follow-up. This article reviews the myriad of imaging methods currently available for the assessment of pulmonary circulation, from the simple chest X-ray to techniques that are more complex and promising, such as electrical impedance tomography.
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Affiliation(s)
- André Hovnanian
- Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
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Dünser MW, Hasibeder WR. Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med 2009; 24:293-316. [PMID: 19703817 DOI: 10.1177/0885066609340519] [Citation(s) in RCA: 321] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The term ''adrenergic'' originates from ''adrenaline'' and describes hormones or drugs whose effects are similar to those of epinephrine. Adrenergic stress is mediated by stimulation of adrenergic receptors and activation of post-receptor pathways. Critical illness is a potent stimulus of the sympathetic nervous system. It is undisputable that the adrenergic-driven ''fight-flight response'' is a physiologically meaningful reaction allowing humans to survive during evolution. However, in critical illness an overshooting stimulation of the sympathetic nervous system may well exceed in time and scope its beneficial effects. Comparable to the overwhelming immune response during sepsis, adrenergic stress in critical illness may get out of control and cause adverse effects. Several organ systems may be affected. The heart seems to be most susceptible to sympathetic overstimulation. Detrimental effects include impaired diastolic function, tachycardia and tachyarrhythmia, myocardial ischemia, stunning, apoptosis and necrosis. Adverse catecholamine effects have been observed in other organs such as the lungs (pulmonary edema, elevated pulmonary arterial pressures), the coagulation (hypercoagulability, thrombus formation), gastrointestinal (hypoperfusion, inhibition of peristalsis), endocrinologic (decreased prolactin, thyroid and growth hormone secretion) and immune systems (immunomodulation, stimulation of bacterial growth), and metabolism (increase in cell energy expenditure, hyperglycemia, catabolism, lipolysis, hyperlactatemia, electrolyte changes), bone marrow (anemia), and skeletal muscles (apoptosis). Potential therapeutic options to reduce excessive adrenergic stress comprise temperature and heart rate control, adequate use of sedative/analgesic drugs, and aiming for reasonable cardiovascular targets, adequate fluid therapy, use of levosimendan, hydrocortisone or supplementary arginine vasopressin.
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Affiliation(s)
- Martin W Dünser
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse, Innsbruck, Austria.
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