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Alvarado-Sánchez JI, Salazar-Ruiz S, Caicedo-Ruiz JD, Diaztagle-Fernández JJ, Cárdenas-Bolivar YR, Carreño-Hernandez FL, Mora-Salamanca AF, Montañez-Nariño AV, Stozitzky-Ríos MV, Santacruz-Herrera C, Ospina-Tascón GA, Pinsky MR. Predictive value of dynamic arterial elastance for vasopressor withdrawal: a systematic review and meta-analysis. Ann Intensive Care 2024; 14:108. [PMID: 38980442 PMCID: PMC11233481 DOI: 10.1186/s13613-024-01345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Dynamic arterial elastance (Eadyn) has been investigated for its ability to predict hypotension during the weaning of vasopressors. Our study focused on assessing Eadyn's performance in the context of critically ill adult patients admitted to the intensive care unit, regardless of diagnosis. MAIN BODY Our study was conducted in accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis checklist. The protocol was registered in PROSPERO (CRD42023421462) on May 26, 2023. We included prospective observational studies from the MEDLINE and Embase databases through May 2023. Five studies involving 183 patients were included in the quantitative analysis. We extracted data related to patient clinical characteristics, and information about Eadyn measurement methods, results, and norepinephrine dose. Most patients (76%) were diagnosed with septic shock, while the remaining patients required norepinephrine for other reasons. The average pressure responsiveness rate was 36.20%. The synthesized results yielded an area under the curve of 0.85, with a sensitivity of 0.87 (95% CI 0.74-0.93), specificity of 0.76 (95% CI 0.68-0.83), and diagnostic odds ratio of 19.07 (95% CI 8.47-42.92). Subgroup analyses indicated no variations in the Eadyn based on norepinephrine dosage, the Eadyn measurement device, or the Eadyn diagnostic cutoff to predict cessation of vasopressor support. CONCLUSIONS Eadyn, evaluated through subgroup analyses, demonstrated good predictive ability for the discontinuation of vasopressor support in critically ill patients.
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Affiliation(s)
- Jorge Iván Alvarado-Sánchez
- Department of Intensive Care, Fundación Santa Fe de Bogotá, Bogotá, Colombia.
- Department of Physiology Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Sergio Salazar-Ruiz
- Department of Intensive Care, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Department of Physiology Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Juan Daniel Caicedo-Ruiz
- Department of Physiology Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan José Diaztagle-Fernández
- Department of Physiology Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Department of Internal Medicine, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
| | | | | | | | | | | | | | - Gustavo Adolfo Ospina-Tascón
- Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia
- Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Pinsky MR, García MIM, Dubin A. Significance of critical closing pressures (starling resistors) in arterial circulation. Crit Care 2024; 28:127. [PMID: 38637877 PMCID: PMC11025166 DOI: 10.1186/s13054-024-04912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
- Michael R Pinsky
- Department of Critical Care, University of Pittsburgh, 1215.4 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - M Ignacio Monge García
- Unidad de Cuidados Intensivos, Hospital Universitario SAS Jerez, Jerez de La Frontera, Spain
| | - Arnaldo Dubin
- Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
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Bacchi B, Cabrucci F, Chiarello B, Dokollari A, Bonacchi M. Severe Refractory Vasoplegic Shock Syndrome after OPCABG Successfully Treated with Hydroxycobalamin: A Case Report and Review of the Literature. J Clin Med 2023; 13:169. [PMID: 38202178 PMCID: PMC10779867 DOI: 10.3390/jcm13010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Vasoplegic shock syndrome (VSS) after an off-pump coronary artery bypass graft (OPCABG) is an extremely rare condition. Inotropic support is usually the first-line therapy, though it can precipitate several complications or be ineffective. We report the first case of severe refractory VSS after OPCABG successfully treated with hydroxycobalamin. METHODS A 77-year-old gentleman underwent OPCABG for three vessels coronary artery disease. Preoperative LV ejection fraction was 28%, and the patient before surgery started sacubitril/valsartan titrated, then, at the highest dose. Surgery was uneventful and, by the end of the procedure, TEE showed improved biventricular contractility. RESULTS The patient was transferred to the ICU without inotropic support, but soon developed hypotension. TEE ruled out pericardial tamponade and confirmed fair contractility. Norepinephrine was titrated to a medium-high dose, vasopressin was started and a Swan-Ganz catheter was placed. SVR was 480 dyn·s·cm-5. Despite aggressive pharmacologic treatment (including methylprednisolone and methylene blue), no improvements were noticed. Ten grams of hydroxycobalamin were administered. One hour later, hemodynamic status re-assessment showed SVR > 800 dyn·s·cm-5. Afterward, vasopressors were gradually reduced. CONCLUSIONS Our case demonstrated the importance of adequate early treatment in VSS after OPCABG. This case report shows, for the first time, that hydroxycobalamin was effectively used to restore homeostasis.
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Affiliation(s)
- Beatrice Bacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, 50134 Firenze, Italy; (B.B.); (F.C.); (B.C.)
| | - Francesco Cabrucci
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, 50134 Firenze, Italy; (B.B.); (F.C.); (B.C.)
| | - Bruno Chiarello
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, 50134 Firenze, Italy; (B.B.); (F.C.); (B.C.)
| | - Aleksander Dokollari
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg, MB R2H 2A6, Canada;
| | - Massimo Bonacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, 50134 Firenze, Italy; (B.B.); (F.C.); (B.C.)
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