Cardiac output measured by transthoracic echocardiography and Swan-Ganz catheter. A
            comparative study in mechanically ventilated patients with high positive end-expiratory
            pressure

Gorrasi, José; Pazos, Arturo; Florio, Lucía; Américo, Carlos; Lluberas, Natalia; Parma, Gabriel; Lluberas, Ricardo

doi:10.5935/0103-507x.20190073

Cited by 6 publications

(9 citation statements)

References 51 publications

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“…After measuring HVPG, right heart catheterization was performed to measure pulmonary arterial pressure following methods previously described 11,25 . The procedure was performed using the cuff method to determine PAWP.…”

Section: Methodsmentioning

confidence: 99%

“…After measuring HVPG, right heart catheterization was performed to measure pulmonary arterial pressure following methods previously described. 11,25 The procedure was performed using the cuff method to determine PAWP. A pulmonary arterial catheter (thermodilution catheter; Nipro, Osaka, Japan) was connected to a monitor for pressure and CO recording, with the former being determined using the thermodilution technique.…”

Section: Pulmonary Artery Catheterizationmentioning

confidence: 99%

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Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization

Atsukawa

Tsubota

Hatano

et al. 2020

Hepatology Research

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Portopulmonary hypertension (PoPH) is a well-known complication of liver cirrhosis. The aim of this study was to clarify the pulmonary hemodynamics and the prevalence and characteristics of PoPH in patients with portal hypertension. Methods: The subjects were 335 patients with portal hypertension diagnosed by hepatic vein pressure gradient (HVPG). Among them, 186 patients received measurements of pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR). PoPH was diagnosed by PAP >20 mmHg, PVR ≥3 Wood units (WU) and PAWP ≤15 mmHg. Results: The Child-Pugh classification was class A in 53, B in 92 and C in 41 patients. Median (range) values of HVPG, PAP, PVR and PAWP were 18.4 (5.5-39.0) mmHg, 12.9 (6.6-40.8) mmHg, 0.8 (0.1-4.5) WU and 7.5 (2.2-15.4) mmHg, respectively. Of six patients with PAP >20 mmHg, four had autoimmune hepatitis or primary biliary cholangitis, with the prevalence being significantly higher than that in patients with PAP ≤20 mmHg. Meanwhile, no significant difference was noted in the hepatic functional reserve or HVPG between patients with PAP >20 mmHg and ≤20 mmHg. Only two patients met the diagnostic criteria of PoPH and both patients were Child-Pugh B. The Child-Pugh score and HVPG were not associated with PoPH. Conclusions: Our study demonstrated that only two patients were complicated by PoPH. High PAP values were noted in patients with primary biliary cholangitis or autoimmune hepatitis. However, the presence of PoPH and high PAP were not associated with the degree of hepatic functional reserve or HVPG.

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Section: Methodsmentioning

confidence: 99%

Section: Pulmonary Artery Catheterizationmentioning

confidence: 99%

Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization

Atsukawa

Tsubota

Hatano

et al. 2020

Hepatology Research

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“…It is well known that either the quality and sharpness of image or the process of technician may have an in uence on the value of VTi. Moreover, Gorassi et al [36] demonstrated that pulsed Doppler has limitations in detecting high cardiac output values when the blood ow velocity is greater than 2 m/sm, especially in septic shock patients who showed the greatest variability in CO. What is more, the CO measured by PAC integrated over several heartbeats, while the VTi was measured on a beat-to-beat basis, and then calculates CO by the products of SV and HR, which may increase the potential error of CO estimation. VTi seemed to be more likely in uenced by heart-lung interaction than PAC, and previous studies have shown that CO is more reliable on an average of serial measurements [37].…”

Section: Discussionmentioning

confidence: 99%

“…VTi seemed to be more likely in uenced by heart-lung interaction than PAC, and previous studies have shown that CO is more reliable on an average of serial measurements [37]. Based on the published studies evidences, the accuracy of PAC is higher than that of the transthoracic echocardiography [23,36,38].…”

Section: Discussionmentioning

confidence: 99%

“…First, as we discussed before, the accuracy varies with different hemodynamic techniques. With the development of techniques in assessing the circulatory function, the new generation measurements noted by less or non-invasive, such as TEE, bio-impedance and TTE are more likely to be applied in recent decade [36,44]. Our ndings depend on PAC to monitor CO, and the results may not be extrapolated to other techniques used to monitor CO. Second, 77% of the patients responded to uid administration after a total volume of 500 mL gelatin, and the proportion of responders (PR) was higher than in other studies.…”

Section: Discussionmentioning

confidence: 99%

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A Mini-fluid Challenge of 200 mL Predicts fluid Responsiveness Using Pulmonary Artery Catheter in Septic Shock Patients an Observational Study

Yang

Weng

Jiang

et al. 2020

Preprint

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Background: Mini-fluid challenge may predict fluid responsiveness and limit fluid overload. This study was designed to explore the minimal infusion volume in effectively predicting fluid responsiveness in septic shock patients.Methods: ICU septic shock patients with indwelling pulmonary artery catheter received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output was measured with thermodilution before fluid challenge (baseline) and three minutes after each bolus. Fluid responsiveness (FR) was defined as an increase in CO greater than 10% after 500 mL fluid infusion. The smallest volume which can perform an effective fluid challenge was analyzed. Results: Forty-seven patients were included in this prospective study. After 500 mL volume expansion, thirty-six patients presented with FR (77%) and 11 patients were fluid nonresponders. A mini fluid of 100 mL colloid had a poor predictive value (AUC = 0.67, p > 0.05). The minimal volume required to predict FR in a mini fluid challenge was 200 mL. An increase in CO greater than 5.2% after 200 mL colloid infusion was able to predict FR with a sensitivity of 83.3% and specificity of 90.9%. The AUC under the ROC curve was 0.93 (95% CI: 0.84 – 1, p < 0.05). Conclusion: In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders and nonresponders.Trial registration: ClinicalTrial.gov (NCT01941472). Registered on 13 September 2013.

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Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

et al. 2022

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Background Measurement of the tricuspid regurgitation pressure gradient (TRPG) by echocardiography is recommended as the most objective examination for the detection of portopulmonary hypertension (PoPH). This prospective study aimed to identify factors associated with a high TRPG in patients with cirrhosis and develop a screening method for identifying patients most likely to bene t from investigation with echocardiography.Results Four hundreds and eighty-six patients with cirrhosis underwent Doppler echocardiography, and were analyzed in the present study. Of the 486 patients, 51 (10.5%) had TRPG ≥35 mmHg. The median BNP was 39.5 (range, 3.3-712.0) pg/mL. Ninety-one (18.7%) patients reported shortness of breath.Multivariate analysis identi ed female, shortness of breath, and BNP ≥49 pg/mL as independent factors for TRPG ≥35 mmHg. The risk score for predicting TRPG ≥35 mmHg was calculated: risk score = −3.230 + 0.622 × gender (female: 1, male: 0) + 1.403 × shortness of breath (presence: 1, absence: 0) + 0.726 × BNP (≥ 49pg/mL: 1, <49 pg/mL: 0). An optimal cut-off risk score for predicting TRPG ≥35 mmHg was −1.882 (AUC, 0.731; sensitivity, 68.6%; speci city, 70.6%). The prevalence of TRPG ≥35 mmHg in patients with a risk score ≥−1.882 (21.5%) was signi cantly higher than that in patients with a risk score <−1.882(5.0%) (p = 7.02 × 10 −8 ).Conclusions We clari ed the characteristics of patients with suspected PoPH, and developed a scoring model for identifying patients at high risk of PoPH, which may have utility in selecting patients with cirrhosis that may bene t from echocardiography.

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Cardiac output measured by transthoracic echocardiography and Swan-Ganz catheter. A comparative study in mechanically ventilated patients with high positive end-expiratory pressure

Cited by 6 publications

References 51 publications

Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization

Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization

A Mini-fluid Challenge of 200 mL Predicts fluid Responsiveness Using Pulmonary Artery Catheter in Septic Shock Patients an Observational Study

Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

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