Dynamic arterial elastance measured by uncalibrated pulse contour analysis predicts arterial-pressure response to a decrease in norepinephrine

Bar, Stéphane; Leviel, F.; Abou-Arab, Osama; Badoux, Louise; Mahjoub, Yazine; Dupont, Hervé; Lorne, Emmanuel; Guinot, Pierre-Grégoire

doi:10.1016/j.bja.2018.01.032

Cited by 19 publications

(27 citation statements)

References 23 publications

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“…The sample size also limited the use of parametric approach and prevented the realisation of more specific analysis such as ROC curve comparison between TTE-E Adyn and PCA-E Adyn (or TTE-SVV and PCA-SVV). The monocentric nature of the study limits the external validity, but our results are in accordance with previously reported data [7][8][9] . Finally, we did not measure ventriculo-arterial coupling.…”

Section: Discussionsupporting

confidence: 91%

“…Dynamic elastance (E Adyn ) might be estimated as the ratio of stroke volume variation (SVV) to pulse pressure variation (PPV). Authors have demonstrated that E Adyn measured by calibrated pulse contour analysis (PCA-E Adyn ) and by uncalibrated pulse contour analysis can predict the pressure response to a decrease in norepinephrine [7][8][9] . Patients with acute circulatory failure and treated with vasopressors are not always monitored by calibrated pulse contour analysis.…”

Section: Rocmentioning

confidence: 99%

“…The LSC was 7% (confidence interval 95% (CI 95% ): 4-10). Based on LSC, we defined a positive response www.nature.com/scientificreports/ (pressure responders) as a decrease in MAP of over 10% 8 . Qualitative data were compared with a chi-squared test or Fisher's test, and quantitative data were assessed with a Student's t test or Kruskal-Wallis sum rank test, as appropriate.…”

Section: Statistical Analysesmentioning

confidence: 99%

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Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study

Nguyen

Abou‐Arab

Bar

et al. 2021

Sci Rep

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The purpose of this study was to determine whether dynamic elastance EAdyn derived from echocardiographic measurements of stroke volume variations can predict the success of a one-step decrease of norepinephrine dose. In this prospective single-center study, 39 patients with vasoplegic syndrome treated with norepinephrine and for whom the attending physician had decided to decrease norepinephrine dose and monitored by thermodilution were analyzed. EAdyn is the ratio of pulse pressure variation to stroke volume variation and was calculated from echocardiography stroke volume variations and from transpulmonary thermodilution. Pulse pressure variation was obtained from invasive arterial monitoring. Responders were defined by a decrease in mean arterial pressure (MAP) > 10% following norepinephrine decrease. The median decrease in norepinephrine was of 0.04 [0.03–0.05] µg kg−1 min−1. Twelve patients (31%) were classified as pressure responders with a median decrease in MAP of 13% [12–15%]. EAdyn was lower in pressure responders (0.40 [0.24–0.57] vs 0.95 [0.77–1.09], p < 0.01). EAdyn was able to discriminate between pressure responders and non-responders with an area under the curve of 0.86 (CI95% [0.71 to1.0], p < 0.05). The optimal cut-off was 0.8. EAdyn calculated from the echocardiographic estimation of the stroke volume variation and the invasive arterial pulse pressure variation can be used to discriminate pressure response to norepinephrine weaning. Agreement between EAdyn calculated from echocardiography and thermodilution was poor. Echocardiographic EAdyn might be used at bedside to optimize hemodynamic treatment.

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Section: Discussionsupporting

confidence: 91%

Section: Rocmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

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Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study

Nguyen

Abou‐Arab

Bar

et al. 2021

Sci Rep

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“…One can suppose that in patients treated with vasopressor, Ea dyn mainly reflects vascular resistance because C A is fixed. This hypothesis may also explain the ability of Ea dyn (when measured with an uncalibrated CO device) to predict arterial pressure changes (Bar et al, 2018b). The arterial load and Ea dyn may vary in a complex manner as a function of the therapeutic intervention while decreasing Ea dyn 's ability to predict blood pressure changes.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Arterial Elastance Is Associated With the Vascular Waterfall in Patients Treated With Norepinephrine: An Observational Study

et al. 2021

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Introduction: It has been suggested that dynamic arterial elastance (Eadyn) can predict decreases in arterial pressure in response to changing norepinephrine levels. The objective of this study was to determine whether Eadyn is correlated with determinants of the vascular waterfall [critical closing pressure (CCP) and systemic arterial resistance (SARi)] in patients treated with norepinephrine.Materials and Methods: Patients treated with norepinephrine for vasoplegia following cardiac surgery were studied. Vascular and flow parameters were recorded immediately before the norepinephrine infusion and then again once hemodynamic parameters had been stable for 15 min. The primary outcomes were Eadyn and its associations with CCP and SARi. The secondary outcomes were the associations between Eadyn and vascular/flow parameters.Results: At baseline, all patients were hypotensive with Eadyn of 0.93 [0.47;1.27]. Norepinephrine increased the arterial blood pressure, cardiac index, CCP, total peripheral resistance (TPRi), arterial elastance, and ventricular elastance and decreased Eadyn [0.40 (0.30;0.60)] and SARi. Eadyn was significantly associated with arterial compliance (CA), CCP, and TPRi (p < 0.05).Conclusion: In patients with vasoplegic syndrome, Eadyn was correlated with determinants of the vascular waterfall. Eadyn is an easy-to-read functional index of arterial load that can be used to assess the patient’s macro/microcirculatory status.Clinical Trial Registration:ClinicalTrials.gov #NCT03478709.

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“…In preload-dependent patients,[41] it may predict whether blood pressure will increase along with cardiac output following fluid administration, or it may predict whether vasopressors may be reduced whilst maintaining blood pressure. [3942] As such, it may guide in functionally assessing afterload and may discriminate between hypotension secondary to either hypovolaemia (Ea dyn high, fluids probably beneficial), or hypovolaemia secondary to vasoplegia (Ea dyn low), requiring vasopressor(s). Figuratively, we might consider Ea dyn the SVV of the pressure world.…”

Section: Hpi and The Cause Of Hypotensionmentioning

confidence: 99%

Intraoperative hypotension and its prediction

Vos

Scheeren

2019

Indian J Anaesth

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Intraoperative hypotension (IOH) very commonly accompanies general anaesthesia in patients undergoing major surgical procedures. The development of IOH is unwanted, since it is associated with adverse outcomes such as acute kidney injury and myocardial injury, stroke and mortality. Although the definition of IOH is variable, harm starts to occur below a mean arterial pressure (MAP) threshold of 65 mmHg. The odds of adverse outcome increase for increasing duration and/or magnitude of IOH below this threshold, and even short periods of IOH seem to be associated with adverse outcomes. Therefore, reducing the hypotensive burden by predicting and preventing IOH through proactive appropriate treatment may potentially improve patient outcome. In this review article, we summarise the current state of the prediction of IOH by the use of so-called machine-learning algorithms. Machine-learning algorithms that use high-fidelity data from the arterial pressure waveform, may be used to reveal 'traits' that are unseen by the human eye and are associated with the later development of IOH. These algorithms can use large datasets for 'training', and can subsequently be used by clinicians for haemodynamic monitoring and guiding therapy. A first clinically available application, the hypotension prediction index (HPI), is aimed to predict an impending hypotensive event, and additionally, to guide appropriate treatment by calculated secondary variables to asses preload (dynamic preload variables), contractility (dP/dtmax), and afterload (dynamic arterial elastance, Eadyn). In this narrative review, we summarise the current state of the prediction of hypotension using such novel, automated algorithms and we will highlight HPI and the secondary variables provided to identify the probable origin of the (impending) hypotensive event.

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Dynamic arterial elastance measured by uncalibrated pulse contour analysis predicts arterial-pressure response to a decrease in norepinephrine

Abstract: DRCIT95.

Cited by 19 publications

References 23 publications

Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study

Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study

Dynamic Arterial Elastance Is Associated With the Vascular Waterfall in Patients Treated With Norepinephrine: An Observational Study

Intraoperative hypotension and its prediction

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