Effect of pain and analgesia on compensatory reserve

Hinojosa‐Laborde, Carmen; Fernandez, Jessie Renee D.; Muniz, Gary W.; Nawn, Corinne D.; Burns, Rebecca K.; Le, Thuan H.; Porter, Kathy B.; Hardy, John; Convertino, Víctor A.

doi:10.1097/ta.0000000000001544

Cited by 4 publications

(2 citation statements)

References 35 publications

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“…45 In addition, although ICU patients are frequently intubated, paralyzed, or sedated, there is evidence that analgesia may have minimal effects on the CR. 76 Previous studies in the laboratory have defined the underlying physiology of the CR, and the results from case reports, case series, and prospective clinical investigations are consistently promising. However, specific clinical data from ICU patients are necessary.…”

Section: Discussionmentioning

confidence: 97%

Unmasking the Hypovolemic Shock Continuum: The Compensatory Reserve

Suresh

Chung

Schiller

et al. 2018

J Intensive Care Med

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Hypovolemic shock exists as a spectrum, with its early stages characterized by subtle pathophysiologic tissue insults and its late stages defined by multi-system organ dysfunction. The importance of timely detection of shock is well known, as early interventions improve mortality, while delays render these same interventions ineffective. However, detection is limited by the monitors, parameters, and vital signs that are traditionally used in the intensive care unit (ICU). Many parameters change minimally during the early stages, and when they finally become abnormal, hypovolemic shock has already occurred. The compensatory reserve (CR) is a parameter that represents a new paradigm for assessing physiologic status, as it comprises the sum total of compensatory mechanisms that maintain adequate perfusion to vital organs during hypovolemia. When these mechanisms are overwhelmed, hemodynamic instability and circulatory collapse will follow. Previous studies involving CR measurements demonstrated their utility in detecting central blood volume loss before hemodynamic parameters and vital signs changed. Measurements of the CR have also been used in clinical studies involving patients with traumatic injuries or bleeding, and the results from these studies have been promising. Moreover, these measurements can be made at the bedside, and they provide a real-time assessment of hemodynamic stability. Given the need for rapid diagnostics when treating critically ill patients, CR measurements would complement parameters that are currently being used. Consequently, the purpose of this article is to introduce a conceptual framework where the CR represents a new approach to monitoring critically ill patients. Within this framework, we present evidence to support the notion that the use of the CR could potentially improve the outcomes of ICU patients by alerting intensivists to impending hypovolemic shock before its onset.

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Section: Discussionmentioning

confidence: 97%

Unmasking the Hypovolemic Shock Continuum: The Compensatory Reserve

Suresh

Chung

Schiller

et al. 2018

J Intensive Care Med

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“…[9][10][11][12] It has been proven equivalent to lactate, a well-studied parameter of hemorrhagic shock, in monitoring perfusion status and subsequent resuscitation. 13 Studies validating this technology have largely been in the setting of hemorrhage in trauma patients, but there are other patient populations that would likely benefit from this measure. To date, there has only been one published study that included an obstetrical population.…”

mentioning

confidence: 99%

Detection of Postpartum Hemorrhage Using Compensatory Reserve Index in Patients Undergoing Cesarean Delivery

Reppucci,

Rogerson,

Pickett

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Early recognition and management are imperative for improved outcomes. The compensatory reserve index (CRI) is a novel physiological parameter that trends changes in intravascular volume, by continuously comparing extracted photoplethysmogram waveforms to a reference model that was derived from a human model of acute blood loss. This study sought to determine whether the CRI pattern was differential between those who do and do not experience PPH during cesarean delivery and compare these results to the American Society of Anesthesiologists (ASA) standards for noninvasive monitoring. METHODS: Parturients undergoing cesarean delivery were enrolled between February 2020 and May 2021. A noninvasive CRI monitor was applied to collect continuous CRI values throughout the intraoperative and immediate postpartum periods. Patients were stratified based on blood loss into PPH versus non-PPH groups. PPH was defined as a quantitative blood loss >1000 mL. Function-on-scalar (FoS) regression was used to compare trends in CRI between groups (PPH versus non-PPH) during the 10 to 60-minute window after delivery. Two subanalyses excluding patients who received general anesthesia and preeclamptics were performed. RESULTS: Fifty-one patients were enrolled in the study. Thirteen (25.5%) patients experienced PPH. Pregnant patients who experienced PPH had, on average, lower postdelivery CRI values (−0.13; 95% CI, −0.13 to −0.12; P < .001) than those who did not experience PPH. This persisted even when adjusting for preeclampsia and administration of uterotonics. The average mean arterial pressure (MAP) measurements were not statistically significant (−1.67; 95% CI, −3.57 to 0.22; P = .09). Similar trends were seen when excluding patients who underwent general anesthesia. When excluding preeclamptics, CRI values remained lower in those who hemorrhaged (−0.18; 95% CI, −0.19 to −0.17; P < .001). CONCLUSIONS: CRI detects changes in central volume status not distinguished by MAP. It has the potential to serve as a continuous, informative metric, notifying providers of acute changes in central volume status due to PPH during cesarean delivery.

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