Maintaining Survivors??? Values of Left Ventricular Power Output during Shock Resuscitation: A Prospective Pilot Study

Mc, Chang; Jw, Mason; Eh, Kincaid; Pr, Miller

doi:10.1097/00005373-200007000-00004

Cited by 22 publications

(8 citation statements)

References 14 publications

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“…7 Prospectively, patients resuscitated to a LVP of 320 mm Hg ⅐ L/min/m 2 demonstrated more rapid clearance of base deficit than those resuscitated to maximize oxygen transport. 8 Also, improved VAC was associated with improved myocardial efficiency, base deficit clearance, and survival. 6 -7 This current study provides further evidence supporting the value of stroke work and VAC-based resuscitation goals.…”

Section: Discussionmentioning

confidence: 93%

“…Prior studies at Wake Forest University School of Medicine (WFUSOM) have focused on the use of ventricular power and stroke work in the resuscitation of severely injured patients. [6][7][8] Higher levels of stroke work index (SWI) and improved ventricular-arterial coupling (VAC) have been associated with survival after severe injury. 7 Prospectively, maintaining greater left ventricular power (LVP) resulted in improved resolution of acidosis and decreased rates of organ dysfunction.…”

mentioning

confidence: 99%

“…7 Prospectively, maintaining greater left ventricular power (LVP) resulted in improved resolution of acidosis and decreased rates of organ dysfunction. 8 Recently, technology has emerged in the intensive care unit (ICU) that allows vast amounts of physiologic data to be captured, stored, and used for clinical and research purposes. The Signal Interpretation and Monitoring (SIMON) system provides continuous data management throughout the Vanderbilt University Medical Center (VUMC) trauma ICU.…”

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confidence: 99%

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Validation of Stroke Work and Ventricular Arterial Coupling as Markers of Cardiovascular Performance during Resuscitation

Martin

Norris

Kilgo

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

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confidence: 99%

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Validation of Stroke Work and Ventricular Arterial Coupling as Markers of Cardiovascular Performance during Resuscitation

Martin

Norris

Kilgo

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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“…There are numerous aspects of the PAC use that remain to be fully elucidated: (a) the optimization of oxygen delivery based on stroke volume per unit of body mass;[ 10 13 ] (b) the development of new “vital signs” based on beat-to-beat variability within various PAC-derived parameters;[ 13 14 ] and (c) validation of the proposed benefits of the PAC in the most severely injured trauma patients,[ 2 ] among many others. Perhaps, the most clinically relevant aspect of PAC use is the refinement of ICU resuscitations [ Table 3 ].…”

Section: Pulmonary Artery Catheter: Controversiesmentioning

confidence: 99%

The pulmonary artery catheter in 2008 – A (finally) maturing modality?

Stawicki

Prosciak

2017

Int J Crit Illn Inj Sci

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The first description of the flow-directed pulmonary artery catheter (PAC) was published in the 1970s by Jeremy Swan and William Ganz. Ever since its clinical debut, many controversies surrounded the use of the PAC. Regardless of these controversies, the most fundamental issues surrounding this hemodynamic monitoring device remain unresolved, including the exact indications, contraindications, identification of patients who potentially benefit from this technology, and the way we interpret and use PAC-derived parameters. Despite recent intensification of attacks against the use of the PAC by its opponents, it seems overly harsh to discount a technology that might be beneficial in appropriately selected clinical situations, especially when considering the fact that our true knowledge of this technology is somewhat limited. In fact, the PAC may still play an important role considering the resurgence of the concepts of euvolemic resuscitation and hemodynamic sufficiency.Republished with Permission from: Stawicki SP, Prosciak MP. The pulmonary artery catheter in 2008 – a (finally) maturing modality? OPUS 12 Scientist 2008;2(4):5-9.

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“…Cardiac power variables have also been used as overall hemodynamic guides in trauma resuscitation with associated survival benefit (Chang et al. ).…”

Section: Introductionmentioning

confidence: 99%

Post cardiac surgery stunning reduces stroke work, but leaves cardiac power output unchanged in patients with normal ejection fraction

et al. 2018

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This study assesses positional changes in cardiac power output and stroke work compared with classic hemodynamic variables, measured before and after elective coronary artery bypass graft surgery. The hypothesis was that cardiac power output was altered in relation to cardiac stunning. The study is a retrospective analysis of data from two previous studies performed in a tertiary care university hospital. Thirty‐six patients scheduled for elective coronary artery bypass graft surgery, with relatively preserved left ventricular function, were included. A pulmonary artery catheter and a radial artery catheter were placed preoperatively. Cardiac power output and stroke work were calculated through thermodilution both supine and standing prior to induction of anesthesia and again day one postoperatively. Virtually all systemic hemodynamic parameters changed significantly from pre‐ to postoperatively, and from supine to standing. Cardiac power output was maintained at 0.9–1.0 (±0.3) W both pre‐ and postoperatively and from supine to standing on both days. Stroke work fell from pre‐ to postoperatively from 1.1 to 0.8 J (P < 0.001), there was a significant fall in stroke work with positional change preoperatively from 1.1 to 0.9 J (P < 0.001). Postoperatively the stroke work remained at 0.8 J despite positional change. Cardiac power output was the only systemic hemodynamic variable which remained unaltered during all changes. Stroke work appears to be a more sensitive marker for temporary cardiovascular dysfunction than cardiac power output. Further studies should explore the relationship between stroke work and cardiac performance and whether cardiac power output is an autoregulated intrinsic physiological parameter.

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Maintaining Survivors??? Values of Left Ventricular Power Output during Shock Resuscitation: A Prospective Pilot Study

Abstract: Prospectively maintaining LVP above 320 mm Hg x L/min/m2 during resuscitation is an achievable goal. It is associated with improved base deficit clearance and a lower rate of organ dysfunction after resuscitation from traumatic shock.

Cited by 22 publications

References 14 publications

Validation of Stroke Work and Ventricular Arterial Coupling as Markers of Cardiovascular Performance during Resuscitation

Validation of Stroke Work and Ventricular Arterial Coupling as Markers of Cardiovascular Performance during Resuscitation

The pulmonary artery catheter in 2008 – A (finally) maturing modality?

Post cardiac surgery stunning reduces stroke work, but leaves cardiac power output unchanged in patients with normal ejection fraction

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