Oesophageal Doppler guided optimization of cardiac output does not increase visceral microvascular blood flow in healthy volunteers

Heinink, Thomas P; Read, David; Mitchell, William K.; Bhalla, Ashish; Lund, Jonathan N.; Phillips, Bethan E.; Williams, John P.

doi:10.1111/cpf.12401

Cited by 4 publications

(7 citation statements)

References 28 publications

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“…Our previous study demonstrated that CO as assessed by ODM in healthy volunteers did not correlate with CEUS assessed renal microvascular blood flow. 8 Similarly, in this study of patients undergoing colorectal surgery, we found no correlation between CI, SV or MAP when compared with our measure of renal microvascular perfusion. This suggests that CO may be a poor predictor of vital organ perfusion in patients undergoing surgery.…”

Section: Discussionmentioning

confidence: 42%

“…Despite the advantages of CO assessed indices of cardiovascular performance over traditional methods such as BP measurements, their use in directing fluid therapy during major surgery has provided conflicting results. 8,13,17,22 This may be due to the fact that CO monitors are unable to accurately assess organ microvascular perfusion. Our previous study demonstrated that CO as assessed by ODM in healthy volunteers did not correlate with CEUS assessed renal microvascular blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…correlation between CEUS assessed renal blood flow and serum creatinine. [31][32][33] Our previous work with CEUS in healthy volunteers in a laboratory setting 8 has demonstrated that interventions such as intravenous fluid therapy that induce increases in CO may not affect visceral microvascular blood flow. As previous studies have found an association between poor microvascular perfusion and an increase in postoperative complications, 10,25,[34][35][36] this may explain the mixed results from trials using ODM guided fluid therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Sample size calculations demonstrated that for an α of 0.05 and 1β of 0.85, 32 subjects were needed to detect a 25% difference in microvascular blood flow, with a coefficient of variation 0.43 as seen from our previous CEUS studies. 8 Descriptive data are reported as mean ± SD, median [inter-quartile range] or number (%) as appropriate. Correlation between macrovascular and microvascular indices was assessed using Pearson's or Spearman's correlation as appropriate (normality testing using the Shapiro-Wilk test).…”

Section: Statisticalanalysismentioning

confidence: 99%

“…Some studies in healthy research volunteers have suggested that ODM-derived CO indices may be poor predictors of organ microvascular blood flow. 8 Insufficient renal microvascular blood flow may promote AKI, 9 and poor microvascular perfusion of other vital organs is also associated with postoperative complications. 10 Most current monitors used in anaesthetic practice, including CO monitors, are unable to accurately assess microvascular blood flow, which may explain inconsistent results regarding their use to reduce mortality in patients undergoing surgery.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Contrast‐enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery

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Doleman

Heinink

et al. 2021

Clin Exp Pharma Physio

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Statisticalanalysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Contrast‐enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery

Read

Doleman

Heinink

et al. 2021

Clin Exp Pharma Physio

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Application of dynamic contrast enhanced ultrasound in the assessment of kidney diseases

Selby

Williams

Piasecki

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Many forms of acute and chronic disease are linked to changes in renal blood flow, perfusion, vascular density and hypoxia, but there are no readily available methods to assess these parameters in clinical practice. Dynamic contrast enhanced ultrasound (DCE-US) is a method that provides quantitative assessments of organ perfusion without ionising radiation or risk of nephrotoxicity. It can be performed at the bedside and is suitable for repeated measurements. The purpose of this review is to provide updates from recent publications on the utility of DCE-US in the diagnosis or assessment of renal disease, excluding the evaluation of benign or malignant renal masses. Recent findings DCE-US has been applied in clinical studies of acute kidney injury (AKI), renal transplantation, chronic kidney disease (CKD), diabetic kidney disease and to determine acute effects of pharmacological agents on renal haemodynamics. DCE-US can detect changes in renal perfusion across these clinical scenarios and can differentiate healthy controls from those with CKD. In sepsis, reduced DCE-US measures of perfusion may indicate those at increased risk of developing AKI, but this requires confirmation in larger studies as there can be wide individual variation in perfusion measures in acutely unwell patients. Recent studies in transplantation have not provided robust evidence to show that DCE-US can differentiate between different causes of graft dysfunction, although it may show more promise as a prognostic indicator of graft function 1 year after transplant. DCE-US can detect acute haemodynamic changes in response to medication that correlate with changes in renal plasma flow as measured by para-aminohippurate clearance. Summary DCE-US shows promise and has a number of advantages that make it suitable for the assessment of patients with various forms of kidney disease. However, further research is required to evidence its reproducibility and utility before clinical use can be advocated.

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2019

ASOAJ

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Background: Vasoactive drugs are routinely used clinically to alter mean arterial blood pressure (MAP) and cardiac output (CO) and to maintain organ perfusion. However, the effect of such drugs on microvascular visceral blood flow (MiBF) is not fully understood. We aimed to track changes in renal MiBF, using the well-validated technique of Contrast Enhanced Ultrasound (CEUS), across a range of MAP and CO generated via the vasoactive drugs, phenylephrine and ephedrine.Methods: Baseline cardiovascular measurements were recorded, with renal MiBF determined via CEUS as renal microvascular transit time (RTT). Phenylephrine was then administered, via a standardized protocol, to increase MAP and CO, with repeat CEUS. Following return to baseline, the above was repeated using ephedrine. CEUS time-intensity curves were constructed and renal MiBF calculated.Results: In 11 male volunteers (median age 32), phenylephrine increased MAP (98.7 vs 110.8 mmHg, p<0.001), but not CO (4211 vs. 4089 ml.min -1 , p=0.42), while ephedrine increased CO (4110 vs 6097, p<0.001) and MAP (95.6 vs 100.9, p=0.02). Phenylephrine reduced time to organ perfusion (TTOP) (22.3 vs 18.4 secs, p=0.009), but not RTT (14 vs 13.2 secs, p=0.46). Ephedrine decreased TTOP (21.1 vs 14.7 secs, p=0.003), and RTT (3.5 vs 9.6 secs, p=0.007). Change in CO predicted change in TTOP (r 2 =0.26, p=0.02), but not RTT (r 2 =0.04, p=0.43). Change in MAP did not predict change in TTOP (r2=0.02, p=0.58), or RTT (r2<0.001, p=0.89). Conclusion:Changes in MAP and CO fail to predict renal MiBF. Key pointsQuestion: Do macrovascular changes predict renal microvascular perfusion.Findings: Changes in cardiac output and mean arterial blood pressure fail to predict renal microvascular perfusion.

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Oesophageal Doppler guided optimization of cardiac output does not increase visceral microvascular blood flow in healthy volunteers

Cited by 4 publications

References 28 publications

Contrast‐enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery

Contrast‐enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery

Application of dynamic contrast enhanced ultrasound in the assessment of kidney diseases

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