The increase of vasomotor tone avoids the ability of the dynamic preload indicators to estimate fluid responsiveness

Bouchacourt, Juan Pablo; Grignola, Juan C.

doi:10.1186/1471-2253-13-41

Cited by 21 publications

(25 citation statements)

References 39 publications

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“…3,16 Moreover, no study has demonstrated an association between CO and Ea dyn . 3,4,13,14 We found a weak association between Ea dyn and CO TTE probably related to the HR dependence of CO. As expected, we did not find any association with SV, which represents a flow factor independent of HR.…”

Section: Discussionmentioning

confidence: 57%

“…14e16 In studies assessing the effect of vasopressors, Ea dyn was demonstrated to change while CO did not change. 3,4,14 Ea dyn was demonstrated to be associated to cardiac factors (HR and peak of velocity of aortic blood flow) and vascular factors (arterial compliance and vascular resistance). 3,16 Moreover, no study has demonstrated an association between CO and Ea dyn .…”

Section: Discussionmentioning

confidence: 99%

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

Bar

Leviel

Abou-Arab

et al. 2018

British Journal of Anaesthesia

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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

Bar

Leviel

Abou-Arab

et al. 2018

British Journal of Anaesthesia

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“…19) High variability of SV indicates the presence of hypovolemia at a steady vascular tone, whereas vasodilators have been shown to increase SVV at constant body fluid. 20) The strong correlation between peaks of the Pd/Pa ratio and SVV observed in this The Pd/Pa ratio at maximal hyperemia is affected by the degree of stenosis, whereas the positions of SVV peaks are influenced by vascular tone and preload. This precludes direct evaluation of the relations between these two parameters.…”

Section: Discussionmentioning

confidence: 64%

Identification of the State of Maximal Hyperemia in the Assessment of Coronary Fractional Flow Reserve Using Non-Invasive Electrical Velocimetry

et al. 2017

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SummaryPrevious research revealed that, in patients with coronary pressure-derived fractional flow reserve (FFR) in the 'grey zone' (0.75-0.85), repeated FFR assessments sometimes yield conflicting results. One of the causes of the fluctuations in FFR values around the grey zone may be imprecise identification of the point where maximal hyperemia is achieved. Identification of the state of maximal hyperemia during assessment of FFR can be challenging. This study aimed to determine whether non-invasive electrical velocimetry (EV) can be used to identify the state of maximal hyperemia.Stroke volume (SV), SV variation (SVV), and systemic vascular resistance index (SVRI) were determined by EV in 15 patients who underwent FFR assessment. Time intervals from initiation of adenosine infusion to achieving maximal hyperemia (time mFRR ), as well as to achieving maximal cardiac output (CO), SV, SVV, and SVRI (time which is determined as the ratio of distal to proximal pressure (Pd/Pa) under conditions of maximal hyperemia, represents a reproducible indicator of physiologically significant coronary stenosis.1,2) FFR-guided percutaneous coronary intervention (PCI) has significantly better clinical outcomes than PCI guided by angiography.3,4) Therefore, therapy guided by FFR is a key part of clinical management in patients with coronary artery disease (CAD).Although maximal hyperemia is a crucial factor for the assessment of FFR, 5) it is not always easy to obtain confirmatory evidence of reaching the maximal point of hyperemia in clinical practice. Intravenous adenosine administration is considered the gold standard for elicitation of maximal hyperemia, 3) but there is no clear evidence indicating the point of maximal hyperemia. Moreover, heart rate and blood pressure fluctuate because of respiration and are influenced by intravenous adenosine administration itself, which may lead to an inaccurate FFR. Intravenous adenosine administration is known to increase myocardial blood flow, cardiac output (CO), and stroke volume (SV) and to reduce systemic vascular resistance index (SVRI).6,7) Maximal hyperemia is a condition of maximal vasodilatation with the highest SV and the lowest SVRI. Accordingly, the monitoring of SV and SVRI may be used to verify whether maximal hyperemia has been achieved. Although pulmonary artery catheterization (PAC) is a reliable and reproducible method for assessing circulatory dynamics, 8) CO and SV measured with non-invasive electrical velocimetry (EV) were recently shown to be a viable alternative.9,10) Noninvasive EV is based on impedance cardiography, which can measure fluctuations in aortic blood volume during the cardiac cycle. EV additionally traces the direction and changes in the mechanical characteristics of erythrocytes for circulatory dynamics calculation. In the beginning of systole, this orientation changes into an alignment that leads to an acceleration of the erythrocytes, causing a maximum rate of change in electrical impedance. The general condition during FFR assessment is relative...

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“…However, in a rabbit hemorrhage model, we have shown that PHE infusion (15 mcg/kg/min) induced a decrease in aortic flow with a significant SV decrease after BW compared with normovolemia. The different hemodynamic response to PHE may be probably related to the different doses of the α-adrenergic agonist (small boluses vs. relatively large continuous doses) 11,20 . We propose that PHE infusion had a predominant effect on the Rv (decreased slope of the VR curve without a change of MCFP), which tends to decrease VR.…”

Section: Discussionmentioning

confidence: 99%

End-Expiratory Occlusion Test During Increase of Vasomotor Tone in a Rabbit Model of Hemorrhage

Bouchacourt

Grignola

2020

Sci Rep

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end-expiratory occlusion test (eeot) has been proposed as a preload responsiveness test that overcomes several limitations of pulse pressure (ppV) and stroke volume (SVV) variations. We compared the ability of EEOT versus SVV and PPV to predict fluid responsiveness during the increase of the vasomotor tone in a rabbit model of hemorrhage. ten rabbits were anesthetized, paralyzed, and mechanically ventilated during basal load (BL), after progressive blood withdrawal (BW), and after volume replacement. other two sets of data were obtained during vasomotor increase by phenylephrine (pHe) infusion in BL and BW. We estimated the change of stroke volume (∆SV eeot ) and aortic flow (∆Aof eeot ) during the eeot. ppV and SVV were obtained by the variation of beat-tobeat pp and SV, respectively. Baseline ppV, SVV, ∆SV eeot , and ∆Aof eeot increased significantly after BW, with a decrease of aortic flow (P < 0.05). PHE induced a significant decrease of PPV and SVV, but without affecting ∆SV eeot , and ∆Aof eeot . We conclude that ∆SV and ∆Aof during eeot kept the ability to predict fluid responsiveness during PHE infusion in a rabbit hemorrhage model. This result may suggest the advantage of EEOT with respect to SVV and PPV in predicting fluid responsiveness during vasomotor tone increase.The main goal of fluid therapy is to correct hypovolemia avoiding both under and over-resuscitation, as well as the excessive use of inotropic and vasopressor drugs. Moreover, the comorbidities and type of disease determine that not all patients are volume responsive. The preload responsiveness should be assessed to decide both to administer fluid in the early resuscitation phase of shock states and to stop fluid administration in the de-escalation phase of shock management 1 . Several indices are available at the bedside to predict fluid responsiveness. Dynamic parameters based on heart-lung interactions have been proposed to predict fluid responsiveness and to promote more rational fluid administration 2 . Nevertheless, respiratory variations of stroke volume (SVV), pulse pressure (PPV), and vena cava diameter have numerous limitations that reduce their accuracy and applicability in clinical scenarios 3 . By interrupting cyclic ventilation at end-expiration for a few seconds (end-expiratory occlusion, EEO), abolishing the inspiratory increase in intrathoracic pressure, and by passive leg raising tests, we can produce a self-volume challenge and increase cardiac output (CO) by a rapid and reversible increase of venous return (VR) in those patients preload-responsive 4,5 . Both tests have shown an excellent predictive value keeping their accuracy in patients with cardiac arrhythmias, with spontaneous breathing activity, with low compliance of the respiratory system and independently of positive end-expiratory pressure in acute respiratory distress syndrome patients 6,7 . However, passive leg raising presents some false negatives in patients with intra-abdominal pressure ≥16 mmHg, is contra-indicated to perform in patients with head trauma ...

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The increase of vasomotor tone avoids the ability of the dynamic preload indicators to estimate fluid responsiveness

Cited by 21 publications

References 39 publications

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

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

Identification of the State of Maximal Hyperemia in the Assessment of Coronary Fractional Flow Reserve Using Non-Invasive Electrical Velocimetry

End-Expiratory Occlusion Test During Increase of Vasomotor Tone in a Rabbit Model of Hemorrhage

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