The Inflammatory Reflex and Neural Tourniquet: Harnessing the Healing Power of the Vagus Nerve

Fritz, Jason R.

doi:10.2217/bem-2017-0002

Cited by 5 publications

(3 citation statements)

References 55 publications

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“…Typically, a reduced baroreflex FB gain and a depressed HRV, together with an elevated HR, are interpreted as signs of a depressed vagal activity at the heart level. These observations suggest a vagal driver for an effective resuscitation, and this hypothesis is in line with the recent literature on vagus nerve stimulation as an innovative therapeutic strategy, which has been proven to be beneficial also in septic shock (Borovikova et al, 2000;Tracey, 2002;Liu et al, 2006;Bansal et al, 2010;Czura et al, 2010;Huston and Fritz, 2018).…”

Section: Autonomic Dysfunction and Association With Vascular Changessupporting

confidence: 85%

Vascular Decoupling in Septic Shock: The Combined Role of Autonomic Nervous System, Arterial Stiffness, and Peripheral Vascular Tone

et al. 2020

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Background: Acute inflammation and sepsis are known to induce changes in vascular properties, leading to increased arterial stiffness; at the same time, the autonomic nervous system (ANS) also affects vascular properties by modulating the arterial smooth muscle tone, and it is widely reported that sepsis and septic shock severely impair ANS activity. Currently, clinical guidelines are mainly concerned to resuscitate septic shock patients from hypotension, hypovolemia, and hypoperfusion; however, if the current resuscitation maneuvers have a beneficial effect also on vascular properties and autonomic functionality is still unclear. The objective of this work is to assess the effects of standard resuscitation at vascular level and to verify if there is any association between alterations in vascular properties and ANS activity.

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Section: Autonomic Dysfunction and Association With Vascular Changessupporting

confidence: 85%

Vascular Decoupling in Septic Shock: The Combined Role of Autonomic Nervous System, Arterial Stiffness, and Peripheral Vascular Tone

et al. 2020

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“…As final remark, innovative technologies in the field of bioelectronic medicine are growing and they are advocated as the future medicine for the vast majority of diseases. These techniques are based on the direct stimulation of the ANS, in particular of the vagus nerve and clinical trials are ongoing [44]. Our model could be used to evaluate the efficacy of such treatment on LV contractility and relating control mechanisms.…”

Section: Discussionmentioning

confidence: 99%

A Mathematical Model of dP/dt Max for the Evaluation of the Dynamic Control of Heart Contractility in Septic Shock

Carrara

Herpain²,

Baselli

et al. 2019

IEEE Trans. Biomed. Eng.

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Objective: Septic shock (SS) patients often show elevated heart rate (HR) despite resuscitation, and this condition is considered an early manifestation of myocardial dysfunction due to an impairment of autonomic nervous system (ANS). We aimed at proposing a mathematical model to assess the autonomic control of ventricular contractility (VC) and HR to track changes in heart functionality during an experimental animal model of SS and resuscitation. Methods: SS was induced in six adult swine by polymicrobial peritonitis. We analyzed the beat-to-beat variability of the maximum positive time derivative of left ventricular pressure (dP/dt max), heart period (HP), and aortic blood pressure (ABP). We identified the transfer functions relating fluctuations in ABP and HP to dP/dt max to characterize the static and dynamic properties of the arterial baroreflex and the force-frequency relation mechanisms, respectively. Standard indices of autonomic dysfunction have also been considered as HR variability (HRV) and baroreflex sensitivity (BRS). Results: During baseline, the baroreflex is predominant in controlling VC with a gain value of −5.8 (−7.5,−3) s −1 , compared to −1.2 (−1.9,−0.5) mmHg/s ms −1 of the force-frequency autoregulation. During shock, both mechanisms increase their extent in VC control (higher gains and slightly faster dynamics for the baroreflex). After resuscitation, the physiological control of VC is not restored and all the animals still exhibit high HR and reduced HRV and BRS. Conclusion: A condition of cardiovascular inefficiency is persistent after resuscitation and this could be due to autonomic dysfunction. Significance: The ANS in SS is crucial to restore homeostasis. Our model could be used to evaluate the efficacy of treatments on VC and related control mechanisms.

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“…Mental stress is also one of the causes of VVS. Studies showed that mental stress is a main cause of vagal reflex in patients undergoing vascular intervention [10]. PICC catheterization is an invasive operation on blood vessels and many patients suffer from mental stress because they have limited knowledge about the operation.…”

Section: Mental Stressmentioning

confidence: 99%

Analysis on Related Factors and Nursing Interventions of Vasovagal Syncope During Ultrasound-guided PICC

Wu¹,

He²,

Qi³

et al. 2020

AJNS

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Purpose: To investigate the causes and the nursing interventions of vasovagal syncope (VVS) during ultrasound-guided Modified Seldinger Technique (MST) PICC catheterization. Methods: Clinical data (medical records, demographic data, diagnosis, local vascular compression situation, B-mode ultrasound-recorded catheter/vessel ratio and the occurrence time, symptoms and treatment of syncope) of 14 patients diagnosed as vasovagal syncope during ultrasound-guided PICC catheterization at three hospitals in Guangdong province from September 2018 to September 2019 were collected for this retrospective analysis. Results: There were 3091 cases of ultrasound-guided MST PICC catheterization in the venous catheter outpatient clinics of the 3 hospitals from September 2018 to October 2019 with 14 cases (0.45%) of intraoperative vasovagal syncope, all cancer patients (5 males, 9 females) with a mean age 45± 3.8. They all received PICC for the first time and were under mental stress during the operation. Among the 14 patients (2 mild, 7 moderate, 5 severe), 8 had multiple lymphadenectasis in the neck and clavicular areas of the catheterization side, which resulted in different degree of venous compression and difficulty in insertion; 5 had catheter/vessel ratio over 45%. 2 cases of VVS occurred when the patients were asked to turn their heads against shoulders on to the puncture side; 10 occurred when using B-mode ultrasound probe to examine the jugular vein; 2 occurred when pulling out the catheter sheath. Conclusion: The related factors of vasovagal syncope during ultrasound-guided PICC catheterization include overcompression and avulsion on blood vessels and mental stress. Therefore, it is recommended to implement psychological interventions before surgery, reduce compression and avulsion of the vascular access during catheterization, and improve practitioners' abilities in vessel selection (vessels with a catheter/vessel ratio less than 45%) and catheterization skills to eliminate the incidence of vasovagal syncope during PICC catheterization.

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The Inflammatory Reflex and Neural Tourniquet: Harnessing the Healing Power of the Vagus Nerve

Cited by 5 publications

References 55 publications

Vascular Decoupling in Septic Shock: The Combined Role of Autonomic Nervous System, Arterial Stiffness, and Peripheral Vascular Tone

Vascular Decoupling in Septic Shock: The Combined Role of Autonomic Nervous System, Arterial Stiffness, and Peripheral Vascular Tone

A Mathematical Model of dP/dt Max for the Evaluation of the Dynamic Control of Heart Contractility in Septic Shock

Analysis on Related Factors and Nursing Interventions of Vasovagal Syncope During Ultrasound-guided PICC

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