Understanding arterial load

García, Manuel Ignacio Monge; Orduña, Paula Saludes; Cecconi, Maurizio

doi:10.1007/s00134-016-4212-z

Cited by 39 publications

(20 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The arterial load describes all the extracardiac factors opposing left ventricular ejection [28]. In clinical practice, arterial load is often related to systemic vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study

Courson

Boyer

Grobost

et al. 2019

Ann. Intensive Care

View full text Add to dashboard Cite

BackgroundDynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variations and stroke volume variations, has been proposed to assess functional arterial load. We evaluated the evolution of Eadyn during volume expansion and the effects of neosynephrine infusion in hypotensive and preload-responsive patients.MethodsIn this prospective bicentre study, we included 56 mechanically ventilated patients in the operating room. Each patient had volume expansion and neosynephrine infusion. Stroke volume and stroke volume variations were obtained using esophageal Doppler, and pulse pressure variations were measured through the arterial line. Pressure response to volume expansion was defined as an increase in mean arterial pressure (MAP) ≥ 10%.ResultsTwenty-one patients were pressure responders to volume expansion. Volume expansion induced a decrease in Eadyn (from 0.69 [0.58–0.85] to 0.59 [0.42–0.77]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after volume expansion were related to age, history of arterial hypertension, net arterial compliance and effective arterial elastance. Eadyn value before volume expansion > 0.65 predicted a MAP increase ≥ 10% with a sensitivity of 76% (95% CI 53–92%) and a specificity of 60% (95% CI 42–76%). Neosynephrine infusion induced a decrease in Eadyn (from 0.67 [0.48–0.80] to 0.54 [0.37–0.68]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after neosynephrine infusion were only related to heart rate.ConclusionEadyn is a potential sensitive marker of arterial tone changes following vasopressor infusion.

show abstract

“…The arterial load describes all the extracardiac factors opposing left ventricular ejection [28]. In clinical practice, arterial load is often related to systemic vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study

Courson

Boyer

Grobost

et al. 2019

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…Flow is important to deliver oxygen whereas pressure is important to allow for autoregulation of blood flow distribution. Because the interaction of arterial system with the heart, a given arterial pressure and CO that maintains necessary organ perfusion can be achieved by different cardiovascular configurations (Monge Garcia et al, 2016). However, an optimal combination of cardiac function and arterial system state has been described that ensures the maximal mechanical energy transfer from the ventricle to the arterial tree (Guarracino et al, 2013).…”

Section: Ea Dyn As a Ventriculo-arterial Coupling Indexmentioning

confidence: 99%

Dynamic Arterial Elastance as a Ventriculo-Arterial Coupling Index: An Experimental Animal Study

García¹,

Jian

Hatib

et al. 2020

Front. Physiol.

Self Cite

View full text Add to dashboard Cite

Dynamic arterial elastance (Ea dyn), the ratio between arterial pulse pressure and stroke volume changes during respiration, has been postulated as an index of the coupling between the left ventricle (LV) and the arterial system. We aimed to confirm this hypothesis using the gold-standard for defining LV contractility, afterload, and evaluating ventricular-arterial (VA) coupling and LV efficiency during different loading and contractile experimental conditions. Twelve Yorkshire healthy female pigs submitted to three consecutive stages with two opposite interventions each: changes in afterload (phenylephrine/nitroprusside), preload (bleeding/fluid bolus), and contractility (esmolol/dobutamine). LV pressure-volume data was obtained with a conductance catheter, and arterial pressures were measured via a fluid-filled catheter in the proximal aorta and the radial artery. End-systolic elastance (Ees), a load-independent index of myocardial contractility, was calculated during an inferior vena cava occlusion. Effective arterial elastance (Ea, an index of LV afterload) was calculated as LV end-systolic pressure/stroke volume. VA coupling was defined as the ratio Ea/Ees. LV efficiency (LV eff) was defined as the ratio between stroke work and the LV pressure-volume area. Ea dyn was calculated as the ratio between the aortic pulse pressure variation (PPV) and conductance-derived stroke volume variation (SVV). A linear mixed model was used for evaluating the relationship between Ees, Ea, VA coupling, LV eff with Ea dyn. Ea dyn was inversely related to VA coupling and directly to LV eff. The higher the Ea dyn , the higher the LV eff and the lower the VA coupling. Thus, Ea dyn , an easily measured parameter at the bedside, may be of clinical relevance for hemodynamic assessment of the unstable patient.

show abstract

“…Importantly, it is a functional variable, representing the actual position on the pressure-volume curve, not a direct measure of afterload or SVR. In preload-dependent patients,[41] it may predict whether blood pressure will increase along with cardiac output following fluid administration, or it may predict whether vasopressors may be reduced whilst maintaining blood pressure. [3942] As such, it may guide in functionally assessing afterload and may discriminate between hypotension secondary to either hypovolaemia (Ea dyn high, fluids probably beneficial), or hypovolaemia secondary to vasoplegia (Ea dyn low), requiring vasopressor(s).…”

Section: Hpi and The Cause Of Hypotensionmentioning

confidence: 99%

Intraoperative hypotension and its prediction

Vos

Scheeren

2019

Indian J Anaesth

View full text Add to dashboard Cite

Intraoperative hypotension (IOH) very commonly accompanies general anaesthesia in patients undergoing major surgical procedures. The development of IOH is unwanted, since it is associated with adverse outcomes such as acute kidney injury and myocardial injury, stroke and mortality. Although the definition of IOH is variable, harm starts to occur below a mean arterial pressure (MAP) threshold of 65 mmHg. The odds of adverse outcome increase for increasing duration and/or magnitude of IOH below this threshold, and even short periods of IOH seem to be associated with adverse outcomes. Therefore, reducing the hypotensive burden by predicting and preventing IOH through proactive appropriate treatment may potentially improve patient outcome. In this review article, we summarise the current state of the prediction of IOH by the use of so-called machine-learning algorithms. Machine-learning algorithms that use high-fidelity data from the arterial pressure waveform, may be used to reveal 'traits' that are unseen by the human eye and are associated with the later development of IOH. These algorithms can use large datasets for 'training', and can subsequently be used by clinicians for haemodynamic monitoring and guiding therapy. A first clinically available application, the hypotension prediction index (HPI), is aimed to predict an impending hypotensive event, and additionally, to guide appropriate treatment by calculated secondary variables to asses preload (dynamic preload variables), contractility (dP/dtmax), and afterload (dynamic arterial elastance, Eadyn). In this narrative review, we summarise the current state of the prediction of hypotension using such novel, automated algorithms and we will highlight HPI and the secondary variables provided to identify the probable origin of the (impending) hypotensive event.

show abstract

Understanding arterial load

Cited by 39 publications

References 15 publications

Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study

Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study

Dynamic Arterial Elastance as a Ventriculo-Arterial Coupling Index: An Experimental Animal Study

Intraoperative hypotension and its prediction

Contact Info

Product

Resources

About