Venous Circulation: A Few Challenging Concepts in Goal-Directed Hemodynamic Therapy (GDHT)

Gelman, Simon

doi:10.1007/978-3-030-48374-6_16

Cited by 8 publications

(33 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An extrapolation model was created to assess circulatory volumes in steady-state and pathophysiological conditions using 20-kg Landrace–Large White swine. As the animals’ baseline hemodynamics closely resemble human hemodynamics [ 9 , 10 ], we accepted that 30% of their TBV represents Vs and the remaining 70% is Vu [ 11 , 12 , 13 , 14 ]. The TBV of the Landrace–Large White swine is 7% of the total body weight, i.e., 1400 mL for a 20 kg animal, and therefore, their baseline Vs is 420 mL.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock

Chalkias

Laou

Papagiannakis

et al. 2022

JPM

View full text Add to dashboard Cite

The present work investigated the dynamic changes in stressed volume (Vs) and other determinants of venous return using a porcine model of hyperdynamic septic shock. Septicemia was induced in 10 anesthetized swine, and fluid challenges were started after the diagnosis of sepsis-induced arterial hypotension and/or tissue hypoperfusion. Norepinephrine infusion targeting a mean arterial pressure (MAP) of 65 mmHg was started after three consecutive fluid challenges. After septic shock was confirmed, norepinephrine infusion was discontinued, and the animals were left untreated until cardiac arrest occurred. Baseline Vs decreased by 7% for each mmHg decrease in MAP during progression of septic shock. Mean circulatory filling pressure (Pmcf) analogue (Pmca), right atrial pressure, resistance to venous return, and efficiency of the heart decreased with time (p < 0.001 for all). Fluid challenges did not improve hemodynamics, but noradrenaline increased Vs from 107 mL to 257 mL (140%) and MAP from 45 mmHg to 66 mmHg (47%). Baseline Pmca and post-cardiac arrest Pmcf did not differ significantly (14.3 ± 1.23 mmHg vs. 14.75 ± 1.5 mmHg, p = 0.24), but the difference between pre-arrest Pmca and post-cardiac arrest Pmcf was statistically significant (9.5 ± 0.57 mmHg vs. 14.75 ± 1.5 mmHg, p < 0.001). In conclusion, the baseline Vs decreased by 7% for each mmHg decrease in MAP during progression of hyperdynamic septic shock. Significant changes were also observed in other determinants of venous return. A new physiological intravascular volume existing at zero transmural distending pressure was identified, termed as the rest volume (Vr).

show abstract

Section: Methodsmentioning

confidence: 99%

Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock

Chalkias

Laou

Papagiannakis

et al. 2022

JPM

View full text Add to dashboard Cite

show abstract

“…Other research groups have shown an increase of 0.036–0.068 mmHg of Pmcf per mmHg PaCO 2 in dogs with hypoxic hypercapnia [ 34 , 35 , 37 ]. The difference between the species might be explained by the order of ranking the component regions of the splanchnic circulation with regard to function as a blood reservoir, which may be specific for the dog, and the sequestration of blood within the canine splanchnic circulation [ 2 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Also, Hoka et al showed that coronary venous outflow increases by 400% and splanchnic venous outflow decreases by 60% after 3.5 min of hypoxic hypercapnia [ 39 ]. The activation of the abundant alpha-adrenergic receptors in the hepatic veins increases the impedance of the outflow of blood from the splanchnic system into systemic circulation and leads to sequestration of blood within the liver [ 2 ]. Based on our findings, the exogenous administration of an alpha-1 adrenergic agonist in patients with increased Pmcf not only seems meaningless, but will further enhance the constriction of arteries that supply blood to veins of relatively low compliance, leading to a decrease in flow through the whole circuit, venous return, and CO [ 2 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…The activation of the abundant alpha-adrenergic receptors in the hepatic veins increases the impedance of the outflow of blood from the splanchnic system into systemic circulation and leads to sequestration of blood within the liver [ 2 ]. Based on our findings, the exogenous administration of an alpha-1 adrenergic agonist in patients with increased Pmcf not only seems meaningless, but will further enhance the constriction of arteries that supply blood to veins of relatively low compliance, leading to a decrease in flow through the whole circuit, venous return, and CO [ 2 , 43 ]. Compared to alpha-1 adrenergic agonists, norepinephrine might exert an additional benefit by stimulation of beta-2 adrenoceptors, facilitating emptying of the venous system, but may also decrease pulmonary vascular compliance.…”

Section: Discussionmentioning

confidence: 99%

“…Mean circulatory filling pressure (Pmcf) is the equilibrium pressure throughout the circulation (systemic and pulmonary system) during circulatory arrest [ 1 ]. It provides information on intravascular effective blood volume, or stressed volume, and is inversely proportional to the compliance of the cardiovascular system [ 2 ]. The stressed volume is crucial for maintaining venous return, which forms the basis for heart–lung interactions in patients with altered vascular states and is the major determinant of cardiac output (CO) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study

Chalkias

Laou

Papagiannakis

et al. 2022

ICMx

View full text Add to dashboard Cite

Background Mean circulatory filling pressure (Pmcf) provides information on stressed volume and is crucial for maintaining venous return. This study investigated the Pmcf and other determinants of venous return in dysrhythmic and asphyxial circulatory shock and arrest. Methods Twenty Landrace/Large-White piglets were allocated into two groups of 10 animals each. In the dysrhythmic group, ventricular fibrillation was induced with a 9 V cadmium battery, while in the asphyxia group, cardiac arrest was induced by stopping and disconnecting the ventilator and clamping the tracheal tube at the end of exhalation. Mean circulatory filling pressure was calculated using the equilibrium mean right atrial pressure at 5–7.5 s after the onset of cardiac arrest and then every 10 s until 1 min post-arrest. Successful resuscitation was defined as return of spontaneous circulation (ROSC) with a MAP of at least 60 mmHg for a minimum of 5 min. Results After the onset of asphyxia, a ΔPmca increase of 0.004 mmHg, 0.01 mmHg, and 1.26 mmHg was observed for each mmHg decrease in PaO2, each mmHg increase in PaCO2, and each unit decrease in pH, respectively. Mean Pmcf value in the ventricular fibrillation and asphyxia group was 14.81 ± 0.5 mmHg and 16.04 ± 0.6 mmHg (p < 0.001) and decreased by 0.031 mmHg and 0.013 mmHg (p < 0.001), respectively, for every additional second passing after the onset of cardiac arrest. With the exception of the 5–7.5 s time interval, post-cardiac arrest right atrial pressure was significantly higher in the asphyxia group. Mean circulatory filling pressure at 5 to 7.5 s after cardiac arrest predicted ROSC in both groups, with a cut-off value of 16 mmHg (AUC = 0.905, p < 0.001). Conclusion Mean circulatory filling pressure was higher in hypoxic hypercapnic conditions and decreased at a lower rate after cardiac arrest compared to normoxemic and normocapnic state. A Pmcf cut-off point of 16 mmHg at 5–7.5 s after cardiac arrest can highly predict ROSC.

show abstract

Venous Circulation: A Few Challenging Concepts in Goal-Directed Hemodynamic Therapy (GDHT)

Cited by 8 publications

References 71 publications

Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock

Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock

Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study

Using small doses of norepinephrine or phenylephrine during the peri-operative period

Contact Info

Product

Resources

About