scholarly journals Estimation of pulse pressure variation and cardiac output in patients having major abdominal surgery: a comparison between a mobile application for snapshot pulse wave analysis and invasive pulse wave analysis

2020 ◽  
Author(s):  
Phillip Hoppe ◽  
Fabian Gleibs ◽  
Luisa Briesenick ◽  
Alexandre Joosten ◽  
Bernd Saugel
Keyword(s):  
Cardiac Output ◽  
Abdominal Surgery ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Mobile Application ◽  
Pulse Wave ◽  
Pressure Variation ◽  
Pulse Wave Analysis ◽  
Major Abdominal Surgery ◽  
Wave Analysis

scholarly journals Preload Dependence Is Associated with Reduced Sublingual Microcirculation during Major Abdominal Surgery

2019 ◽  
Vol 130 (4) ◽  
pp. 541-549 ◽  
Author(s):  
Karim Bouattour ◽  
Jean-Louis Teboul ◽  
Laurent Varin ◽  
Eric Vicaut ◽  
Jacques Duranteau
Keyword(s):  
Mean Arterial Pressure ◽  
Abdominal Surgery ◽  
Stroke Volume ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Stroke Volume Index ◽  
Pressure Variation ◽  
Major Abdominal Surgery ◽  
Volume Index ◽  
Sublingual Microcirculation

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Dynamic indices, such as pulse pressure variation, detect preload dependence and are used to predict fluid responsiveness. The behavior of sublingual microcirculation during preload dependence is unknown during major abdominal surgery. The purpose of this study was to test the hypothesis that during abdominal surgery, microvascular perfusion is impaired during preload dependence and recovers after fluid administration. Methods This prospective observational study included patients having major abdominal surgery. Pulse pressure variation was used to identify preload dependence. A fluid challenge was performed when pulse pressure variation was greater than 13%. Macrocirculation variables (mean arterial pressure, heart rate, stroke volume index, and pulse pressure variation) and sublingual microcirculation variables (perfused vessel density, microvascular flow index, proportion of perfused vessels, and flow heterogeneity index) were recorded every 10 min. Results In 17 patients, who contributed 32 preload dependence episodes, the occurrence of preload dependence during major abdominal surgery was associated with a decrease in mean arterial pressure (72 ± 9 vs. 83 ± 15 mmHg [mean ± SD]; P = 0.016) and stroke volume index (36 ± 8 vs. 43 ± 8 ml/m2; P < 0.001) with a concomitant decrease in microvascular flow index (median [interquartile range], 2.33 [1.81, 2.75] vs. 2.84 [2.56, 2.88]; P = 0.009) and perfused vessel density (14.9 [12.0, 16.4] vs. 16.1 mm/mm2 [14.7, 21.4], P = 0.009), while heterogeneity index was increased from 0.2 (0.2, 0.4) to 0.5 (0.4, 0.7; P = 0.001). After fluid challenge, all microvascular parameters and the stroke volume index improved, while mean arterial pressure and heart rate remained unchanged. Conclusions Preload dependence was associated with reduced sublingual microcirculation during major abdominal surgery. Fluid administration successfully restored microvascular perfusion.

scholarly journals The use of pulse pressure variation for predicting impairment of microcirculatory blood flow

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christoph R. Behem ◽  
Michael F. Graessler ◽  
Till Friedheim ◽  
Rahel Kluttig ◽  
Hans O. Pinnschmidt ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Reperfusion Injury ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Pressure Variation ◽  
Volume Loading ◽  
Microcirculatory Blood Flow

AbstractDynamic parameters of preload have been widely recommended to guide fluid therapy based on the principle of fluid responsiveness and with regard to cardiac output. An equally important aspect is however to also avoid volume-overload. This accounts particularly when capillary leakage is present and volume-overload will promote impairment of microcirculatory blood flow. The aim of this study was to evaluate, whether an impairment of intestinal microcirculation caused by volume-load potentially can be predicted using pulse pressure variation in an experimental model of ischemia/reperfusion injury. The study was designed as a prospective explorative large animal pilot study. The study was performed in 8 anesthetized domestic pigs (German landrace). Ischemia/reperfusion was induced during aortic surgery. 6 h after ischemia/reperfusion-injury measurements were performed during 4 consecutive volume-loading-steps, each consisting of 6 ml kg−1 bodyweight−1. Mean microcirculatory blood flow (mean Flux) of the ileum was measured using direct laser-speckle-contrast-imaging. Receiver operating characteristic analysis was performed to determine the ability of pulse pressure variation to predict a decrease in microcirculation. A reduction of ≥ 10% mean Flux was considered a relevant decrease. After ischemia–reperfusion, volume-loading-steps led to a significant increase of cardiac output as well as mean arterial pressure, while pulse pressure variation and mean Flux were significantly reduced (Pairwise comparison ischemia/reperfusion-injury vs. volume loading step no. 4): cardiac output (l min−1) 1.68 (1.02–2.35) versus 2.84 (2.15–3.53), p = 0.002, mean arterial pressure (mmHg) 29.89 (21.65–38.12) versus 52.34 (43.55–61.14), p < 0.001, pulse pressure variation (%) 24.84 (17.45–32.22) versus 9.59 (1.68–17.49), p = 0.004, mean Flux (p.u.) 414.95 (295.18–534.72) versus 327.21 (206.95–447.48), p = 0.006. Receiver operating characteristic analysis revealed an area under the curve of 0.88 (CI 95% 0.73–1.00; p value < 0.001) for pulse pressure variation for predicting a decrease of microcirculatory blood flow. The results of our study show that pulse pressure variation does have the potential to predict decreases of intestinal microcirculatory blood flow due to volume-load after ischemia/reperfusion-injury. This should encourage further translational research and might help to prevent microcirculatory impairment due to excessive fluid resuscitation and to guide fluid therapy in the future.

scholarly journals Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation?

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Temistocle Taccheri ◽  
Francesco Gavelli ◽  
Jean-Louis Teboul ◽  
Rui Shi ◽  
Xavier Monnet
Keyword(s):  
Cardiac Output ◽  
Inferior Vena Cava ◽  
Tidal Volume ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Pressure Variation ◽  
Diagnostic Threshold ◽  
Preload Responsiveness

Abstract Background In patients ventilated with tidal volume (Vt) < 8 mL/kg, pulse pressure variation (PPV) and, likely, the variation of distensibility of the inferior vena cava diameter (IVCDV) are unable to detect preload responsiveness. In this condition, passive leg raising (PLR) could be used, but it requires a measurement of cardiac output. The tidal volume (Vt) challenge (PPV changes induced by a 1-min increase in Vt from 6 to 8 mL/kg) is another alternative, but it requires an arterial line. We tested whether, in case of Vt = 6 mL/kg, the effects of PLR could be assessed through changes in PPV (ΔPPVPLR) or in IVCDV (ΔIVCDVPLR) rather than changes in cardiac output, and whether the effects of the Vt challenge could be assessed by changes in IVCDV (ΔIVCDVVt) rather than changes in PPV (ΔPPVVt). Methods In 30 critically ill patients without spontaneous breathing and cardiac arrhythmias, ventilated with Vt = 6 mL/kg, we measured cardiac index (CI) (PiCCO2), IVCDV and PPV before/during a PLR test and before/during a Vt challenge. A PLR-induced increase in CI ≥ 10% defined preload responsiveness. Results At baseline, IVCDV was not different between preload responders (n = 15) and non-responders. Compared to non-responders, PPV and IVCDV decreased more during PLR (by − 38 ± 16% and − 26 ± 28%, respectively) and increased more during the Vt challenge (by 64 ± 42% and 91 ± 72%, respectively) in responders. ∆PPVPLR, expressed either as absolute or as percent relative changes, detected preload responsiveness (area under the receiver operating curve, AUROC: 0.98 ± 0.02 for both). ∆IVCDVPLR detected preload responsiveness only when expressed in absolute changes (AUROC: 0.76 ± 0.10), not in relative changes. ∆PPVVt, expressed as absolute or percent relative changes, detected preload responsiveness (AUROC: 0.98 ± 0.02 and 0.94 ± 0.04, respectively). This was also the case for ∆IVCDVVt, but the diagnostic threshold (1 point or 4%) was below the least significant change of IVCDV (9[3–18]%). Conclusions During mechanical ventilation with Vt = 6 mL/kg, the effects of PLR can be assessed by changes in PPV. If IVCDV is used, it should be expressed in percent and not absolute changes. The effects of the Vt challenge can be assessed on PPV, but not on IVCDV, since the diagnostic threshold is too small compared to the reproducibility of this variable. Trial registration: Agence Nationale de Sécurité du Médicament et des Produits de santé: ID-RCB: 2016-A00893-48.

SEMI INVASIVE CARDIAC OUTPUT MONITORING IN A CARDIAC PATIENT UNDERGOING TOTAL THYROIDECTOMY USING SMARTPHONE APP CAPSTESIA.

2021 ◽  
pp. 4-5
Author(s):  
Santosh Kumar Rai ◽  
Vishal Vashist ◽  
Deepak Bhardwaj ◽  
Bhanu Gupta
Keyword(s):  
Cardiac Output ◽  
Cardiac Index ◽  
Real Time ◽  
Hemodynamic Monitoring ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Output Pulse ◽  
Pressure Variation ◽  
Smartphone App ◽  
Arterial Waveform

Introduction: Advanced hemodynamic monitoring is need of today especially in patients with limited cardiac reserve. With the advent of smartphones & specially designed applications, hemodynamic monitoring becomes quite easy. Materials & Methods: Patient was pre – medicated with Inj. Fentanyl & inj. Glycopyrrolate, induced with Inj. Etomidate & Inj. Vecuronium and maintained with mixture ofIsourane, Nitrous Oxide & Oxygen. An arterial line was secured in Left Radial Artery. We used the CAPSTESIA app to take picture of the arterial waveform using a smartphone. Demographic data of the patient was fed in the app. App used it's pre- fed algorithm to give the real time Cardiac Output, Pulse Pressure variations, Cardiac Index based upon the arterial waveform. Results: Using the application we were able to monitor the cardiac output of the patient in real time using semi- invasive means. It enabled us to regulate the uid management of the patient and avoid any adverse cardiac events (hypotension). With Pulse Pressure variation also available in real time, we were able to restrict use of vasopressors since the Left Ventricle Ejection Fraction of the patient was 35 % on ECHO. Surgery was conducted without any untoward event. Patient was successfully extubated and sent to PACU. Conclusions:Advanced hemodynamic monitoring is time consuming using manual methods. We found the smartphone app CAPSTESIA pretty useful for semi-invasive hemodynamic monitoring of the Cardiac Output, Pulse Pressure variation, Cardiac Index,etc in real time.

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