Effect of esmolol on positive-pressure ventilation-induced variations of arterial pressure in anaesthetized humans

2004 ◽  
Vol 107 (3) ◽  
pp. 303-308 ◽  
Author(s):  
Hsien Yong LAI ◽  
Cheryl C. H. YANG ◽  
Ching-Feng CHENG ◽  
Fan Yen HUANG ◽  
Yi LEE ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Positive Pressure Ventilation ◽  
Linear Regression Analysis ◽  
Systolic Pressure ◽  
Pressure Variation ◽  
Positive Pressure ◽  
Mechanically Ventilated ◽  
Arterial Pressure Variability ◽  
Before And After ◽  
Sympathetic Regulation

Positive-pressure ventilation-induced variations in arterial pressure have been related to cardiac sympathetic activity in animals. However, the effect of β-adrenoceptor blockade on these variations in anaesthetized humans under positive-pressure ventilation has not yet been investigated. In the present study, RAPV (respiratory-related arterial pressure variability) and %SPV (percentile systolic pressure variation) were determined before and after esmolol treatment in ten mechanically ventilated patients. RAPV and %SPV decreased significantly after intravenous esmolol (1 mg/kg of body weight) treatment (maximal decrease of RAPV, 50% and %SPV, 35%). Linear regression analysis of RAPV and %SPV before and after esmolol treatment both revealed high correlation (r=0.93 and 0.91 respectively). The amplitudes of RAPV and %SPV also significantly increased in a graded way with higher tidal volumes. Thus we propose that esmolol suppresses the variations in arterial pressure induced by positive-pressure mechanical ventilation, and we suggest that RAPV and %SPV may be alternative choices for monitoring cardiac sympathetic regulation in anaesthetized patients under positive-pressure ventilation.

Respiratory-related arterial pressure variability as an indicator of graded blood loss: involvement of the autonomic nervous system

2003 ◽  
Vol 105 (4) ◽  
pp. 491-497 ◽  
Author(s):  
Hsien Yong LAI ◽  
Cheryl C. H. YANG ◽  
Fan-Yen HUANG ◽  
Yi LEE ◽  
Yu Ling KUO ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Blood Volume ◽  
Autonomic Function ◽  
Systolic Pressure ◽  
Pressure Variation ◽  
Positive Pressure ◽  
Systolic Pressure Variation ◽  
Discernible Effect ◽  
Arterial Pressure Variability ◽  
Saline Vehicle

During positive pressure mechanical ventilation, percentile systolic pressure variation (%SPV) or respiratory-related arterial pressure variability (RAPV) have both been used in assessment of graded haemorrhage. We aimed to investigate whether changes in %SPV and RAPV are correlated during graded haemorrhage (by 5, 10 or 20% of the estimated blood volume) in anaesthetized positive pressure ventilated rats and to investigate the involvement of autonomic regulation. Saline vehicle or atropine produced no discernible effect on baseline %SPV or RAPV but, thereafter, %SPV and RAPV increased progressively with graded haemorrhage. Propranolol significantly decreased baseline %SPV and RAPV and changes induced in %SPV and RAPV by graded haemorrhage. Phentolamine significantly enhanced baseline %SPV and RAPV, and further enhancement of %SPV and RAPV by graded haemorrhage did not occur until 20% of the estimated blood volume was removed. RAPV was significantly correlated with %SPV in all experimental groups. We conclude that RAPV is comparable with%SPV as an indicator of graded haemorrhage and that, in anaesthetized and positive pressure ventilated rats, both are dependent on autonomic function, especially β-adrenoceptors.

scholarly journals Intraoperative Assessment of Fluid Responsiveness in Normotensive Dogs under Isoflurane Anaesthesia

2021 ◽  
Vol 8 (2) ◽  
pp. 26
Author(s):  
Despoina Skouropoulou ◽  
Luca Lacitignola ◽  
Caterina Di Bella ◽  
Marzia Stabile ◽  
Claudia Acquafredda ◽  
...  
Keyword(s):  
Fluid Responsiveness ◽  
Systolic Pressure ◽  
Fluid Challenge ◽  
Pressure Variation ◽  
Before And After ◽  
Ringer’S Lactate ◽  
Controlled Mechanical Ventilation ◽  
Variability Index ◽  
Plethysmographic Variability Index ◽  
Volume Controlled

The aim of this study was to evaluate the incidence of fluid responsiveness (FR) to a fluid challenge (FC) in normotensive dogs under anaesthesia. The accuracy of pulse pressure variation (PPV), systolic pressure variation (SPV), stroke volume variation (SVV), and plethysmographic variability index (PVI) for predicting FR was also evaluated. Dogs were anaesthetised with methadone, propofol, and inhaled isoflurane in oxygen, under volume-controlled mechanical ventilation. FC was performed by the administration of 5 mL/kg of Ringer’s lactate within 5 min. Cardiac index (CI; L/min/m2), PPV, (%), SVV (%), SPV (%), and PVI (%) were registered before and after FC. Data were analysed with ANOVA and ROC tests (p < 0.05). Fluid responsiveness was defined as 15% increase in CI. Eighty dogs completed the study. Fifty (62.5%) were responders and 30 (37.5%) were nonresponders. The PPV, PVI, SPV, and SVV cut-off values (AUC, p) for discriminating responders from nonresponders were PPV >13.8% (0.979, <0.001), PVI >14% (0.956, <0.001), SPV >4.1% (0.793, <0.001), and SVV >14.7% (0.729, <0.001), respectively. Up to 62.5% of normotensive dogs under inhalant anaesthesia may be fluid responders. PPV and PVI have better diagnostic accuracy to predict FR, compared to SPV and SVV.

Haemodynamic assessments in mechanically ventilated patients

2020 ◽  
pp. 321-326
Author(s):  
Antoine Vieillard-Baron
Keyword(s):  
Pulse Pressure ◽  
Positive Pressure Ventilation ◽  
Superior Vena ◽  
Vena Cava ◽  
Positive Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Pulmonary Capillaries ◽  
The Right ◽  
Ventilated Patients

Knowledge of heart–lung interactions is key to manage haemodynamics in mechanically ventilated patients (see also Chapter 5). It allows intensivists to understand the meaning of blood and pulse pressure respiratory variations (PPV). Unlike spontaneous breathing, positive pressure ventilation increases blood pressure and pulse pressure during inspiration following by a decrease during expiration. This is called reverse pulsus paradoxus and includes a ‘d-down’ and a ‘d-up’ effect. No variation means no effect of mechanical ventilation on the heart and especially on the right heart. In case of significant PPV, tidal volume usually reduces right ventricular stroke volume by way of reducing preload where systemic venous return is decreased (fluid expansion is useful to restore haemodynamics, when impaired) or increasing afterload (obstruction of pulmonary capillaries due to alveolar inflation and, in this case, fluid expansion is useless or even sometimes deleterious). Clinical examination as well as evaluation of respiratory variations of superior vena cava by echo, helps to distinguish between these two situations. By studying the beat-by-beat changes in echo parameters induced by positive pressure ventilation heartbeat by heartbeat, echocardiography is perfectly suited to study heart–lung interactions and then to propose an appropriate optimization in case of haemodynamic impairment.

scholarly journals The Systolic Blood Pressure Variation as an Indicator of Pulmonary Capillary Wedge Pressure in Ventilated Patients

1993 ◽  
Vol 21 (4) ◽  
pp. 405-408 ◽  
Author(s):  
P. E. Marik
Keyword(s):  
Data Base ◽  
Pulmonary Capillary Wedge Pressure ◽  
Correlation Coefficient ◽  
Systolic Pressure ◽  
Pressure Variation ◽  
Positive Pressure ◽  
Data Set ◽  
Pulmonary Capillary ◽  
Wedge Pressure ◽  
Ventilated Patients

Animal data have suggested that the systolic pressure variation (SPV) noted during positive pressure ventilation may be a sensitive indicator of hypovolaemia. The aim of this study was to correlate the SPV with the pulmonary capillary wedge pressure (PCWP) in a heterogeneous group of ICU patients on volume-cycled ventilation. Three hundred data sets were collected on 226 patients. The correlation coefficient between the SPV and PCWP for the first half of the data set was - 0.84 (P<0.001). The linear regression formula from this data set was: PCWP = 20- (SPV*0.7). Using this formula the predicted PCWP was then correlated with the measured PCWP using the second half of the data base. The correlation coefficient was 0.87 (P<0.001). The correlation coefficient between the SPV and PCWP for the entire data base (300 observations) was -0.86 (P<0.001). It is concluded that analysis of the arterial pressure tracing may be useful in estimating the pulmonary capillary wedge pressure in ventilated patients.

Sign in / Sign up

Export Citation Format

Share Document