Effects of Fenoldopam in the Pediatric Population: Fluid Status, Serum Biomarkers, and Hemodynamics. A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Enrique G. Villarreal ◽  
Jacqueline Rausa ◽  
A Claire Chapel ◽  
Rohit S. Loomba ◽  
Saul Flores
Keyword(s):  
Blood Pressure ◽  
Serum Creatinine ◽  
Central Venous Pressure ◽  
Patient Population ◽  
Urine Output ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Venous Pressure ◽  
Central Venous ◽  
Inotrope Score

AbstractFluid overload is a frequent complication in children during critical illness. Fluid restriction and diuretic agents have been the mainstay therapies so far. Fenoldopam, a selective dopamine-1 receptor agonist, is a diuretic agent with promising effects in the pediatric population. The purpose of this meta-analysis is to evaluate the outcomes of pediatric patients who received fenoldopam. We hypothesized that the administration of fenoldopam will cause an increase in urine output and decrease in serum creatinine in this patient population. A comprehensive database search of PubMed, EMBASE, and Cochrane libraries from the databases' inception through December 2018 was undertaken. Independent reviewers selected appropriate studies and the reviewed data. A meta-analysis was then conducted to determine the effects of fenoldopam on hemodynamics, the amount of vasoactive support, and renal function in children under the critical care setting. The selected end points were measured prior to the administration of fenoldopam and 24 hours after the initiation of the infusion: urine output, serum creatinine, serum sodium, inotrope score, heart rate, central venous pressure, systolic blood pressure, and mean blood pressure. Forest plots were generated to demonstrate individual study data as well as pooled data for each end point. A total of five studies (three retrospective cohort studies, two randomized trials) with 121 patients were included for analysis. No significant difference was observed in urine output, inotrope score, systolic blood pressure, or mean blood pressure. There was a statistically significant increase in serum creatinine and central venous pressure. There was statistically significant decrease in serum sodium and heart rate, and central venous pressure. This meta-analysis did not identify significant renoprotective or vasodilator effects from fenoldopam in this patient population. Although mild electrolyte and hemodynamic changes were identified, larger studies are warranted to determine the clinical significance of fenoldopam in this patient population.

Functional Interaction between Angiotensin and Sympathetic Reflexes in Cats

1982 ◽  
Vol 62 (1) ◽  
pp. 51-56 ◽  
Author(s):  
R. Hatton ◽  
D. P. Clough ◽  
S. A. Adigun ◽  
J. Conway
Keyword(s):  
Blood Pressure ◽  
Central Venous Pressure ◽  
Arterial Blood Pressure ◽  
Venous Pressure ◽  
Partial Recovery ◽  
Ang Ii ◽  
Central Venous ◽  
Efferent Nerve ◽  
Arterial Blood ◽  
Sympathetic Reflexes

1. Lower-body negative pressure (LBNP) was used to stimulate sympathetic reflexes in anaesthetized cats. At −50 mmHg for 10 min it caused transient reduction in central venous pressure and systemic arterial blood pressure. Arterial blood pressure was then restored within 30 s and there was a tachycardia. Central venous pressure showed only partial recovery. The resting level of plasma renin activity (PRA; 2.9–3.2 ng h−1 ml−1) did not change until approximately 5 min into the manoeuvre. 2. When converting-enzyme inhibitor (CEI) was given 75 s after the onset of suction it caused a greater and more sustained fall in arterial blood pressure than when administered alone. The angiotensin II (ANG II) antagonist [Sar1,Ala8]ANG II produced similar effects after a short-lived pressor response. 3. This prolonged fall in arterial blood pressure produced by CEI was not associated with reduced sympathetic efferent nerve activity. This indicates that the inhibitor affects one of the peripheral actions of angiotensin and in so doing produces vasodilatation of neurogenic origin. 4. These findings suggest that angiotensin, at a level which does not exert a direct vasoconstrictor action, interacts with the sympathetic nervous system to maintain arterial blood pressure when homeostatic reflexes are activated. A reduction in the efficiency of these reflexes by CEI may contribute to its hypotensive effect.

ANP-mediated volume depletion attenuates renal responses in humans

1992 ◽  
Vol 263 (6) ◽  
pp. R1303-R1308 ◽  
Author(s):  
T. J. Ebert ◽  
L. Groban ◽  
M. Muzi ◽  
M. Hanson ◽  
A. W. Cowley
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Central Venous Pressure ◽  
Sodium Excretion ◽  
Healthy Subjects ◽  
Venous Pressure ◽  
Urine Volume ◽  
Positive Pressure ◽  
Plasma Norepinephrine ◽  
Central Venous

Brief low-dose infusions of atrial natriuretic peptide (ANP) that emulate physiological plasma concentrations in humans have little if any effect on renal excretory function. This study explored the possibility that ANP-mediated reductions in cardiac filling pressures (through ANP's rapid effect on capillary dynamics) could attenuate its purported renal effects. Protocol A consisted of 16 healthy subjects (ages 19-27 yr old) who underwent three consecutive 45-min experimental sequences: 1) placebo, 2) ANP (10 ng.kg-1 x min-1), and 3) ANP alone (n = 8) or ANP with simultaneous lower body positive pressure (LBPP, n = 8). Electrocardiogram and direct measures of arterial and central venous pressures were continuously monitored. Blood was sampled at the end of each 45-min sequence before subjects stood to void. Compared with control (placebo), ANP produced a hemoconcentration and increased plasma norepinephrine, but did not change heart rate, blood pressure, plasma levels of renin, aldosterone, or vasopressin, or renal excretion of volume or sodium. In subjects receiving LBPP to maintain central venous pressure during the last 45 min of ANP infusion, norepinephrine did not increase and urine volume and sodium excretion increased (P < 0.05). In a second study (protocol B), five healthy subjects received a placebo infusion for 45 min followed by two consecutive 45-min infusions of ANP (10 ng.kg-1 x min-1). Central venous pressure was maintained (LBPP) at placebo baseline throughout the two ANP infusion periods. Urine volume and sodium excretion rates increased progressively and significantly during both ANP infusion periods (P < 0.05) without significant changes in creatinine clearance, blood pressure, or heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Heat-stress-induced changes in central venous pressure do not explain interindividual differences in orthostatic tolerance during heat stress

2011 ◽  
Vol 110 (5) ◽  
pp. 1283-1289 ◽  
Author(s):  
R. Matthew Brothers ◽  
David M. Keller ◽  
Jonathan E. Wingo ◽  
Matthew S. Ganio ◽  
Craig G. Crandall
Keyword(s):  
Blood Pressure ◽  
Heat Stress ◽  
Central Venous Pressure ◽  
Blood Pressure Control ◽  
Lower Body Negative Pressure ◽  
Venous Pressure ◽  
Pressure Control ◽  
Stress Index ◽  
Central Venous ◽  
The Difference

The extent to which heat stress compromises blood pressure control is variable among individuals, with some individuals becoming very intolerant to a hypotensive challenge, such as lower body negative pressure (LBNP) while heat stressed, while others are relatively tolerant. Heat stress itself reduces indexes of ventricular filling pressure, including central venous pressure, which may be reflective of reductions in tolerance in this thermal condition. This study tested the hypothesis that the magnitude of the reduction in central venous pressure in response to heat stress alone is related to the subsequent decrement in LBNP tolerance. In 19 subjects, central hypovolemia was imposed via LBNP to presyncope in both normothermic and heat-stress conditions. Tolerance to LBNP was quantified using a cumulative stress index (CSI), and the difference between normothermic CSI and heat-stress CSI was calculated for each individual. The eight individuals with the greatest CSI difference between normothermic and heat-stress tolerances (LargeDif), and the eight individuals with the smallest CSI difference (SmallDif), were grouped together. By design, the difference in CSI between thermal conditions was greater in the LargeDif group (969 vs. 382 mmHg × min; P < 0.001). Despite this profound difference in the effect of heat stress in decreasing LBNP tolerance between groups, coupled with no difference in the rise in core body temperatures to the heat stress (LargeDif, 1.4 ± 0.1°C vs. SmallDif, 1.4 ± 0.1°C; interaction P = 0.89), the reduction in central venous pressure during heat stress alone was similar between groups (LargeDif: 5.7 ± 1.9 mmHg vs. SmallDif: 5.2 ± 2.0 mmHg; interaction P = 0.85). Contrary to the proposed hypothesis, differences in blood pressure control during LBNP are not related to differences in the magnitude of the heat-stress-induced reductions in central venous pressure.

scholarly journals Prospective Study of Central Venous Pressure Trends during Major Neurosurgical Procedures in an Elective Operation Theatre Setting of a Tertiary Care Centre

2021 ◽  
Vol 8 (07) ◽  
pp. 369-373
Author(s):  
Rajeev Damodaran Sarojini ◽  
Sanjay Sahadevan ◽  
Jayakumar Christhudas
Keyword(s):  
Blood Pressure ◽  
Intracranial Pressure ◽  
Prospective Study ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Ultra Sound ◽  
Neurosurgical Procedures ◽  
Central Venous ◽  
Intraoperative Period

BACKGROUND There are extensive variations in central venous pressure during intraoperative period of a major neurosurgical patients. Monitoring of central venous pressure is vital for guiding the administration of fluids, blood and blood products. Central venous pressure (CVP) also measures the intracranial pressure indirectly. Increased intracranial pressure thereby reduces the cerebral blood flow, leading to cerebral ischemia. METHODS This is a prospective study where 25 major neurosurgical cases posted for elective major neurosurgery were selected. Right subclavian vein was selected for cannulation, by blind technique in all these cases. CVP was recorded every 15 minutes. Central venous catheter was connected to a pressure transducer linked to a multichannel monitor; zeroing was done and the CVP reading obtained. RESULTS Central venous pressure reading was done serially and showed the trends in haemodynamics in various stages of surgery. Initial intraoperative periods showed lower values due to intravenous (I / V) induction of anaesthesia, use of mannitol and diuretics. Later on, the trends changed to higher side subsequent to administration of fluids and blood as required. CONCLUSIONS Monitoring of CVP is an important component of haemodynamic monitoring along with non-invasive blood pressure (NIBP), intra-arterial blood pressure (IABP), and urine output. Central venous pressure can be used to aspirate an air embolism occurring during the intraoperative period after employing Durant’s position. KEYWORDS CVP, NIBP , USS – Ultra Sound Scan, IVC – Inferior Vena Cava, IVCCI – Inferior Vena Cave Collapsibility Index, PEEP – Positive End Expiratory Pressure, C / L – Central Line, IABP.

scholarly journals P-L03 The efficacy and safety of controlled low central venous pressure for liver resection: a systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Zhong Chen ◽  
Dundong Sun ◽  
Feiran Wang
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Central Venous Pressure ◽  
Meta Analysis ◽  
Venous Pressure ◽  
Control Group ◽  
Significant Heterogeneity ◽  
Complication Rates ◽  
Central Venous ◽  
Low Central Venous Pressure

Abstract Background Partial hepatectomy is an effective treatment for benign and malignant liver diseases . However, intraoperative bleeding is one of the major factors affecting the outcome of hepatectomy. Currently, the most commonly used method of hepatic blood flow occlusion in clinical practice is Pringle method, but this method has a great impact on liver function and can cause hepatic ischemia-reperfusion injury. .Studies have shown that blood loss volume during hepatectomy is related to central venous pressure (CVP) . Intraoperative control of central venous pressure (LCVP) is increasingly popular in hepatectomy, but its effectiveness and safety remain controversial.  Methods The main result of the analysis was to reduce the blood loss and blood infusion. Secondary outcomes included operative time, fluid infusion, urine volume, ALT, TBIL, BUN, CR, postoperative complication rates and length of hospital stay. Statistical analysis was performed using RevMan 5.3 software (Cochrane Collaboration, Oxford, England). The results of all studies were measured by mean ± standard deviation. If there is significant heterogeneity between the results (P &lt; 0.05), a random-effects model is used. A fixed-effect model was used when there was no significant heterogeneity (P &gt; 0.05). Heterogeneity was assessed using the Cochrane χ2 text .  Results In total, 10 studies, involving 324 patients undergoing liver resection with controlled low central venous pressure, were identified. Meta-analysis showed that blood loss in the LCVP group was significantly less than that in the control group ( P = 0.0002). blood transfusion in the LCVP group was also significantly less than that in the control group(P = 0.0006). there was no difference between LCVP group and control group in operation time(P = 0.17), fluid infusion( P = 0.46), urinary volume(P = 0.38), ALT( P = 0.23), TBIL(P = 0.86), BUN(P = 0.67), CR(P =0.59), postoperative complication rates( P = 0.01) and hospital stay(P = 0.26).  Conclusions Compared with the control, controlled low central venous pressure showed comparable efficacy and safety for the treatment during liver resection.

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