scholarly journals Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery

2009 ◽  
Vol 103 (5) ◽  
pp. 678-684 ◽  
Author(s):  
A. Derichard ◽  
E. Robin ◽  
B. Tavernier ◽  
M. Costecalde ◽  
M. Fleyfel ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Stroke Volume ◽  
Radial Artery ◽  
Pulse Pressure ◽  
Major Abdominal Surgery ◽  
Stroke Volume Variations

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 Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maxime Nguyen ◽  
Osama Abou-Arab ◽  
Stéphane Bar ◽  
Hervé Dupont ◽  
Bélaïd Bouhemad ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Stroke Volume Variation ◽  
Pressure Variation ◽  
Pressure Response ◽  
Arterial Elastance ◽  
Volume Variation ◽  
Norepinephrine Dose ◽  
Stroke Volume Variations

AbstractThe purpose of this study was to determine whether dynamic elastance EAdyn derived from echocardiographic measurements of stroke volume variations can predict the success of a one-step decrease of norepinephrine dose. In this prospective single-center study, 39 patients with vasoplegic syndrome treated with norepinephrine and for whom the attending physician had decided to decrease norepinephrine dose and monitored by thermodilution were analyzed. EAdyn is the ratio of pulse pressure variation to stroke volume variation and was calculated from echocardiography stroke volume variations and from transpulmonary thermodilution. Pulse pressure variation was obtained from invasive arterial monitoring. Responders were defined by a decrease in mean arterial pressure (MAP) > 10% following norepinephrine decrease. The median decrease in norepinephrine was of 0.04 [0.03–0.05] µg kg−1 min−1. Twelve patients (31%) were classified as pressure responders with a median decrease in MAP of 13% [12–15%]. EAdyn was lower in pressure responders (0.40 [0.24–0.57] vs 0.95 [0.77–1.09], p < 0.01). EAdyn was able to discriminate between pressure responders and non-responders with an area under the curve of 0.86 (CI95% [0.71 to1.0], p < 0.05). The optimal cut-off was 0.8. EAdyn calculated from the echocardiographic estimation of the stroke volume variation and the invasive arterial pulse pressure variation can be used to discriminate pressure response to norepinephrine weaning. Agreement between EAdyn calculated from echocardiography and thermodilution was poor. Echocardiographic EAdyn might be used at bedside to optimize hemodynamic treatment.

scholarly journals Decrease in pulse pressure and stroke volume variations after mini-fluid challenge accurately predicts fluid responsiveness †

2015 ◽  
Vol 115 (3) ◽  
pp. 449-456 ◽  
Author(s):  
J. Mallat ◽  
M. Meddour ◽  
E. Durville ◽  
M. Lemyze ◽  
F. Pepy ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Fluid Challenge ◽  
Stroke Volume Variations

scholarly journals Comparison between Respiratory Variations in Pulse Oximetry Plethysmographic Waveform Amplitude and Arterial Pulse Pressure during Major Abdominal Surgery

2012 ◽  
Vol 117 (5) ◽  
pp. 973-980 ◽  
Author(s):  
Baptiste Hengy ◽  
Mathieu Gazon ◽  
Zoe Schmitt ◽  
Karima Benyoub ◽  
Aurélie Bonnet ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Pulse Oximetry ◽  
Pulse Pressure ◽  
Mean Value ◽  
Major Abdominal Surgery ◽  
Systematic Bias ◽  
Limits Of Agreement ◽  
Plethysmographic Waveform ◽  
The Mean ◽  
Waveform Amplitude

Background To assess preload dependence, the variation of the plethysmographic waveform of pulse oximetry (ΔPOP) has been proposed as a surrogate of the pulse pressure variation (ΔPP). The aim of the study was to assess the ability of the pulse oximeter-derived plethysmographic analysis to accurately trend ΔPP in patients undergoing major abdominal surgery by using standard monitors. Methods A continuous recording of arterial and plethysmographic waveform was performed in 43 patients undergoing abdominal surgery. ΔPP and ΔPOP were calculated on validated respiratory cycles. Results For analysis, 92,467 respiratory cycles were kept (73.5% of cycles recorded in 40 patients). The mean of intrapatient coefficients of correlation was low (r = 0.22). The Bland and Altman analysis showed a systematic bias of 5.21; the ΔPOP being greater than the ΔPP, this bias increased with the mean value of the two indices and the limits of agreement were wide (upper 21.7% and lower -11.3%). Considering a ΔPP threshold at 12% to classify respiratory cycles as responders and nonresponders, the corresponding best cutoff value of ΔPOP was 13.6 ± 4.3%. Using these threshold values, the observed classification agreement was moderate (κ = 0.50 ± 0.09). Conclusions The wide limits of agreement between ΔPP and ΔPOP and the weak correlation between both values cast doubt regarding the ability of ΔPOP to substitute ΔPP to follow trend in preload dependence and classify respiratory cycles as responders or nonresponders using standard monitor during anesthesia for major abdominal surgery.

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

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hugues de Courson ◽  
Philippe Boyer ◽  
Romain Grobost ◽  
Romain Lanchon ◽  
Musa Sesay ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Operating Room ◽  
Pulse Pressure ◽  
Volume Expansion ◽  
Arterial Compliance ◽  
Arterial Line ◽  
Arterial Elastance ◽  
History Of ◽  
Line Pressure ◽  
Stroke Volume Variations

Abstract Background Dynamic 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. Methods In 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%. Results Twenty-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. Conclusion Eadyn is a potential sensitive marker of arterial tone changes following vasopressor infusion.

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