scholarly journals Comparison of Goal-Directed Hemodynamic Optimization Using Pulmonary Artery Catheter and Transpulmonary Thermodilution in Combined Valve Repair: A Randomized Clinical Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Andrey I. Lenkin ◽  
Mikhail Y. Kirov ◽  
Vsevolod V. Kuzkov ◽  
Konstantin V. Paromov ◽  
Alexey A. Smetkin ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Oxygen Transport ◽  
Transpulmonary Thermodilution ◽  
Stroke Volume Index ◽  
Pulmonary Artery Occlusion Pressure ◽  
Valve Surgery ◽  
Volume Index ◽  
Lung Water ◽  
Goal Directed Therapy

Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery.Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group. In the PAC group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the TTD group we additionally used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO2I). We observed a gradual increase in GEDVI, whereas EVLWI and PAOP decreased by 20–30% postoperatively (P<0.05). The TTD group received 20% more fluid accompanied by increased stroke volume index and DO2I by 15–20% compared to the PAC group (P<0.05). Duration of mechanical ventilation was increased by 5.2 hrs in the PAC group (P=0.04).Conclusions. As compared to the PAC-guided algorithm, goal-directed therapy based on transpulmonary thermodilution and oxygen transport increases the volume of fluid therapy, improves hemodynamics and DO2I, and reduces the duration of respiratory support after complex valve surgery.

Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study

2019 ◽  
Vol 35 (12) ◽  
pp. 1426-1433 ◽  
Author(s):  
Alessandro Sionis ◽  
Mercedes Rivas-Lasarte ◽  
Alexandre Mebazaa ◽  
Tuukka Tarvasmäki ◽  
Jordi Sans-Roselló ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Pulmonary Artery Catheter ◽  
Risk Score ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Propensity Score Matching Analysis ◽  
Net Reclassification Improvement ◽  
Life Threatening

Background: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Methods: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Results: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices ( P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. Conclusions: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.

Systolic Pressure Variation as a Guide to Fluid Therapy in Patients with Sepsis-induced Hypotension 

1998 ◽  
Vol 89 (6) ◽  
pp. 1313-1321 ◽  
Author(s):  
Benoit Tavernier ◽  
Olivier Makhotine ◽  
Gilles Lebuffe ◽  
Jacques Dupont ◽  
Philippe Scherpereel
Keyword(s):  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Stroke Volume Index ◽  
Pulmonary Artery Occlusion Pressure ◽  
Artery Occlusion ◽  
Pressure Variation ◽  
Volume Index ◽  
Occlusion Pressure ◽  
Area Index ◽  
Systolic Pressure Variation

Background Monitoring left ventricular preload is critical to achieve adequate fluid resuscitation in patients with hypotension and sepsis. This prospective study tested the correlation of the pulmonary artery occlusion pressure, the left ventricular end-diastolic area index measured by transesophageal echocardiography, the arterial systolic pressure variation (the difference between maximal and minimal systolic blood pressure values during one mechanical breath), and its delta down (dDown) component (= apneic - minimum systolic blood pressure) with the response of cardiac output to volume expansion during sepsis. Methods Preload parameters were measured at baseline and during graded volume expansion (increments of 500 ml) in 15 patients with sepsis-induced hypotension who required mechanical ventilation. Each volume-loading step (VLS) was classified as a responder (increase in stroke volume index &gt; or = 15%) or a nonresponder. Successive VLSs were performed until a nonresponder VLS was obtained. Results Thirty-five VLSs (21 responders) were performed. Fluid loading caused an overall significant increase in pulmonary artery occlusion pressure and end-diastolic area index, and a significant decrease in systolic pressure variation and delta down (P &lt; 0.01). There was a significant difference between responder and nonresponder VLSs in end-diastolic area index, systolic pressure variation, and dDown, but not in pulmonary artery occlusion pressure. Receiver-operator curve analysis showed that dDown was a more accurate indicator of the response of stroke volume index to volume loading than end-diastolic area index and pulmonary artery occlusion pressure. A dDown component of more than 5 mmHg indicated that the stroke volume index would increase in response to a subsequent fluid challenge (positive and negative predictive values: 95% and 93%, respectively). Conclusion The dDown component of the systolic pressure variation is a sensitive indicator of the response of cardiac output to volume infusion in patient with sepsis-induced hypotension who require mechanical ventilation.

Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bedside alternatives to the pulmonary artery catheter

2006 ◽  
Vol 291 (6) ◽  
pp. L1118-L1131 ◽  
Author(s):  
Warren Isakow ◽  
Daniel P. Schuster
Keyword(s):  
Cardiac Output ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Critically Ill ◽  
Extravascular Lung Water ◽  
Ejection Time ◽  
Lung Water ◽  
Descending Aorta ◽  
Hemodynamic Management ◽  
Flow Through

The recently completed Fluid and Catheter Treatment Trial conducted by the National Institutes of Health ARDSNetwork casts doubt on the value of routine pulmonary artery catheterization for hemodynamic management of the critically ill. Several alternatives are available, and, in this review, we evaluate the theoretical, validation, and empirical databases for two of these: transpulmonary thermodilution measurements (yielding estimates of cardiac output, intrathoracic blood volume, and extravascular lung water) that do not require a pulmonary artery catheter, and hemodynamic measurements (including estimates of cardiac output and ejection time, a variable sensitive to intravascular volume) obtained by esophageal Doppler analysis of blood flow through the descending aorta. We conclude that both deserve serious consideration as a means of acquiring useful hemodynamic data for managing shock and fluid resuscitation in the critically ill, especially in those with acute lung injury and pulmonary edema, but that additional study, including carefully performed, prospective clinical trials demonstrating outcome benefit, is needed.

scholarly journals The effect of compliance with a perioperative goal-directed therapy protocol on outcomes after high-risk surgery: a before-after study

2020 ◽  
Author(s):  
M. F. Boekel ◽  
C. S. Venema ◽  
T. Kaufmann ◽  
I. C. C. van der Horst ◽  
J. J. Vos ◽  
...  
Keyword(s):  
High Risk ◽  
Stroke Volume ◽  
Stroke Volume Variation ◽  
Stroke Volume Index ◽  
Postoperative Outcomes ◽  
Volume Index ◽  
Goal Directed Therapy ◽  
Volume Variation ◽  
Protocol Compliance ◽  
Therapy Protocol

Abstract Perioperative goal-directed therapy is considered to improve patient outcomes after high-risk surgery. The association of compliance with perioperative goal-directed therapy protocols and postoperative outcomes is unclear. The purpose of this study is to determine the effect of protocol compliance on postoperative outcomes following high-risk surgery, after implementation of a perioperative goal-directed therapy protocol. Through a before-after study design, patients undergoing elective high-risk surgery before (before-group) and after implementation of a perioperative goal-directed therapy protocol (after-group) were included. Perioperative goal-directed therapy in the after-group consisted of optimized stroke volume variation or stroke volume index and optimized cardiac index. Additionally, the association of protocol compliance with postoperative complications when using perioperative goal-directed therapy was assessed. High protocol compliance was defined as ≥ 85% of the procedure time spent within the individual targets. The difference in complications during the first 30 postoperative days before and after implementation of the protocol was assessed. In the before-group, 214 patients were included and 193 patients in the after-group. The number of complications was higher in the before-group compared to the after-group (n = 414 vs. 282; p = 0.031). In the after-group, patients with high protocol compliance for stroke volume variation or stroke volume index had less complications compared to patients with low protocol compliance for stroke volume variation or stroke volume index (n = 187 vs. 90; p = 0.01). Protocol compliance by the attending clinicians is essential and should be monitored to facilitate an improvement in postoperative outcomes desired by the implementation of perioperative goal-directed therapy protocols.

scholarly journals The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis

2021 ◽  
Author(s):  
I. T. Bootsma ◽  
E. C. Boerma ◽  
F. de Lange ◽  
T. W. L. Scheeren
Keyword(s):  
Cardiac Output ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Supply And Demand ◽  
Waveform Analysis ◽  
Volume Index ◽  
End Diastolic Volume ◽  
Venous Oxygen Saturation ◽  
History Of ◽  
The Difference

AbstractNowadays, the classical pulmonary artery catheter (PAC) has an almost 50-year-old history of its clinical use for hemodynamic monitoring. In recent years, the PAC evolved from a device that enabled intermittent cardiac output measurements in combination with static pressures to a monitoring tool that provides continuous data on cardiac output, oxygen supply and-demand balance, as well as right ventricular (RV) performance. In this review, which consists of two parts, we will introduce the difference between intermittent pulmonary artery thermodilution using cold bolus injections, and the contemporary PAC enabling continuous measurements by using a thermal filament which at random heats up the blood. In this first part, the insertion techniques, interpretation of waveforms of the PAC, the interaction of waveforms with the respiratory cycle and airway pressure as well as pitfalls in waveform analysis are discussed. The second part will cover the measurements of the contemporary PAC including measurement of continuous cardiac output, RV ejection fraction, end-diastolic volume index, and mixed venous oxygen saturation. Limitations of all of these measurements will be highlighted there as well. We conclude that thorough understanding of measurements obtained from the PAC are the first step in successful application of the PAC in daily clinical practice.

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