Doppler echocardiography for assessment of systemic vascular resistances in cardiogenic shock patients

2018 ◽  
Vol 9 (2) ◽  
pp. 102-107 ◽  
Author(s):  
Mélanie Gaubert ◽  
Noémie Resseguier ◽  
Franck Thuny ◽  
Franck Paganelli ◽  
Jennifer Cautela ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Doppler Echocardiography ◽  
Transpulmonary Thermodilution ◽  
Intraclass Correlation ◽  
Resistance Index ◽  
Systemic Vascular Resistance Index ◽  
Non Invasive ◽  
The Mean

Objective: Impaired vascular tone plays an important role in cardiogenic shock. Doppler echocardiography provides a non-invasive estimation of systemic vascular resistance. The aim of the present study was to compare Doppler echocardiography with the transpulmonary thermodilution method for the assessment of systemic vascular resistance in patients with cardiogenic shock. Methods: This prospective monocentric comparison study was conducted in a single cardiology intensive care unit (Hopital Nord, Marseille, France). We assessed the systemic vascular resistance index by both echocardiography and transpulmonary thermodilution in 28 patients admitted for cardiogenic shock, on admission and after the introduction of an inotrope or vasopressor treatment. Results: A total of 35 paired echocardiographic and transpulmonary thermodilution estimations of the systemic vascular resistance index were compared. Echocardiography values ranged from 1309 to 3526 dynes.s.m2/cm5 and transpulmonary thermodilution values ranged from 1320 to 3901 dynes.s.m2/cm5. A statistically significant correlation was found between echocardiography and transpulmonary thermodilution ( r=0.86, 95% confidence interval (CI) 0.74, 0.93; P<0.0001). The intraclass correlation coefficient was 0.84 (95% CI 0.72, 0.92). The mean bias was −111.95 dynes.s.m2/cm5 (95% CI −230.06, 6.16). Limits of agreement were −785.86, 561.96. Conclusions: Doppler echocardiography constitutes an accurate non-invasive alternative to transpulmonary thermodilution to provide an estimation of systemic vascular resistance in patients with cardiogenic shock.

Increased organ blood flow in chronic endotoxemia is reversed by nitric oxide synthase inhibition

1994 ◽  
Vol 76 (6) ◽  
pp. 2785-2793 ◽  
Author(s):  
J. Meyer ◽  
F. Hinder ◽  
J. Stothert ◽  
L. D. Traber ◽  
D. N. Herndon ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Cardiac Index ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
No Synthase ◽  
Organ Blood Flow ◽  
Systemic Vascular Resistance Index ◽  
Blood Flows ◽  
Regional Blood Flows

We evaluated regional blood flows in a hyperdynamic sepsis model and the reversal of increased flows by blockade of nitric oxide (NO) synthase. Seven awake sheep were continuously infused with Escherichia coli endotoxin [lipopolysaccharide (LPS), 10 ng.kg-1.min-1] for 48 h. The NO synthase inhibitor N omega-nitro-L-arginine methyl ester (L-NAME, 25 mg/kg) was injected after 24 h. Blood flows to systemic organs were determined with the radioactive microsphere technique. LPS induced elevation of cardiac index by 36% (P < 0.05) and a fall in systemic vascular resistance index by 37% (P < 0.05) at 0 h [time of L-NAME administration, 24 h after infusion of LPS had begun] L-NAME administration normalized cardiac index [6.1 +/- 0.5 at 4 h posttreatment, 6.1 +/- 0.5 l.min-1.m-2 at -24 h (baseline)] and systemic vascular resistance index (1,333 +/- 105 at 4 h posttreatment, 1,280 +/- 163 dyn.s.cm-5.m2 at -24 h) and reduced all regional blood flows to near-baseline levels for the remainder of the study period (24 h). O2 consumption was unaffected by treatment.

Circulatory responses to onset of exercise: role of arterial and cardiac baroreflexes

1985 ◽  
Vol 248 (4) ◽  
pp. H457-H467 ◽  
Author(s):  
J. Ludbrook ◽  
W. F. Graham
Keyword(s):  
Arterial Pressure ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Systemic Vascular Resistance Index ◽  
Receptor Input ◽  
Cardiovascular Variables ◽  
Tonic Reflex ◽  
Cardiac Receptors

Six rabbits were exercised on a moving belt at 13 m/min for 60's. Heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), and systemic vascular resistance index (SVRI) were measured. Exercise was done under the following four permutations of input from baroreceptors (B) and cardiac receptors (C): BC, both inputs present; B, only baroreceptor input (intrapericardial procaine); C, only cardiac receptor input (surgical barodenervation); 0, both inputs deleted. The reflex effects on SVRI of the two inputs were calculated as (B - 0) and (C - 0) and their interaction as (BC - 0) - [(B - 0) + (C - 0)]. The effects of baroreceptor input plus interaction on all cardiovascular variables were also calculated, as (BC - C). At rest, (B - 0) and (C - 0) each tonically depressed SVRI without interacting, and (BC - C) tonically depressed SVRI, MAP, and HR. Within 10 s of the start of exercise these tonic effects were abolished, although a small, SVRI-lowering interaction appeared. Suppression of the tonic reflex effects of arterial baroreceptor and cardiac receptor input supported systemic vascular resistance at the onset of exercise and contributed to the rise of arterial pressure.

Pathogenetic mechanisms of venous congestion after the Fontan procedure

2001 ◽  
Vol 11 (2) ◽  
pp. 161-168 ◽  
Author(s):  
Reiner Buchhorn ◽  
Dietmar Bartmus ◽  
Wolfgang Buhre ◽  
Joachim Bürsch
Keyword(s):  
Cardiac Index ◽  
Capillary Pressure ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Postoperative Period ◽  
Venous Pressure ◽  
Resistance Index ◽  
Venous Congestion ◽  
Systemic Vascular Resistance Index ◽  
Central Venous

Background: The hemodynamic status after a Fontan type procedure for definitive palliation of functionally univentricular hearts is dominated by a high central venous pressure, which seems to be one of several factors responsible for venous congestion appearing as a frequent complication in the early and late postoperative course. The purpose of our study was to find other hemodynamic parameters correlating with the presence of venous congestion and effusions in these patients. Methods: We compared the hemodynamic data of 18 patients who had an uneventful long-term course after a Fontan type procedure with the respective data of 10 patients who developed symptoms of venous congestion in the immediate postoperative period. Based on a theoretical model, we developed an algorithm to calculate mean hydrostatic capillary pressure from mean arterial pressure, systemic vascular resistance index and central venous pressure. Results: Pulmonary vascular resistance index (2.1 ± 1.0 mmHg L-1 min m2), mean left atrial pressure (9.7 ± 4.0 mmHg) and cardiac index (3.6 ± 0.6 1/min/m2) are mainly normal in patients with venous congestion in the immediate postoperative period, but mean hydrostatic capillary pressure is significantly higher compared to patients without venous congestion (24.3 ± 3.1 vs 18.3 ± 4.0 mmHg). Lower mean hydrostatic capillary pressures in these patients are due to a highly significant increase of systemic vascular resistance index (18.6 ± 4.2 versus 33.6 ± 6.6 mmHg L-1 min m2) and a concomitant decrease of cardiac index to 2.4 ± 0.3 1/min/m2. Conclusions: The increase of mean hydrostatic capillary pressure, caused by high central venous pressures but also by relatively low systemic vascular resistance indexes, seems to be the hemodynamic key parameter responsible for venous congestion and effusions in patients after a Fontan type procedure in the immediate postoperative period.

scholarly journals Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study

2021 ◽  
Author(s):  
Bernd Saugel ◽  
Elisa-Johanna Bebert ◽  
Luisa Briesenick ◽  
Phillip Hoppe ◽  
Gillis Greiwe ◽  
...  
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Stroke Volume ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Systemic Vascular Resistance Index ◽  
Anesthetic Induction

AbstractIt remains unclear whether reduced myocardial contractility, venous dilation with decreased venous return, or arterial dilation with reduced systemic vascular resistance contribute most to hypotension after induction of general anesthesia. We sought to assess the relative contribution of various hemodynamic mechanisms to hypotension after induction of general anesthesia with sufentanil, propofol, and rocuronium. In this prospective observational study, we continuously recorded hemodynamic variables during anesthetic induction using a finger-cuff method in 92 non-cardiac surgery patients. After sufentanil administration, there was no clinically important change in arterial pressure, but heart rate increased from baseline by 11 (99.89% confidence interval: 7 to 16) bpm (P < 0.001). After administration of propofol, mean arterial pressure decreased by 23 (17 to 28) mmHg and systemic vascular resistance index decreased by 565 (419 to 712) dyn*s*cm−5*m2 (P values < 0.001). Mean arterial pressure was < 65 mmHg in 27 patients (29%). After propofol administration, heart rate returned to baseline, and stroke volume index and cardiac index remained stable. After tracheal intubation, there were no clinically important differences compared to baseline in heart rate, stroke volume index, and cardiac index, but arterial pressure and systemic vascular resistance index remained markedly decreased. Anesthetic induction with sufentanil, propofol, and rocuronium reduced arterial pressure and systemic vascular resistance index. Heart rate, stroke volume index, and cardiac index remained stable. Post-induction hypotension therefore appears to result from arterial dilation with reduced systemic vascular resistance rather than venous dilation or reduced myocardial contractility.

Reversal of hyperdynamic response to continuous endotoxin administration by inhibition of NO synthesis

1992 ◽  
Vol 73 (1) ◽  
pp. 324-328 ◽  
Author(s):  
J. Meyer ◽  
L. D. Traber ◽  
S. Nelson ◽  
C. W. Lentz ◽  
H. Nakazawa ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Methyl Ester ◽  
Arterial Pressure ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Volume Index ◽  
Systemic Vascular Resistance Index ◽  
Cardiovascular Performance

Septic shock is characterized by an increase in cardiac output and a fall in systemic vascular resistance index and mean arterial pressure. Endotoxin alters the smooth muscle function of blood vessels, probably by means of an increased production of the potent vasodilator nitric oxide (NO). The present study was accomplished to determine how the inhibition of NO synthesis influences cardiovascular performance in an ovine model of hyperdynamic endotoxemia. Endotoxemia was induced in five range ewes (41 +/- 2 kg) by continuous infusion of Escherichia coli endotoxin (LPS, 10 ng.kg-1.min-1) over the entire study period. After 24 h of LPS infusion, cardiac output increased from 5.2 +/- 0.3 to 7.9 +/- 0.6 (SE) 1/min (P less than 0.05) and mean arterial pressure and systemic vascular resistance index fell from 92 +/- 5 to 79 +/- 6 mmHg (P = 0.08) and from 1,473 +/- 173 to 824 +/- 108 dyn.s.cm-5.m2 (P less than 0.05), respectively. The pulmonary shunt fraction increased from 0.23 +/- 0.03 to 0.32 +/- 0.03 (P less than 0.05). The intravenous administration of the NO synthase inhibitor N omega-nitro-L-arginine methyl ester (25 mg/kg) 24 h after the start of the LPS infusion changed these values to approximately baseline levels over the subsequent 4 h. Although N omega-nitro-L-arginine methyl ester increased pulmonary arterial pressure and pulmonary vascular resistance (P less than 0.05), right and left ventricular stroke volume index showed no significant changes. It is concluded that NO has a major function in cardiovascular performance in endotoxemia.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254352
Author(s):  
Jochen J. Schoettler ◽  
Thomas Kirschning ◽  
Michael Hagmann ◽  
Bianka Hahn ◽  
Anna-Meagan Fairley ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Oxygen Saturation ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Oxygen Delivery ◽  
Intestinal Ischemia ◽  
Arterial Oxygen Saturation ◽  
Resistance Index ◽  
Arterial Oxygen ◽  
Systemic Vascular Resistance Index

Background Intestinal ischemia is a common complication with obscure pathophysiology in critically ill patients. Since insufficient delivery of oxygen is discussed, we investigated the influence of oxygen delivery, hemoglobin, arterial oxygen saturation, cardiac index and the systemic vascular resistance index on the development of intestinal ischemia. Furthermore, we evaluated the predictive power of elevated lactate levels for the diagnosis of intestinal ischemia. Methods In a retrospective case-control study data (mean oxygen delivery, minimum oxygen delivery, systemic vascular resistance index) of critical ill patients from 02/2009–07/2017 were analyzed using a proportional hazard model. General model fit and linearity were tested by likelihood ratio tests. The components of oxygen delivery (hemoglobin, arterial oxygen saturation and cardiac index) were individually tested in models. Results 59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m2 (LRT vs. null model: p = 0.018; LRT for non-linearity: p = 0.012) as well as a minimum oxygen delivery less than 400ml/min/m2 (LRT vs null model: p = 0.016; LRT for linearity: p = 0.019) were associated with increased risk of the development of intestinal ischemia. We found no significant influence of hemoglobin, arterial oxygen saturation, cardiac index or systemic vascular resistance index. Receiver operating characteristics analysis for elevated lactate levels, pH, CO2 and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786. Conclusion There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m2 respectively 400ml/min/m2. Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors.

Intratracheal instillation of a novel NO/nucleophile adduct selectively reduces pulmonary hypertension

1997 ◽  
Vol 83 (6) ◽  
pp. 1968-1975 ◽  
Author(s):  
Richard J. Brilli ◽  
Brian Krafte-Jacobs ◽  
Daniel J. Smith ◽  
Dominick Roselle ◽  
Daniel Passerini ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Steady State ◽  
Vascular Resistance ◽  
Intratracheal Instillation ◽  
Resistance Index ◽  
Systemic Vascular Resistance Index ◽  
Group 4 ◽  
The Mean ◽  
Change In Mean ◽  
Group 1

Brilli, Richard J., Brian Krafte-Jacobs, Daniel J. Smith, Dominick Roselle, Daniel Passerini, Amos Vromen, Lori Moore, Csaba Szabó, and Andrew L. Salzman. Intratracheal instillation of a novel NO/nucleophile adduct selectively reduces pulmonary hypertension. J. Appl. Physiol. 83(6): 1968–1975, 1997.—We examined the pulmonary and systemic hemodynamic effects of administering soluble nitric oxide (NO) donor compounds (NO/nucleophile adducts, i.e., NONOates) directly into the trachea of animals with experimentally induced pulmonary hypertension. Steady-state pulmonary hypertension was created by using the thromboxane agonist U-46619. Yorkshire pigs were randomly assigned to one of four groups: group 1, intratracheal saline (control; n = 8); group 2, intratracheal sodium nitroprusside ( n = 6); group 3, intratracheal ethylputreanine NONOate ( n = 6); and group 4, intratracheal 2-(dimethylamino)-ethylputreanine NONOate (DMAEP/NO; n = 6). Pulmonary and systemic hemodynamics were monitored after drug instillation. Group 4 had significant reductions in pulmonary vascular resistance index (PVRI) at all time points compared with steady state and compared with group 1 ( P < 0.05), whereas systemic vascular resistance index did not change. The mean change in mean pulmonary arterial pressure in group 4 was −33.1 ± 1.2% compared with +6.4 ± 1.3% in group 1( P < 0.001), and the mean change in mean arterial pressure was −9.3 ± 0.7% compared with a control value of −0.9 ± 0.5% ( P < 0.05). Groups 2 and 3 had significant decreases in both PVRI and systemic vascular resistance index compared with steady state and with group 1. In conclusion, intratracheal instillation of a polar-charged tertiary amine NONOate DMAEP/NO results in the selective reduction of PVRI. Intermittent intratracheal instillation of selective NONOates may be an alternative to continuously inhaled NO in the treatment of pulmonary hypertension.

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