scholarly journals Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Pablo Blanco
Keyword(s):  
Cardiac Output ◽  
Stroke Volume ◽  
Point Of Care ◽  
Velocity Time Integral ◽  
Time Integral

scholarly journals Comparison of end-tidal carbon dioxide and point-of-care echocardiography for fluid response at the bedside

2019 ◽  
pp. 102490791987092 ◽  
Author(s):  
Semih Korkut ◽  
Erden Erol Ünlüer ◽  
Arif Karagöz ◽  
Karama Bouchaala Mnif ◽  
Emine Kadioğlu
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Output ◽  
Point Of Care ◽  
Passive Leg Raising ◽  
Velocity Time Integral ◽  
Time Integral ◽  
End Tidal Carbon Dioxide ◽  
Before And After ◽  
End Tidal ◽  
Bedside Method

Purpose: In this study, we aimed to compare cardiac output, echocardiographic pulmonary velocity-time integral, and end-tidal carbon dioxide values before and after the passive leg raising maneuver in healthy volunteers. Methods: The Ethical Commission approved the study. A total of 36 volunteers were included after signed informed consent in our study. After 12 h of fasting, vital signs, cardiac output, pulmonary velocity-time integral, and end-tidal carbon dioxide were measured when the participants were lying supine. Then, participants’ legs were elevated to 45° passively, and all measurements were repeated. Pulmonary velocity-time integral was obtained in parasternal short-axis view with the aid of pulse Doppler. Pulmonary root measurements were recorded. Echocardiographic stroke volume and cardiac output were calculated. The differences between values of cardiac output, pulmonary velocity-time integral, and end-tidal carbon dioxide before and after passive leg raising were statistically compared. The level of significance was accepted as p < 0.05. Results: Significant differences were found between pre- and post-passive leg raising values of these three measurements. The effect of passive leg raising on pulmonary velocity-time integral measurements was greater. The change in end-tidal carbon dioxide was not correlated with either cardiac output or pulmonary velocity-time integral alteration. Conclusion: Our results showed that measurement of pulmonary velocity-time integral changes after passive leg raising is a more useful bedside method to predict fluid responsiveness than measurement of end-tidal carbon dioxide and cardiac output alteration.

scholarly journals IMPACT OF HIGH LEVELS OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON CARDIAC OUTPUT IN PRETERM NEONATES: A PROSPECTIVE PHYSIOLOGICAL STUDY

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e16-e17
Author(s):  
Amit Mukerji ◽  
Abdul Gani Muzafar Wahab ◽  
Souvik Mitra ◽  
Tapas Mondal ◽  
Debie Paterson ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Preterm Neonates ◽  
Velocity Time Integral ◽  
Time Integral ◽  
Postmenstrual Age ◽  
Physiological Impact

Abstract BACKGROUND Many NICUs employ high (>8 cmH2O) positive end-expiratory pressures (PEEP) on nasal continuous positive airway pressure (NCPAP) to prevent intubation and associated ventilator-induced lung injury, despite limited safety/efficacy data. OBJECTIVES This study sought to evaluate the physiological impact of high NCPAP PEEP. DESIGN/METHODS Fifteen preterm neonates at postmenstrual age ≥32 weeks (without congenital anomalies or acute intercurrent illness) on NCPAP PEEP of 5 cmH2O were enrolled. PEEP was increased by 2 cmH2O increments until 13 cmH2O. At each increment, following 5 minutes washout, cardiac output (aortic velocity-time integral x heart rate) and cardiorespiratory parameters including blood pressure, heart rate, respiratory rate were measured over 10 minutes. Predefined cut-off values for changes in cardiorespiratory parameters were used as termination criteria. Data are presented as mean (SD), and were compared using one-way ANOVA. RESULTS The mean GA, age at study, and weight of subjects were 27.4 (2.6) weeks, 58.5 (35.5) days, and 2.3 (0.6) kg, respectively. Cardiac output (mL/kg/min) at PEEPs of 5, 7, 9, 11, and 13 cmH2O were not different at 295 (75), 290 (66), 281 (69), 286 (73), and 292 (58), respectively (P=0.986), as shown in Figure 1a. Importantly there were also no differences in either aortic velocity-time integral or heart rate over these PEEP ranges (Figures 1b and 1c). There were no significant differences in cardiorespiratory parameters; no subjects met cut-off criteria. Data collection was terminated in 2 subjects after PEEP 9 cmH2O due to lung over-distension subjectively noted on echocardiogram. CONCLUSION High levels of NCPAP PEEP were well tolerated for short durations. Further physiological and clinical research is required on safety/efficacy in neonates with more severe lung disease, as well as its impact over longer durations.

Echocardiography Evaluation of the Effects of Midazolam on Passive Leg Raising Test in Critically ill Patients in the Intensive Care Unit, diagnosed with Sepsis, determined to be hypovolemic and responding to fluid treatment

2020 ◽  
Author(s):  
Abdulkadir Yektaş
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Output ◽  
Intensive Care ◽  
Cardiac Index ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Passive Leg Raising ◽  
Velocity Time Integral ◽  
Time Integral ◽  
Before And After

Abstract Background This study used echocardiography parameters to investigate the effects of midazolam sedation on intravascular volume in intubated patients who are diagnosed with sepsis and treated with invasive mechanical ventilation in continuous positive airway pressure mode. Methods This study included 152 intensive care unit patients aged 30–50 years with spontaneous breathing; all were intubated, had their lungs ventilated with a positive end-expiratory pressure of 5 cmH2O in continuous positive airway pressure mode via invasive mechanical ventilation, had a Ramsey sedation scale score of 5–6 at 5 min after midazolam administration, and exhibited a fluid deficit (i.e., inferior vena cava collapsibility index > 42% and > 12% systolic arterial pressure increase in the passive leg raising test). Cardiac index, cardiac output, and velocity time integral measurements were taken after the passive leg raising test, before and after midazolam sedation, in patients with hypovolaemia who responded to fluid treatment. Changes in passive leg raising test results were compared before and after administration of midazolam. Results Cardiac output > 15%, cardiac index > 10%, and > 15% increase in velocity time integral during the passive leg raising test before midazolam administration indicated that patients exhibited hypovolaemia and responded to fluid therapy. Cardiac output < 15%, cardiac index < 10%, and < 15% increase in velocity time integral during the passive leg raising test after midazolam administration indicated that patients did not exhibit hypovolaemia. Conclusions We recommend that the passive leg raising test, which is used to determine intravascular volume status of critically ill intensive care unit patients who exhibit hypovolaemia and respond to fluid therapy, should be performed before midazolam sedation.

scholarly journals Can Left ventricular outflow tract aortic velocity time integral guide fluid resuscitation in septic patients? - A case report

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Livio Colombo ◽  
Francesco Panizzardi ◽  
Irene Rusconi ◽  
Anna Roncoroni ◽  
Marta Bergamaschi ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Case Report ◽  
Left Ventricular Outflow Tract ◽  
Venous Pressure ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Velocity Time Integral ◽  
Time Integral ◽  
Left Ventricular Outflow

Hemodynamic monitoring of unstable patients is an everyday issue for Emergency Physicians (EP). Considering the difficulty, in Emergency Department (ED) settings, to assess invasively Stroke Volume (SV), Cardiac Output (CO) and Peripheral Vascular Resistance (PVR), EP should be familiar with non-invasive, easy and reproducible methods that can estimate these parameters. The use of Left Ventricular Outflow Tract aortic Velocity Time Integral (LVOT-VTI) with echocardiography, as estimate of SV, integrated with inferior vena cava collapse index and clinical examination could give the opportunity to non-invasively understand at which point of an ideal cardiac output/central venous pressure relation (according to the Frank Starling law) the patient is situated. In this case report we describe a septic patient accessing the ED with both respiratory and cardiac failure, and we show that the use of aortic LVOT-VTI is an easy and reproducible approach to understand cardiac hemodynamic in scenarios involving multiple pathologic mechanisms.

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