Evaluation of radial artery pulse pressure effects on detection of stroke volume changes after volume loading maneuvers in cardiac surgical patients

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.

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Evaluation of Stroke Volume Variation Obtained by the FloTrac™/Vigileo™ System to Guide Preoperative Fluid Therapy in Patients Undergoing Brain Surgery

Journal of International Medical Research ◽

10.1177/147323001204000338 ◽

2012 ◽

Vol 40 (3) ◽

pp. 1175-1181 ◽

Cited By ~ 6

Author(s):

J Li ◽

Fh Ji ◽

Jp Yang

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stroke Volume ◽

Stroke Volume Variation ◽

Brain Surgery ◽

Fluid Loading ◽

Volume Loading ◽

Fluid Infusion ◽

Volume Variation ◽

Ringer’S Lactate

OBJECTIVE: The accuracy of stroke volume variation (SVV) obtained by the FloTrac™/Vigileo™ system in otherwise healthy patients undergoing brain surgery was assessed. METHODS: Anaesthesia was induced in 48 patients with minimal fluid infusion. Before surgery, fluid volume loading was performed by infusion with Ringer's lactate solution in 200 ml steps over 3 min, repeated successively if the patient responded with an increase in stroke volume of ≥ 10%, until the increase was < 10% (nonresponsive). RESULTS: A total of 157 volume loading steps were performed in the 48 patients. Responsive and nonresponsive steps differed significantly in baseline values of blood pressure, heart rate and SVV. Significant correlations were found between the change in stroke volume after fluid loading and values of blood pressure, heart rate and SVV before fluid loading, with SVV the most sensitive variable. CONCLUSION: Stroke volume variation obtained using the FloTrac™/Vigileo™ system is a sensitive predictor of fluid responsiveness in healthy patients before brain surgery.

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The use of pulse pressure variation for predicting impairment of microcirculatory blood flow

Scientific Reports ◽

10.1038/s41598-021-88458-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christoph R. Behem ◽

Michael F. Graessler ◽

Till Friedheim ◽

Rahel Kluttig ◽

Hans O. Pinnschmidt ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Output ◽

Reperfusion Injury ◽

Pulse Pressure ◽

Pulse Pressure Variation ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Pressure Variation ◽

Volume Loading ◽

Microcirculatory Blood Flow

AbstractDynamic parameters of preload have been widely recommended to guide fluid therapy based on the principle of fluid responsiveness and with regard to cardiac output. An equally important aspect is however to also avoid volume-overload. This accounts particularly when capillary leakage is present and volume-overload will promote impairment of microcirculatory blood flow. The aim of this study was to evaluate, whether an impairment of intestinal microcirculation caused by volume-load potentially can be predicted using pulse pressure variation in an experimental model of ischemia/reperfusion injury. The study was designed as a prospective explorative large animal pilot study. The study was performed in 8 anesthetized domestic pigs (German landrace). Ischemia/reperfusion was induced during aortic surgery. 6 h after ischemia/reperfusion-injury measurements were performed during 4 consecutive volume-loading-steps, each consisting of 6 ml kg−1 bodyweight−1. Mean microcirculatory blood flow (mean Flux) of the ileum was measured using direct laser-speckle-contrast-imaging. Receiver operating characteristic analysis was performed to determine the ability of pulse pressure variation to predict a decrease in microcirculation. A reduction of ≥ 10% mean Flux was considered a relevant decrease. After ischemia–reperfusion, volume-loading-steps led to a significant increase of cardiac output as well as mean arterial pressure, while pulse pressure variation and mean Flux were significantly reduced (Pairwise comparison ischemia/reperfusion-injury vs. volume loading step no. 4): cardiac output (l min−1) 1.68 (1.02–2.35) versus 2.84 (2.15–3.53), p = 0.002, mean arterial pressure (mmHg) 29.89 (21.65–38.12) versus 52.34 (43.55–61.14), p < 0.001, pulse pressure variation (%) 24.84 (17.45–32.22) versus 9.59 (1.68–17.49), p = 0.004, mean Flux (p.u.) 414.95 (295.18–534.72) versus 327.21 (206.95–447.48), p = 0.006. Receiver operating characteristic analysis revealed an area under the curve of 0.88 (CI 95% 0.73–1.00; p value < 0.001) for pulse pressure variation for predicting a decrease of microcirculatory blood flow. The results of our study show that pulse pressure variation does have the potential to predict decreases of intestinal microcirculatory blood flow due to volume-load after ischemia/reperfusion-injury. This should encourage further translational research and might help to prevent microcirculatory impairment due to excessive fluid resuscitation and to guide fluid therapy in the future.

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Artifact Elimination in Impedance Cardiography using Gradient based Adaptive Signal Enhancement Techniques

International Journal of Recent Technology and Engineering - 2 ◽

10.35940/ijrte.b1632.078219 ◽

2019 ◽

Vol 8 (2) ◽

pp. 598-606

Keyword(s):

Stroke Volume ◽

Blood Volume ◽

Impedance Cardiography ◽

Signal Enhancement ◽

The Body ◽

Body Segment ◽

Volume Changes ◽

The Real ◽

Adaptive Techniques ◽

Adaptive Signal

Impedance Cardiography (ICG) is a noninvasive method for indirect measurement of stroke volume, monitoring the cardiac output and observing the other hemodynamic parameters by the blood volume changes in the body. The blood volume changes inside a certain body segment due to a number of physiological processes are extracted in the form of the impedance variations of the body segment. The ICG analysis provides the heart stroke volume in sudden cardiac arrest. In the clinical environment desired ICG signals are influenced by several physiological and non-physiological artifacts.As these artifacts are not stationary in nature, we proposed adaptive filtering techniques to eliminate the artifacts. In this paper we used Least Mean Square (LMS), Least Mean Fourth (LMF), Median LMS (MLMS), Leaky LMS (LLMS), and Dead Zone (DZLMS) adaptive techniques to eliminate artifacts from the desired signals. Several adaptive signal enhancement units (ASEUs) are developed based on these adaptive techniques, and evaluated on the real ICG signal components. The ability of these algorithms is evaluated by performing the experiments to eliminate the various artifacts such as sinusoidal artifacts (SA), respiration artifacts (RA), muscle artifacts (MA) and electrode artifacts (EA). Among these techniques, the DZLMS based ASEU performs better in the filtering process. The signal to noise ratio improvement (SNRI) for this algorithm is calculated as 11.9140 dB, 7.3657 dB, 10.4060 dB and 10.5125 dB respectively for SA, RA, MA and EA. Hence, the DZLMS based ASEUs are well suitable for ICG filtering in the real time health care monitoring systems.

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