scholarly journals The Impact of Fluid Resuscitation on Hemodynamic of Hemorrhagic Shock: An Animal Model Experimental Study

2020 ◽  
Author(s):  
Antonius Hocky Pudjiadi ◽  
Agus Firmansyah ◽  
Gunanti Soeyono ◽  
Saptawati Bardosono ◽  
Sri Widia Jusman ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Fluid Resuscitation ◽  
Normal Saline ◽  
Oxygen Delivery ◽  
Resistance Index ◽  
Hemoglobin Concentration ◽  
Volume Resuscitation ◽  
Lung Water ◽  
The Impact

Abstract Background: To investigate the effect of fluid resuscitation on glycocalyx shedding, and extravascular lung water index (ELWI), mean arterial pressure (MAP) and oxygen delivery (DO2) changes.Methods: Male domestic piglets (Sus scrofa) 6-10 weeks old anesthetized and bled until mean arterial pressure drop to 20% of baseline and resuscitated with normal saline as much as blood drowned, followed with 40 mL/kg of normal saline after 30 minutes. Cardiac index (CI), ELWI, systemic vascular resistance index (SVRI), MAP, atrial natriuretic peptide (ANP) and syndecan-1 were measured before and after each fluid resuscitations. Results: Serum ANP was increased after normal volume fluid resuscitation (p= 0.043) and return its baseline value after hypervolemia fluid resuscitation. Serum Syndecan-1 levels did not increase. A small increase in ELWI only found 60 minutes after fluid resuscitation (p= 0.021). SVRI undergo a gradual decrease, until the lowest value at hypervolemia volume resuscitation. There was no difference between the MAP of the two groups (p= 0.105). Hemoglobin concentration significantly decreased from normal to hypervolemia volume resuscitation (p= 0.009). Oxygen delivery in hypervolemia resuscitation is higher than in normal volume resuscitation (p= 0.012), due to a significant increase in CI at hypervolemia volume resuscitation (p<0.001).Conclusions: Hypervolemia fluid resuscitation in the animal hemorrhage model is not induced glycocalyx shedding. Small increase ELWI was found in 60 minutes after fluid resuscitation. DO2 is maintained by increasing CI in spite of decreasing hemoglobin level due to hemodilution. Increasing CI is balanced by reducing SVRI to sustain stable MAP.

The Influence of Altitude on Erythropoietin Resistance Index in Maintenance Hemodialysis Patients: Data from Tibetan Plateau

2020 ◽  
pp. 1-6
Author(s):  
Yan Wang ◽  
Zong-hui Dang ◽  
Liang-ying Gan ◽  
Ciren Luobu ◽  
Lei Zhang ◽  
...  
Keyword(s):  
High Altitude ◽  
Sea Level ◽  
Resistance Index ◽  
Hemoglobin Concentration ◽  
Maintenance Hemodialysis ◽  
Autonomous Region ◽  
Tibet Autonomous Region ◽  
Dialysis Vintage ◽  
Peking University ◽  
The Impact

Background: It is known that hypoxia influences many of the biologic processes involved in erythropoiesis; therefore, the high-altitude hypoxia may affect erythropoietin (EPO) responsiveness in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the impact of altitude on EPO responsiveness in MHD patients. Methods: In this retrospective study, MHD patients from Tibet Autonomous Region People’s Hospital (3,650 m above sea level) and Peking University People’s Hospital (43.5 m above sea level) were recruited between May 2016 and December 2018. Patients were divided into 2 groups according to altitude. Variables including age, sex, dialysis vintage, dialysis modality, duration of EPO use, EPO doses, and laboratory tests were collected and analyzed. EPO responsiveness was measured in terms of the EPO resistance index (ERI). ERI was defined as the weekly weight-adjusted dose of EPO (IU/kg/week) divided by hemoglobin concentration (g/dL). The association between ERI and altitude was estimated using a multivariable linear regression model. Results: Sixty-two patients from Tibet Autonomous Region People’s Hospital (high-altitude [HA] group) and 102 patients from Peking University People’s Hospital (low-altitude [LA] group) were recruited. The ERI for HA group and LA group was 6.9 ± 5.1 IU w−1 kg−1 (g/dL)−1 and 11.5 ± 6.4 IU w−1 kg−1 (g/dL)−1, respectively. After adjusting for covariates by multivariable regression, altitude was independently associated with ERI (R2 = 0.245, p < 0.001). Conclusion: Altitude had an independent negative correlation with ERI. This result supported the hypothesis that altitude-associated hypoxia improved EPO responsiveness in MHD patients.

Abstract 477: Diverse Actions of the EP4 Prostaglandin E2 Receptor in Blood Pressure Control

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Marcela Herrera ◽  
Matthew A Sparks ◽  
Beverky H Koller ◽  
Thomas M Coffman
Keyword(s):  
Smooth Muscle ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Smooth Muscle Cells ◽  
Prostaglandin E2 ◽  
Ductus Arteriosus ◽  
Muscle Cells ◽  
High Salt ◽  
Ang Ii ◽  
The Impact

Prostaglandin E2 (PGE2) is a major prostanoid produced by the kidney having the potential to influence renal blood flow, Na excretion, and thus mean arterial pressure (BP). PGE2 actions are mediated by four distinct E-prostanoid (EP) receptor isoforms: EP1-EP4. The EP4 receptor (EP4R) triggers macula densa stimulation of renin, induces vasodilation, and may inhibit epithelial sodium transport. Thus, the impact of EP4Rs on BP may differ with the sites of PGE2 synthesis and pattern of EP4R activation within the kidney. To examine the role of EP4R on BP regulation we generated EP4R-deficient mice. Because deletion of EP4R in utero causes peri-natal mortality due to persistent patent ductus arteriosus, we carried out conditional deletion by crossing EP4flox/flox with a transgenic line with tamoxifen-inducible Cre expression in all tissues. Resting mean arterial pressure (MAP) measured by radiotelemetry was increased by 5±1mm Hg (p<0.05) in mice with total-body EP4R-deficiency (EP4R-TBKO) vs. controls. In addition, EP4R-TBKOs had an exaggerated increase in MAP with high-salt (6% NaCl) feeding (MAP increase: 5±1 vs. 2±1mmHg for controls; p<0.05) and during angiotensin II (Ang II)-dependent hypertension (MAP increase: 37±2 vs. 24±3mmHg for controls; p<0.05). We next hypothesized that exaggerated hypertension in the EP4R-TBKOs was due to elimination of compensatory EP4R-depedent vasodilation mediated by direct actions in vascular smooth muscle cells (VSMCs). Accordingly, we generated mice lacking EP4R in VSMCs (EP4R-SMKOs) using EP4flox/flox and transgenic mice with tamoxifen-inducible expression of Cre limited to smooth muscle cells. In contrast to the EP4R-TBKOs, elimination of EP4R only from VSMC reduced resting MAP by 5±1mm Hg (p<0.04) but did not affect the BP response to high salt feeding (MAP change: 2±1 vs. 2±1 mm Hg; ns) or chronic Ang II infusion (MAP increase: 29±3 vs. 34±4 mm Hg; ns). Thus, the EP4R modulates resting MAP but its specific impact may vary between EP4R populations in different cell lineages. EP4Rs resist the development of salt- and Ang II-dependent hypertension. These anti-hypertensive actions are not mediated by direct effects of EP4R in VSMCs, but may involve EP4R in endothelium, brain, or kidney epithelia.

scholarly journals Biochemical and Haemodynamic Effects of Crystalloid Solutions Administered During Perioperative Period

2009 ◽  
pp. 33-37
Author(s):  
Debasish Banik ◽  
Qumrul Huda ◽  
Abdul Hye ◽  
KM Iqbal
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulse Rate ◽  
Normal Saline ◽  
Urine Output ◽  
Perioperative Period ◽  
The Body ◽  
Post Operative Period ◽  
Significant Difference ◽  
Group A

Forty five (45) ASA grade I & II patients aged between 21 to 55 years, scheduled for electiv abdominal surgery (incision not exceeding 15 cm with minimal blood loss, under general anaesthesia were randomly allocated into three groups (A, and C). Patients of Group A, B and C received infusion of 5% dextrose aqua, normal saline and 5% dextrose in normal saline respectively throughout perioperative course (upto 24 hours after operation). Each group received post operative period. Parameters recorded were mean arterial pressure (MAP), Pulse, Serum elecirolyte (Na+, K+), amount of fluid in fused and urine output during operation and postoperatively Blood samples for serum electrolyte estimation were taken just before induction, immediately before reversal and twenty four hours after surgery. A standard anaesthetic technique was followed for all groups.Percentage increase from pre-operative values were calculated for mean arterial pressure, pulse rate and serum electrolytes. The ratio between urine output and fluid infused during per- and post-operative period were calculated. There were statistically significant (p<0.05) difference between group A and C in perand post-operative change in pulse rate and statistically significant difference (p<0.05) in postoperative output/input ratio between group A and B and highly significant (p<0.01) between A and C. Electrolyte containing fluids of higher osmolality caused increased diuresis in per-operative period and increased pulse rate in post-operative period. So, although there are few difference between three fluids, these didnot produce any effects( beneficial or detrimental) on the body system under normal conditions. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.33-37

scholarly journals Impact of blood pressure changes in cerebral blood perfusion of patients with ischemic Moyamoya disease evaluated by SPECT

2020 ◽  
pp. 0271678X2096745
Author(s):  
Zhao Liming ◽  
Sun Weiliang ◽  
Jia Jia ◽  
Liang Hao ◽  
Liu Yang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Moyamoya Disease ◽  
Emission Computed Tomography ◽  
Study Cohort ◽  
Pressure Changes ◽  
The Impact

Our aim was to determine the impact of targeted blood pressure modifications on cerebral blood flow in ischemic moyamoya disease patients assessed by single-photon emission computed tomography (SPECT). From March to September 2018, we prospectively collected data of 154 moyamoya disease patients and selected 40 patients with ischemic moyamoya disease. All patients underwent in-hospital blood pressure monitoring to determine the mean arterial pressure baseline values. The study cohort was subdivided into two subgroups: (1) Group A or relative high blood pressure (RHBP) with an induced mean arterial pressure 10–20% higher than baseline and (2) Group B or relative low blood pressure (RLBP) including patients with mean arterial pressure 10–20% lower than baseline. All patients underwent initial SPECT study on admission-day, and on the following day, every subgroup underwent a second SPECT study under their respective targeted blood pressure values. In general, RHBP patients showed an increment in perfusion of 10.13% (SD 2.94%), whereas RLBP patients showed a reduction of perfusion of 12.19% (SD 2.68%). Cerebral blood flow of moyamoya disease patients is susceptible to small blood pressure changes, and cerebral autoregulation might be affected due to short dynamic blood pressure modifications.

Effects of hyperglycemia on the cerebrovascular response to rhythmic handgrip exercise

2007 ◽  
Vol 293 (1) ◽  
pp. H467-H473 ◽  
Author(s):  
Yu-Sok Kim ◽  
Rikke Krogh-Madsen ◽  
Peter Rasmussen ◽  
Peter Plomgaard ◽  
Shigehiko Ogoh ◽  
...  
Keyword(s):  
Blood Flow ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Function Analysis ◽  
Low Frequency ◽  
Resistance Index ◽  
Handgrip Exercise ◽  
Dynamic Relationship ◽  
Hyperglycemic Clamp ◽  
Transfer Function Analysis

Dynamic cerebral autoregulation (CA) is challenged by exercise and may become less effective when exercise is exhaustive. Exercise may increase arterial glucose concentration, and we evaluated whether the cerebrovascular response to exercise is affected by hyperglycemia. The effects of a hyperinsulinemic euglycemic clamp (EU) and hyperglycemic clamp (HY) on the cerebrovascular (CVRI) and systemic vascular resistance index (SVRI) responses were evaluated in seven healthy subjects at rest and during rhythmic handgrip exercise. Transfer function analysis of the dynamic relationship between beat-to-beat changes in mean arterial pressure and middle cerebral artery (MCA) mean blood flow velocity ( Vmean) was used to assess dynamic CA. At rest, SVRI decreased with HY and EU ( P < 0.01). CVRI was maintained with EU but became reduced with HY [11% (SD 3); P < 0.01], and MCA Vmean increased ( P < 0.05), whereas brain catecholamine uptake and arterial Pco2 did not change significantly. HY did not affect the normalized low-frequency gain between mean arterial pressure and MCA Vmean or the phase shift, indicating maintained dynamic CA. With HY, the increase in CVRI associated with exercise was enhanced (19 ± 7% vs. 9 ± 7%; P < 0.05), concomitant with a larger increase in heart rate and cardiac output and a larger reduction in SVRI (22 ± 4% vs. 14 ± 2%; P < 0.05). Thus hyperglycemia lowered cerebral vascular tone independently of CA capacity at rest, whereas dynamic CA remained able to modulate cerebral blood flow around the exercise-induced increase in MCA Vmean. These findings suggest that elevated blood glucose does not explain that dynamic CA is affected during intense exercise.

INTRATHECALLY ADMINISTERED ADJUVANTS MIDAZOLAM AND CLONIDINE WITH BUPIVACAINE ON HEMODYNAMIC STABILITY- A PROSPECTIVE STUDY

2021 ◽  
pp. 12-14
Author(s):  
Ganga Nagalakshmi ◽  
Subha . J
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Respiratory Rate ◽  
Pulse Rate ◽  
Normal Saline ◽  
Sensory Block ◽  
Sensory Level ◽  
Motor Blockade ◽  
Hemodynamic Stability ◽  
Sensory Blockade

We conducted a double blinded randomized control study in 60 patients belonging to ASA I and II undergoing elective lower abdominal surgeries. Patients of both sexes ranging between 22 to 65 years of age were included. Our aim was to evaluate the effects of intrathecal midazolam 2mg and clonidine 30 mcg as adjuvant to bupivacaine for hemodynamic stability and postoperative analgesia. Patients were divided randomly using closed cover technique into two groups of 25 each.Group BM received 3ml of 0.5% heavy bupivacaine 0.4ml midazolam (preservative free) and 0.1ml of normal saline. Group BC received 3ml of 0.5% heavy bupivacaine, 0.2ml clonidine and 0.3 ml of normal saline. The total volume of the injected solution was 3.5ml in both groups. The onset of sensory and motor blockade, the duration of sensory and motor blockade, peak sensory level, time to achieve maximum sensory level, changes in pulse rate, changes in mean arterial pressure, duration of analgesia, respiratory rate, o saturation, 2 sedation score and adverse effects were noted in both groups. The data collected were analyzed by Chi square test and students't' tests. We found that onset of sensory and motor blockade, time to achieve maximum sensory level, and duration of complete motor recovery was earlier in BM group than BC group. Duration of Sensory block and duration of analgesia were prolonged in BM group than BC group. In both groups, no signicant changes were observed in respiratory rate, O saturation and sedation in our study. Intrathecal Midazolam as an adjuvant to bupivacaine 2 comparing to Clonidine resulted Rapid onset of sensory and motor blockade, Achieves maximum sensory level at a shorter interval, Increased duration of sensory blockade and decreased duration of Motor blockadeIt gives stable mean arterial pressure and pulse rate.

Abstract P254: Impact of Socially Influencing Systems on Hypertension Control

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Khan Siddiqui ◽  
Ross Goglia ◽  
Aamer Ghaffar
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pressure Change ◽  
Social Recognition ◽  
Impact Behavior ◽  
Hypertension Control ◽  
Social Competition ◽  
Clinical Scenarios ◽  
Significant Difference ◽  
The Impact

Background: Socially influencing systems (SIS) have shown to impact behavior change and outcomes in various clinical scenarios. Two aspects of SIS, i.e., Social Competition and Social Recognition are also known to increase engagement in a program. Objective: To evaluate the impact of social influence on hypertension control. Methods: All hypertensive patients that had initial hypertensive reading between July 1, 2015 and September 30, 2015 using an ambulatory BP kiosk (higi Station, higi SH llc) were identified. A random sample of 1,352 patients were identified as controls and 38,885 patients were invited to participate in a challenge to check their BP on a weekly basis. Weekly drawing for $25 gift card was conducted for those that checked their BP that week and a grand prize of $100 was awarded to the user with the most BP readings. Challenge duration was from October 1, 2015 to January 20, 2016. Patients who joined also received weekly email reminders to check their BP as well as coaching tips on how to maintain or improve their BP. Patients invited to join challenge but did not participate were referred to as Invitees, those who participated were referred to as Joiners and those not invited as Control. Results: A total of 1,655 patients participated in the challenge. Analysis of variance indicated a statistically significant difference between Control and Joiners (p=.016) as well as between Invitees and Joiners (p=0.009). Controls’ mean arterial pressure change increased 38.5% during the course of the study, while Invitees’ mean arterial pressure change increased 12.2%, and Joiners’ mean arterial pressure change dropped by almost 45%. Conclusion: Social competition and social recognition as implemented in the form of a BP check challenge showed significant reduction in mean arterial pressure. Incorporating socially influencing systems in treatment protocols for hypertension can assure adherence to the program and improve outcomes.

scholarly journals Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment

PLoS ONE ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. e0196188 ◽  
Author(s):  
Nándor Öveges ◽  
Ildikó László ◽  
Krisztián Tánczos ◽  
Márton Németh ◽  
Gábor Lebák ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Fluid Resuscitation ◽  
Animal Experiment ◽  
Fluid Overload

Pulmonary vascular response to increase in intracranial pressure: role of sympathetic mechanisms

1977 ◽  
Vol 42 (3) ◽  
pp. 335-343 ◽  
Author(s):  
A. B. Malik
Keyword(s):  
Mean Arterial Pressure ◽  
Intracranial Pressure ◽  
Arterial Pressure ◽  
Left Atrial ◽  
Perfusion Pressure ◽  
Pulmonary Perfusion ◽  
Vascular Response ◽  
Lung Water ◽  
Pulmonary Vasoconstriction ◽  
The Mean

The pulmonary vascular response to intracranial hypertension was studied in anesthetized controlled ventilated dogs in which intracranial pressure (ICP) was elevated to 20 Torr below the mean arterial pressure for a 20-min period, and regulated at this level. Pulmonary vascular resistance (PVR) increased from control value of 2.7 +/- 0.30 to 8.3 +/- 0.51 Torr-l-1-min at the end of 20-min increase in ICP. The increase in PVR was associated with marked increase (P less than 0.001) in pulmonary arterial pressure from 14.4 +/- 1.3 to 35.4 +/- 4.0 Torr, small increase in left atrial pressure from 5.4 +/- 1.2 to 7.9 +/- 1.9 Torr, and no significant change in pulmonary blood flow. The increase in PVR occurred independently of changes in the arterial pressure. The increase in PVR induced by elevated ICP was correlated with increases in lung water, physiological shunt (Qs/Qt), alveolar dead space (VD), and with hypoxemia. Pretreatment with propranolol (1.5 mg-kg-1) attenuated the increase in PVR during elevation in ICP; the smaller increase in PVR was associated with a marked increase in left atrial pressure and a smaller increase in pulmonary perfusion pressure than in the control group. The propranolol-treated dogs also developed increases in lung water, Qs/Qt, VD, and hypoxemia. In contrast, pretreatment with phenoxybenzamine (1.5 mg-kg-1) inhibited the increases in pulmonary perfusion pressure and PVR induced by ICP elevation as well as the associated increases in lung water, Qs/Qt, VD, and hypoxemia. Therefore, a sustained elevation in ICP at a level below the mean arterial pressure in the intact dog evokes pulmonary vasoconstriction which is mediated by alpha-adrenergic mechanisms. The neurogenic pulmonary vasoconstriction results in the increases in lung water, Qs/Qt, VD, and in the hypoxemia.

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