scholarly journals High Central Venous Pressure and Right Ventricle Size are Related to Increased Stroke Volume to Negative Fluid Balance in Critically Ill Patients

2021 ◽  
Author(s):  
Zhao Hua ◽  
Xiaoting Wang ◽  
Liu Dawei ◽  
Ding Xin
Keyword(s):  
Risk Factors ◽  
Stroke Volume ◽  
Central Venous Pressure ◽  
Fluid Balance ◽  
Cardiac Disease ◽  
Venous Pressure ◽  
Central Venous ◽  
College Hospital ◽  
Negative Fluid Balance ◽  
Independent Risk Factors

Abstract BackgroundThis study aimed to determine whether a negative fluid balance can increase stroke volume (SV) and the relationship between changes in hemodynamics variables.MethodsThis prospective study included patients with high central venous pressure (CVP) (≥8 mmHg) treated in the Critical Medicine Department of Peking Union Medical College Hospital. Patients were classified into two groups based on their right to left ventricle diastolic dimension (RVD/LVD) ratio using a cutoff value of 0.6. The hemodynamic and echo parameters of the two groups were recorded at baseline and after negative fluid balance. ResultsThis study included 71 patients: 35 in Group 1 (RVD/LVD≥ 0.6) and 36 in Group 2 (RVD/LVD <0.6). Of all patients, 56.3% showed increased SV after negative fluid balance. Cox logistic regression analysis suggested that a high CVP and RVD/LVD ratio were significant independent risk factors for SV increase after negative fluid balance in critically patients without underlying cardiac disease. The AUC of CVP was 0.894. A CVP> 10.5 mmHg provided a sensitivity of 87.5% and a specificity of 77.4%. The AUC of CVP combined with the RVD/LVD ratio was 0.926 ,which provided a sensitivity of 92.6% and a specificity of 80.4%. ConclusionHigh CVP and RVD/LVD ratio were identified as independent risk factors for RV volume overload in critically patients without underlying cardiac disease. A reduced intravascular volume may increase SV for these patients.

scholarly journals High Central Venous Pressure and Right Ventricle Size Are Related to Non-decreased Left Ventricle Stroke Volume After Negative Fluid Balance in Critically Ill Patients: A Single Prospective Observational Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhao Hua ◽  
Ding Xin ◽  
Wang Xiaoting ◽  
Liu Dawei
Keyword(s):  
Left Ventricle ◽  
Stroke Volume ◽  
Right Ventricle ◽  
Central Venous Pressure ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Venous Pressure ◽  
Central Venous ◽  
Negative Fluid Balance

Background: Optimal adjustment of cardiac preload is essential for improving left ventricle stroke volume (LVSV) and tissue perfusion. Changes in LVSV caused by central venous pressure (CVP) are the most important concerns in the treatment of critically ill patients.Objectives: This study aimed to clarify the changes in LVSV after negative fluid balance in patients with elevated CVP, and to elucidate the relationship between the parameters of right ventricle (RV) filling state and LVSV changes.Methods: This prospective cohort study included patients with high central venous pressure (CVP) (≥8 mmHg) within 24 h of ICU admission in the Critical Medicine Department of Peking Union Medical College Hospital. Patients were classified into two groups based on the LVSV changes after negative fluid balance. The cutoff value was 10%. The hemodynamic and echo parameters of the two groups were recorded at baseline and after negative fluid balance.Results: A total of 71 patients included in this study. Forty in VI Group (LVOT VTI increased ≥10%) and 31 in VNI Group (LVOT VTI increased &lt;10%). Of all patients, 56.3% showed increased LVSV after negative fluid balance. In terms of hemodynamic parameters at T0, patients in VI Group had a higher CVP (p &lt; 0.001) and P(v-a)CO2 (p &lt; 0.001) and lower ScVO2 (p &lt; 0.001) relative to VNI Group, regarding the echo parameters at T0, the RVD/LVD ratio (p &lt; 0.001), DIVC end−expiratory (p &lt; 0.001), and ΔLVOT VTI (p &lt; 0.001) were higher, while T0 LVOT VTI (p &lt; 0.001) was lower, in VI Group patients. The multifactor logistic regression analysis suggested that a high CVP and RVD/LVD ratio ≥0.6 were significant associated with LVSV increase after negative fluid balance in critically patients. The AUC of CVP was 0.894. A CVP &gt;10.5 mmHg provided a sensitivity of 87.5% and a specificity of 77.4%. The AUC of CVP combined with the RVD/LVD ratio ≥0.6 was 0.926, which provided a sensitivity of 92.6% and a specificity of 80.4%.Conclusion: High CVP and RVD/LVD ratio ≥0.6 were significant associated with RV stressed in critically patients. Negative fluid balance will not always lead to a decrease, even an increase, in LVSV in these patients.

scholarly journals Analysis of Risk Factors of Multiorgan Failure After Pericardiectomy For Constrictive Pericarditis

2021 ◽  
Author(s):  
Jing-bin Huang ◽  
Zhao-ke Wen ◽  
Jian-rong Yang ◽  
Jun-jun Li ◽  
Min Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Serum Creatinine ◽  
Cardiogenic Shock ◽  
Central Venous Pressure ◽  
Fluid Balance ◽  
Multiorgan Failure ◽  
Venous Pressure ◽  
Delayed Diagnosis ◽  
Fresh Frozen Plasma ◽  
Central Venous

Abstract Background: We aimed to investigate risk factors of multiorgan failure following pericardiectomy.Methods: This was a retrospective study of patients undergoing pericardiectomy between January 1994 and May 2021 at three hospitals.Results: 826 patients were included in the study and divided into two groups: group with multiorgan failure (n=86) and group without multiorgan failure (n=740). There were 86 patients with multiorgan failure (86/826, 10.4%). There were 66 operative deaths (66/826, 8.0%). The causes of operative deaths were multiorgan failure (86/826, 10.4%), including cardiogenic shock + AKI + ventricular fibrillation (15/86), cardiogenic shock + AKI (46/86), cardiogenic shock + AKI + hepatic failure + septicemia (10/86), cardiogenic shock + AKI + respiratory failure (15/86). Univariate and multivariate analyses showed the factors associated with multiorgan failure, including male (P=0.006), time between symptoms and surgery (P＜0.001), thickness of pericardium (P＜0.001), intubation time (P＜0.001), ICU retention time (P＜0.001), hospitalized time postoperative (P＜0.001), preoperative central venous pressure (P＜0.001), postoperative central venous pressure (P＜0.001), D0 fluid balance (P＜0.001), D2 fluid balance (P＜0.001), postoperative chest drainage (P＜0.001), preoperative LVEDD(P＜0.001), postoperative LVEDD (P＜0.001), surgical duration (P＜0.001), bleeding during operation (P＜0.001), serum creatinine 24h after surgery (P=0.042), serum creatinine 48h after surgery (P＜0.001), fresh-frozen plasma (P＜0.001), packed red cells (P＜0.001), blood lactate (P＜0.001).Conclusion: In our study, incomplete pericardial dissection, fluid overload, delayed diagnosis and treatment are associated with multiorgan failure following pericardiectomy.

Circulation, kidney function, and volume-regulating hormones during prolonged water immersion in humans

1992 ◽  
Vol 73 (2) ◽  
pp. 530-538 ◽  
Author(s):  
C. Stadeager ◽  
L. B. Johansen ◽  
J. Warberg ◽  
N. J. Christensen ◽  
N. Foldager ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Plasma Renin Activity ◽  
Central Venous Pressure ◽  
Water Immersion ◽  
Venous Pressure ◽  
Plasma Renin ◽  
Plasma Aldosterone ◽  
Central Blood Volume ◽  
Central Venous ◽  
Electrolyte Excretion

To investigate whether prolonged water immersion (WI) results in reduction of central blood volume and attenuation of renal fluid and electrolyte excretion, these variables were measured in connection with 12 h of immersion. On separate days, nine healthy males were investigated before, during, and after 12 h of WI to the neck or during appropriate control conditions. Central venous pressure, stroke volume, renal sodium (UNaV) and fluid excretion increased on initiation of WI and thereafter gradually declined but were still elevated compared with control values at the 12th h of WI. Atrial natriuretic peptide (ANP) concentration in plasma initially increased threefold during WI and thereafter declined to preimmersion levels, whereas plasma renin activity, plasma aldosterone, and norepinephrine remained constantly suppressed. It is concluded that, compared with the initial increases, central blood volume (central venous pressure and stroke volume) is reduced during prolonged WI and renal fluid and electrolyte excretion is attenuated. UNaV is still increased at the 12th h of WI, whereas renal water excretion returns to control values within 7 h. The WI-induced changes in ANP, plasma renin activity, plasma aldosterone, and norepinephrine may all contribute to the initial increase in UNaV. The results suggest, however, that the attenuation of UNaV during the later stages of WI is due to the decrease in ANP release.

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