scholarly journals Comparison of diagnostic methods for hemodynamic treatment in unborn and pre-term infants using the measurement of vena cava, lactate, and clinical criteria

10.52011/81 ◽  
2021 ◽  
Vol 22 (3) ◽  
pp. 1-9
Author(s):  
Geyson Deley-Muñoz ◽  
Fabricio González-Andrade
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Lactic Acid ◽  
Birth Weight ◽  
Preterm Infants ◽  
Vena Cava ◽  
Urinary Output ◽  
Clinical Criteria ◽  
Capillary Filling ◽  
Hemodynamic State

Introduction: There is no single criterion available to assess the hemodynamic state of new-born infants and preterm infants and the different variables in the group of newborns, such as gestational age, birth weight, and periods of birth. Methods: This is an epidemiological, cross-sectional, descriptive observational study with two patient cohorts. Newborn-to-term and preterm neonates assisted at the Neonatal Unit of the Pablo Arturo Suarez Hospital participated during the months between November 2019 to January 2020. Results: Ultrasound measurement of the vena cava (FVC) flow is useful for the management treatment of hemodynamically unstable neonatal patients. The sample was made up of 110 newborns treated in the Pablo Arturo Suarez Hospital's neonatology service from November 2019 to January 2020. Quito, Pichincha, Ecuador. The variables low birth weight and moder-ate prematurity have a statistically significant value for inotropic use. The other variables do not present statistically significant values. Heart rate, urinary output, mean blood pressure, lactic acid, capillary filling, upper vena cava flow, and lower vena cava flow had statistically significant values. FVCI and FVCS comparisons with heart rate, urinary output, mean blood pressure, lactic acid, and capillary filling had statistically significant values, except for capil-lary filling> 3 sec in FCVI. Multivariate analysis of categorical main components (CATPCA) was used to characterize the hemodynamic state and inotropic state, which were significant in the bivariate analysis. Dimension, one of the two-dimensional graphs, discriminates the use or not of inotropics and the categories of hemodynamic parameters TAM <35 mmHg, lactic acid, capillary filling, FVCI, and FVCS. Dimension II discriminates between the categories of urinary expenditure and HR. Conclusion: In term and preterm infants with low weight and adequate birth weight with hemodynamic instability in general, who were evaluated with ultrasonography to measure the flow of the vena cava, the agreement between the clinical criteria and the ultrasound assessment of the flow was 0.4 cm/sec in both methods. This situation means that the measurement of venous cava flows by echo sonography is useful for assessing neonatal patients' hemodynamic status.

Intravenous acid infusion stimulates ACTH secretion in sheep

1991 ◽  
Vol 260 (1) ◽  
pp. E154-E161 ◽  
Author(s):  
C. E. Wood ◽  
A. Isa
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Lactic Acid ◽  
Plasma Renin Activity ◽  
Vena Cava ◽  
Plasma Renin ◽  
Renin Activity ◽  
Acth Secretion ◽  
Reflex Responses ◽  
Arterial Blood

Both respiratory and metabolic acidemia stimulate the secretion of adrenocorticotropic hormone (ACTH), vasopressin, and renin. The present study was designed to test the blood pressure, heart rate, and endocrine responses of conscious sheep to low-rate infusions of H+. We infused HCl and lactic acid at a rate of 500 mueq/min into the inferior vena cava of seven chronically catheterized adult sheep. Control experiments in six sheep consisted of infusion of HCl at a rate of 100 mueq/min. Only the 500 mueq/min infusion of HCl stimulated reflex responses. This infusion increased mean arterial blood pressure and plasma ACTH concentration but transiently decreased blood pH only after the onset of the reflex responses. Heart rate appeared to increase initially but then decreased. Overall, the apparent changes in heart rate were not statistically significant. None of the infusions significantly altered plasma renin activity or vasopressin concentration. We speculate that heart rate, plasma renin activity, and vasopressin may have been partially inhibited by the increase in blood pressure. However, the lack of effect of lactic acid suggests that the HCl stimulated reflex ACTH and blood pressure responses via a mechanism not related to the concentration of the acid in the infusate or to the total amount of acid infused. It is possible that HCl, but not lactic acid, stimulated release of a humoral agent that stimulated ACTH secretion directly or reflexly. The results do not appear consistent with the stimulation of a venous chemoreceptor sensitive to H+.

Increased Blood Pressure Following Pupillary Dilation with 2.5% Phenylephrine Hydrochloride in Preterm Infants

PEDIATRICS ◽  
1981 ◽  
Vol 68 (2) ◽  
pp. 231-234
Author(s):  
Bonnie J. Lees ◽  
Luis A. Cabal
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Birth Weight ◽  
Arterial Blood Pressure ◽  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Pupillary Dilation ◽  
Phenylephrine Hydrochloride ◽  
Arterial Blood ◽  
Pressure Changes

Heart rate and blood pressure changes following 0.5% tropicamide and 2.5% phenylephrine hydrochloride were evaluated in seven ill preterm infants (birth weight, 910 to 2,060 gm; gestational age, 26 to 36 weeks) during the first day of life. Each infant was monitored continuously for 30 minutes before and for 75 minutes after, instillation of the pupillary dilators. There were no significant changes in the heart rate, whereas a significant increase in systolic, diastolic, and mean arterial blood pressure was found. The increase in arterial blood pressure was detected at two minutes, peaked at eight minutes, and remained at significantly higher levels for 30 minutes after instillation. Because of the potential relationship between increased blood pressure and intraventricular hemorrhage, arterial blood pressure must be monitored during instillation of mydriatic drugs in the preterm infant.

Optimal Position for a Spinal Tap in Preterm Infants

PEDIATRICS ◽  
1983 ◽  
Vol 71 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Christine A. Gleason ◽  
Richard J. Martin ◽  
John V. Anderson ◽  
Waldemar A. Carlo ◽  
Kathleen J. Sanniti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Preterm Infants ◽  
Minute Ventilation ◽  
Upright Position ◽  
Neck Extension ◽  
Variable Effect ◽  
Optimal Position ◽  
Major Mechanism ◽  
Transcutaneous Po2

Inasmuch as spinal taps in preterm infants are frequently accompanied by clinical deterioration, the optimal position for this procedure was investigated. Three positions were each randomly assigned for five minutes to 17 healthy preterm infants without a spinal tap actually being performed: (1) lateral recumbent with full flexion (flexed position), (2) lateral recumbent with partial neck extension (extended position), and (3) sitting with head support and spine flexion (upright position). Transcutaneous Po2 and Pco2 were monitored in all infants, minute ventilation (V1) in seven, and heart rate and blood pressure in ten infants. Mean transcutaneous Po2 decreased in each of the three positions. This decrease was significantly greater in the flexed (28 ± 8 mm Hg) as compared with the extended (18 ± 8 mm Hg, P &lt; .001) and upright (15 ± 11 mm Hg, P &lt; .001) positions. Mean transcutaneous Pco2 increased only in the flexed position (3 ± 4 mm Hg, P &lt; .005) and levels were still elevated five minutes after that position had been discontinued. The consistent decrease in transcutaneous Po2 was accompanied by a variable effect of positioning on V1 and there were no episodes of airway obstruction or apnea &gt;10 seconds. Heart rate increased in each position whereas blood pressure remained unchanged. These data suggest that although hypoventilation may contribute to the observed decrease in transcutaneous Po2, ventilation/perfusion imbalance appears to be the major mechanism. As spinal taps performed in the widely accepted flexed position carry the greatest risk of potential morbidity, it is recommended that this position be modified with neck extension or that spinal taps be performed in the upright position.

Factors Affecting Heart Rate Variability in Preterm Infants

PEDIATRICS ◽  
1980 ◽  
Vol 65 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Luis A. Cabal ◽  
Bijan Siassi ◽  
Bernardino Zanini ◽  
Joan E. Hodgman ◽  
Edward E. Hon
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Distress Syndrome ◽  
Good Prognosis ◽  
Factors Affecting ◽  
Rate Level ◽  
Heart Rate Level

Neonatal heart rate variability (NHRV) was studied in 92 preterm infants (birth weight, 750 to 2,500 gm; gestational age, 28 to 36 weeks). Each infant was monitored continuously during the first 6 hours and for one hour at 24, 48, and 168 hours of life. During each hour NHRV was quantified and related to the following parameters: sex, gestational age, postnatal age, heart rate, and the presence and severity of respiratory distress syndrome (RDS). NHRV in healthy preterm infants was inversely related to heart rate level and directly related to the infant's postnatal age. In healthy babies with gestations of 30 to 36 weeks there was no significant correlation between NHRV and gestation. Decrease in NHRV was significantly related to the severity of RDS, and the reappearance of NHRV in infants with RDS was associated with a good prognosis. Decreased NHRV significantly differentiated the infants with RDS who survived after the fifth hour of life. The data reveal that NHRV (1) should be corrected for heart rate level and postnatal age; (2) is decreased in RDS; and (3) can be used as an indicator of morbidity and mortality in preterm infants with RDS.

Poor urinary output

2015 ◽  
Author(s):  
Hugo Farne ◽  
Edward Norris-Cervetto ◽  
James Warbrick-Smith
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Urine Output ◽  
Junior Doctor ◽  
Physiological Role ◽  
Urinary Output ◽  
Adequate Blood Supply ◽  
Normal Urine ◽  
Average Size

You should ask the nurse: • What the trend is in urine output—has it been gradually decreasing, or suddenly stopped? If the latter, have they checked if the urinary catheter is blocked by flushing it? This is a rapidly reversible cause of poor urinary output. • What the observations are for the patient. Ask for the heart rate, blood pressure, respiratory rate, oxygen saturations, and temperature, so you can get an idea of how unwell the patient is. This will help you prioritize how soon you need to see the patient. Healthy adults have a urine output of about 1 mL/kg/hour. Oliguria refers to a reduced urine output and is defined variously as <400 mL/day, <0.5 mL/kg/hour, or <30 mL/hour. Anuria refers to the complete absence of urine output. Decreased urine output should be taken very seriously as it may be the first (and only) sign of impending acute renal failure. Untreated, patients may die from hyperkalaemia, profound acidosis, or pulmonary oedema due to the kidneys not performing their usual physiological role. Normal urine output requires: • adequate blood supply to the kidneys • functioning kidneys, and • flow of urine from the kidneys, down the ureters, into the bladder, and out via the urethra. Pathology affecting any of these requirements can result in poor urine output, which is why the differential diagnosis for poor urinary output is often classified as shown in Figure 22.1. In practice, as a junior doctor you want to diagnose and treat the prerenal and postrenal causes. If you come to the conclusion that it is a renal cause (by exclusion), call the renal physicians for an expert opinion. This is crucial in determining the diagnosis: • Adequate intake? Remember that an adult of average size will require about 3 L of fluid intake per 24 hours (30–50 mL/kg/day). Febrile patients will require an extra 500 mL for every 1 °C above 37.0 °C to compensate for increased loss of fluids from evaporation and increased respiratory rate.

Cardiovascular functions in the dog rewarmed rapidly and slowly from deep hypothermia

1960 ◽  
Vol 198 (2) ◽  
pp. 333-335 ◽  
Author(s):  
H. E. D'Amato ◽  
Suzanne Kronheim ◽  
B. G. Covino
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Superior Vena ◽  
Vena Cava ◽  
Deep Hypothermia ◽  
Cardiovascular Collapse ◽  
Cardiovascular Failure ◽  
Myocardial Failure ◽  
Cardiovascular Functions

Heart rate, blood pressure, cardiac output and cardiac minute work were measured in pentobarbitalized dogs prior to induction of hypothermia, at rectal temperatures of 25°C or 20°C and following rapid rewarming in warm water or slow rewarming by wrapping in heated sheeting. During rapid rewarming from either 25°C or 20°C no consistent failure in recovery of normal cardiovascular function was observed, although 1 out of 10 dogs did suffer cardiovascular collapse during rapid rewarming. Slow rewarming from 25° and 20°C resulted in consistent failure of some or all of these functions to recover to prehypothermic levels. Moreover, 5 out of 15 slowly rewarmed dogs suffered cardiovascular collapse during the rewarming process. In five dogs slowly rewarmed from 20°C saline was infused into the superior vena cava. This procedure resulted in moderate increases in blood pressure but dramatic increases in cardiac output and minute work (200% and 270%, respectively), thereby negating myocardial failure as the primary cause of the occasionally observed cardiovascular failure.

Vagal Regulation of Heart Rate in the Prediction of Developmental Outcome for Very Low Birth Weight Preterm Infants

1997 ◽  
Vol 68 (2) ◽  
pp. 173 ◽  
Author(s):  
Jane A. Doussard-Roosevelt ◽  
Stephen W. Porges ◽  
John W. Scanlon ◽  
Behjat Alemi ◽  
Kathleen B. Scanlon
Keyword(s):  
Heart Rate ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Developmental Outcome

scholarly journals Tissue Doppler Imaging in Very Preterm Infants. Relation to Blood Pressure and Superior Vena Cava Flow

2011 ◽  
Vol 70 ◽  
pp. 9-9
Author(s):  
A Lee ◽  
E Nestaas ◽  
K Liestøl ◽  
L Brunvand ◽  
R Lindemann ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Preterm Infants ◽  
Superior Vena Cava ◽  
Tissue Doppler Imaging ◽  
Superior Vena ◽  
Vena Cava ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Very Preterm Infants ◽  
Very Preterm

scholarly journals Predictors of CT-derived FFR in patients with suspected CAD beyond severity of coronary stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Smolka ◽  
A Fava ◽  
M Moshage ◽  
M Marwan ◽  
S Achenbach ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Regression Analysis ◽  
Image Quality ◽  
Coronary Stenosis ◽  
Cleveland Clinic ◽  
Suspected Coronary Artery Disease ◽  
Fractional Flow ◽  
Clinical Criteria ◽  
Flow Reserve

Abstract Background Functional assessment of coronary stenosis using computational fluid dynamics is increasingly used, however other factors besides coronary stenosis may affect the results. We assessed several predictors for CT-derived fractional flow reserve (CT-FFR) in patients with suspected coronary artery disease (CAD) undergoing coronary computed tomographic angiography (CCTA). Methods 2505 consecutive patients with suspected CAD undergoing CCTA from 2008 to 2016 were screened, 1549 were excluded due to incomplete data (934), image quality (345), software error (147) or other reasons (123). Minimal CT-FFR was measured using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany) in coronaries ≥2mm. Several clinical as well as technical criteria were assessed for predicting the minimal CT-FFR per patient. Results 956 patients (51±12 years, 51.2% men) were included in this analysis. Mean EF was 59.4±7.4%, heart rate 63±9 bpm, systolic (126.5±20mmHg) and diastolic (70±11 mmHg) blood pressure (BP). Regression analysis and ANOVA showed low but significant impact on minimal CT-FFR (mean 0.85±0.10) by EF, aortic valvular dysfunction, heart rate and systolic blood pressure as well as image quality (esp. blooming and image noise). See Tables 1 and 2. Conclusion Coronary stenosis may not be the only relevant predictor for CT-FFR. Several clinical criteria (EF, heart rate, BP, aortic valve dysfunction) as well as image criteria (image quality, artifacts) can affect CT-FFR results. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Cleveland Clinic Foundation Table 1. ANOVA analysis Table 2. Regression analysis

scholarly journals Use of Handheld Ultrasound to Estimate Fluid Status of Hemodialysis Patients

2018 ◽  
Vol 1 (2) ◽  
pp. 65-69
Author(s):  
Sanjaya Kumar Shrestha ◽  
Anupam Ghimire ◽  
Safiur Rahman Ansari ◽  
Ashok Adhikari
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Vena Cava ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Clinical Parameters ◽  
Fluid Status ◽  
Before And After ◽  
Handheld Ultrasound ◽  
End Stage

Introduction: Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Materials and Methods: Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration.Results:  Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p<0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p<0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p<0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p<0.001).Conclusions:  Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done. 

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