scholarly journals Comparison of mean systemic pressure in patients with acute circulatory failure receiving passive leg raising vs. pneumatic leg compression

2021 ◽  
Author(s):  
Panu Boontoterm ◽  
Pusit Fuengfoo ◽  
Petch Wacharasint
Keyword(s):  
Venous Pressure ◽  
Circulatory Failure ◽  
Passive Leg Raising ◽  
Secondary Outcome ◽  
Acute Circulatory Failure ◽  
Systemic Pressure ◽  
Hemodynamic Variables ◽  
Carry Over ◽  
Mean Systemic Pressure ◽  
Carry Over Effect

Background: Driving pressure of venous return (VR) is determined by a pressure gradient between mean systemic pressure (Pms) and central venous pressure (CVP). While passive leg raising (PLR) and pneumatic leg compression PC (PC) can increase VR, no study has explored the effects of these two procedures on Pms and VR-related hemodynamic variables. Methods: Forty patients with acute circulatory failure were enrolled in this analysis. All patients obtained both PLR and PC, and were measured for Pms, CVP, mean arterial pressure (MAP), cardiac output (CO), VR resistance (RVR), and systemic vascular resistance (SVR) at baseline and immediately after procedures. To minimize carry over effect, the patients were divided in 2 groups based on procedure sequence which were 1) patients receiving PLR first then PC (PLR-first), and 2) patients receiving PC first then PLR (PC-first). Both groups waited for a washout period before performing the 2 second procedure. Primary outcome was difference in Pms between PLR and PC procedures. Secondary outcome were differences in CVP, MAP, CO, RVR, and SVR between PLR and PC procedures. Results: No difference was found in baseline characteristics and no carry over effect was observed between the 2 groups of patients. Compared with baseline, both PLR and PC significantly increased Pms, CVP, MAP, and CO. PLR increased Pms (9.0±2.3 vs 4.8±1.7 mmHg, p<0.001), CVP (4.5±1.2 vs. 1.6±0.7 mmHg, p<0.001), MAP (22.5±5.6 vs. 14.4±5.0 mmHg, p<0.001), and CO (1.5±0.5 vs. 0.5±0.2 L/min, p<0.001) more than PC. However, PC, also significantly increased RVR (16 ± 27.2 dyn.s/cm5, p=0.001) and SVR (78.4 ± 7.2 dyn.s/cm5, p<0.001) but no difference in PLR group. Conclusion: Among patients with acute circulatory failure, PLR increased Pms, CVP, MAP, and CO more than PC.

scholarly journals Comparison of mean systemic pressure in patients with acute circulatory failure receiving passive leg raising vs. pneumatic leg compression

2021 ◽  
Author(s):  
Panu Boontoterm ◽  
Pusit Fuengfoo ◽  
Petch Wacharasint
Keyword(s):  
Venous Pressure ◽  
Circulatory Failure ◽  
Passive Leg Raising ◽  
Secondary Outcome ◽  
Acute Circulatory Failure ◽  
Systemic Pressure ◽  
Hemodynamic Variables ◽  
Carry Over ◽  
Mean Systemic Pressure ◽  
Carry Over Effect

Background: Driving pressure of venous return (VR) is determined by a pressure gradient between mean systemic pressure (Pms) and central venous pressure (CVP). While passive leg raising (PLR) and pneumatic leg compression PC (PC) can increase VR, no study has explored the effects of these two procedures on Pms and VR-related hemodynamic variables. Methods: Forty patients with acute circulatory failure were enrolled in this analysis. All patients obtained both PLR and PC, and were measured for Pms, CVP, mean arterial pressure (MAP), cardiac output (CO), VR resistance (RVR), and systemic vascular resistance (SVR) at baseline and immediately after procedures. To minimize carry over effect, the patients were divided in 2 groups based on procedure sequence which were 1) patients receiving PLR first then PC (PLR-first), and 2) patients receiving PC first then PLR (PC-first). Both groups waited for a washout period before performing the 2 second procedure. Primary outcome was difference in Pms between PLR and PC procedures. Secondary outcome were differences in CVP, MAP, CO, RVR, and SVR between PLR and PC procedures. Results: No difference was found in baseline characteristics and no carry over effect was observed between the 2 groups of patients. Compared with baseline, both PLR and PC significantly increased Pms, CVP, MAP, and CO. PLR increased Pms (9.0±2.3 vs 4.8±1.7 mmHg, p<0.001), CVP (4.5±1.2 vs. 1.6±0.7 mmHg, p<0.001), MAP (22.5±5.6 vs. 14.4±5.0 mmHg, p<0.001), and CO (1.5±0.5 vs. 0.5±0.2 L/min, p<0.001) more than PC. However, PC, also significantly increased RVR (16 ± 27.2 dyn.s/cm5, p=0.001) and SVR (78.4 ± 7.2 dyn.s/cm5, p<0.001) but no difference in PLR group. Conclusion: Among patients with acute circulatory failure, PLR increased Pms, CVP, MAP, and CO more than PC.

Comparison of Mean Systemic Pressure in Patients with Acute Circulatory Failure Receiving Passive Leg Raising vs. Pneumatic Leg Compression.

2021 ◽  
Author(s):  
PANU BOONTOTERM ◽  
PETCH WACHARASINT ◽  
PUSIT FUENGFOO
Keyword(s):  
Primary Outcome ◽  
Venous Pressure ◽  
Circulatory Failure ◽  
Passive Leg Raising ◽  
Secondary Outcome ◽  
Acute Circulatory Failure ◽  
Systemic Pressure ◽  
Hemodynamic Variables ◽  
Baseline Characteristics ◽  
Mean Systemic Pressure

Abstract Background: Driving pressure of venous return (VR) is determined by mean systemic pressure (Pms) and central venous pressure (CVP). While passive leg raising (PLR) and pneumatic leg compression PC (PC) can increase VR, there is no study explore the effects of these two procedures on Pms and VR-related hemodynamic variables.Methods: Forty patients with acute circulatory failure were included in this analysis. All patients were performed both PLR and PC, and were measured for Pms, CVP, mean arterial pressure (MAP), cardiac output (CO), VR resistance (RVR), and systemic vascular resistance (SVR) at baseline and immediately after procedures. To minimized carry-on effect, the patients were divided into 2 groups based on procedure sequence which were 1) the patients who received PLR first then PC (PLR-first), and 2) the patients who received PC first then PLR (PC-first). Both groups were waited for washing period before performed 2nd procedure. Primary outcome was difference in Pms between PLR and PC procedure. Secondary outcome were differences in CVP, MAP, CO, RVR, and SVR between PLR and PC procedure.Results: There was no difference in baseline characteristics and no carry-on effect between 2 groups of patients. Compared to baseline, both PLR and PC significantly increased Pms, CVP, MAP, and CO. Compared to PC, PLR more increased Pms (9.0±2.3 vs 4.8±1.7 mmHg, p<0.001), CVP (4.5±1.2 vs. 1.6±0.7 mmHg, p<0.001), MAP (22.5±5.6 vs. 14.4±5.0 mmHg, p<0.001), and CO (1.5±0.5 vs. 0.5±0.2 L/min, p<0.001). PC, but not PLR also significantly increased RVR (16 ± 27.2 dyn.s/cm5, p=0.001) and SVR (78.4 ± 7.2 dyn.s/cm5, p<0.001) .Conclusion: In patients with acute circulatory failure, PLR more increased Pms, CVP, MAP, and CO than PC.

scholarly journals Effects of passive leg raising and volume expansion on mean systemic pressure and venous return in shock in humans

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Laurent Guérin ◽  
Jean-Louis Teboul ◽  
Romain Persichini ◽  
Martin Dres ◽  
Christian Richard ◽  
...  
Keyword(s):  
Volume Expansion ◽  
Venous Return ◽  
Passive Leg Raising ◽  
Systemic Pressure ◽  
Mean Systemic Pressure

scholarly journals MP54: Management algorithm for the treatment of intoxications with calcium channel blockers: a simulation trial (MATRICS)

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S62-S62
Author(s):  
V. Gauvin ◽  
É. Raymond-Dufresne ◽  
M. St-Onge
Keyword(s):  
Calcium Channel ◽  
Insulin Infusion ◽  
Secondary Outcome ◽  
Poison Control ◽  
Channel Blockers ◽  
Control Center ◽  
Management Protocol ◽  
Baseline Characteristics ◽  
Carry Over ◽  
Carry Over Effect

Introduction: Cardiotoxicants poisonings are rare but have the potential to be highly lethal. Given the precarious nature of these poisonings, the Quebec Poison Control Center (CAPQ) has established a management protocol for optimal treatment. This study seeks to evaluate whether CAPQ's Calcium Channel Blocker (CCB) poisoning management protocol improves treatment delivery by physicians using simulation. The primary outcome is whether the management protocol decreases time to delivery of calcium and insulin. The secondary outcome is whether use of the management protocol increases appropriate dosing. Methods: For this randomized AB / BA crossover trial, Emergency Medicine and Internal Medicine residents were randomly assigned to one of two groups; one group received the management protocol during the simulation and the other did not. The crossover occurred 3-months later whereby the groups were reversed. Inverse probability weighting was used to compensate for losses at follow-up. Differences in baseline characteristics, as well as carry-over effect, were evaluated. The outcomes were analyzed with a two-level hierarchical model. Results: Twenty-three residents were included in the study. No significant differences in baseline characteristics were noted between the AB / BA groups, and no carry-over effect was identified on statistical analysis for all variables. As for the primary outcomes, time to administration of IV calcium decreased by 87 seconds (CI -266 to 92), time to insulin bolus decreased by 52 seconds (-217 to 114), and time to insulin infusion decreased by 115 seconds (-213 to -18) when the protocol was used. As for the secondary outcomes, there were no statistically significant differences for the percentage of adequate doses of IV calcium (RR: 1.27; 95% CI: 0.80–2.02), insulin bolus (RR: 1.30; 95% CI: 0.80–2.12) and insulin infusion (RR: 1.37; 95% CI: 0.99–1.91). Conclusion: This randomized cross-over study, which uses simulation to evaluate the performance of CAPQ's CCB poisoning management protocol, does not statistically demonstrate decreased time to administration or increased accuracy of dosing, due to the large confidence intervals. Unfortunately, we were not able to obtain the planned sample size due to limited participation. However, our results trend towards more optimal dosing and rapid dosing of treatments, and from a qualitative standpoint, the protocol appeared to increase the structure of patient care.

scholarly journals Left ventricular longitudinal strain variations assessed by speckle-tracking echocardiography after a passive leg raising maneuver in patients with acute circulatory failure to predict fluid responsiveness: A prospective, observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257737
Author(s):  
Clemence Roy ◽  
Gary Duclos ◽  
Cyril Nafati ◽  
Mickael Gardette ◽  
Alexandre Lopez ◽  
...  
Keyword(s):  
Fluid Responsiveness ◽  
Repeated Measures ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Circulatory Failure ◽  
Passive Leg Raising ◽  
Acute Circulatory Failure ◽  
Predict Fluid Responsiveness ◽  
Icu Patients ◽  
Significant Difference

Background An association was reported between the left ventricular longitudinal strain (LV-LS) and preload. LV-LS reflects the left cardiac function curve as it is the ratio of shortening over diastolic dimension. The aim of this study was to determine the sensitivity and specificity of LV-LS variations after a passive leg raising (PLR) maneuver to predict fluid responsiveness in intensive care unit (ICU) patients with acute circulatory failure (ACF). Methods Patients with ACF were prospectively included. Preload-dependency was defined as a velocity time integral (VTI) variation greater than 10% between baseline (T0) and PLR (T1), distinguishing the preload-dependent (PLD+) group and the preload-independent (PLD-) group. A 7-cycles, 4-chamber echocardiography loop was registered at T0 and T1, and strain analysis was performed off-line by a blind clinician. A general linear model for repeated measures was used to compare the LV-LS variation (T0 to T1) between the two groups. Results From June 2018 to August 2019, 60 patients (PLD+ = 33, PLD- = 27) were consecutively enrolled. The VTI variations after PLR were +21% (±8) in the PLD+ group and -1% (±7) in the PLD- group (p<0.01). Mean baseline LV-LS was -11.3% (±4.2) in the PLD+ group and -13.0% (±4.2) in the PLD- group (p = 0.12). LV-LS increased in the whole population after PLR +16.0% (±4.0) (p = 0.04). The LV-LS variations after PLR were +19.0% (±31) (p = 0.05) in the PLD+ group and +11.0% (±38) (p = 0.25) in the PLD- group, with no significant difference between the two groups (p = 0.08). The area under the curve for the LV-LS variations between T0 and T1 was 0.63 [0.48–0.77]. Conclusion Our study confirms that LV-LS is load-dependent; however, the variations in LV-LS after PLR is not a discriminating criterion to predict fluid responsiveness of ICU patients with ACF in this cohort.

scholarly journals Assessing the effectiveness of topical betamethasone to treat chronic chilblains: a randomised clinical trial in primary care

2017 ◽  
Vol 67 (656) ◽  
pp. e187-e193 ◽  
Author(s):  
Ibo H Souwer ◽  
Jacobus HJ Bor ◽  
Paul Smits ◽  
Antoine LM Lagro-Janssen
Keyword(s):  
Primary Care ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Primary Outcome ◽  
Care Setting ◽  
Primary Care Setting ◽  
Randomised Clinical Trial ◽  
Secondary Outcome ◽  
Carry Over ◽  
Carry Over Effect

BackgroundGPs prescribe topical corticosteroids to patients with chronic chilblains despite poor evidence for their effectiveness. The authors of the current study therefore decided to assess the effectiveness of topical steroids in a primary care setting.AimTo assess the effectiveness of topical application of betamethasone valerate 0.1% cream in patients with chronic chilblains.Design and settingA placebo-controlled, double-blind, crossover, randomised clinical trial in a Dutch primary care setting.MethodThe study population consisted of 34 participants suffering from chronic chilblains. Intervention was topical application of betamethasone valerate 0.1% cream twice a day for 6 weeks compared with placebo. Primary outcome was the visual analogue scale on complaints (VOC). Secondary outcome was the visual analogue scale on disability (VOD). Both were assessed with a diary of daily scores on a 100 mm visual analogue scale. The authors took ambient temperatures into account, checked for a carry-over effect, performed additional analysis, and monitored adverse effects.ResultsOn the primary outcome mean VOC, there was a difference of 0.56 mm (95% confidence interval [CI] = −2.88 to 3.99 mm) in favour of placebo (P = 0.744). On the secondary outcome mean VOD, there was a difference of 0.88 mm (95% CI = −2.22 to 3.98 mm) in favour of placebo (P = 0.567). This study found no carry-over effect and no adverse effects.ConclusionIn this study, topical betamethasone was not superior to placebo in the treatment of chronic chilblains. Topical betamethasone should not be used for chronic chilblains without new evidence.

scholarly journals EFFECTS OF PASSIVE LEG RAISING AND VOLUME EXPANSION ON MEAN SYSTEMIC PRESSURE AND VENOUS RETURN IN SHOCK IN HUMANS

2015 ◽  
Vol 3 (Suppl 1) ◽  
pp. A16
Author(s):  
L Guérin ◽  
JL Teboul ◽  
R Persichini ◽  
M Dres ◽  
C Richard ◽  
...  
Keyword(s):  
Volume Expansion ◽  
Venous Return ◽  
Passive Leg Raising ◽  
Systemic Pressure ◽  
Mean Systemic Pressure

Does CBT for Psychosis Have an Impact on Delusions by Improving Reasoning Biases and Negative Self-Schemas?

2018 ◽  
Vol 226 (3) ◽  
pp. 152-163 ◽  
Author(s):  
Stephanie Mehl ◽  
Björn Schlier ◽  
Tania M. Lincoln
Keyword(s):  
Behavioral Therapy ◽  
Theoretical Models ◽  
Self Esteem ◽  
Secondary Outcome ◽  
Intervention Effect ◽  
Produce Change ◽  
Attribution Biases ◽  
Carry Over ◽  
Implicit And Explicit ◽  
Reasoning Biases

Abstract. Cognitive-behavioral therapy for psychosis (CBTp) builds on theoretical models that postulate reasoning biases and negative self-schemas to be involved in the formation and maintenance of delusions. However, it is unclear whether CBTp induces change in delusions by improving these proposed causal mechanisms. This study reports on a mediation analysis of a CBTp effectiveness trial in which delusions were a secondary outcome. Patients with psychosis were randomized to individualized CBTp (n = 36) or a waiting list condition (WL; n = 34). Reasoning biases (jumping to conclusions, theory of mind, attribution biases) and self-schemas (implicit and explicit self-esteem; self-schemas related to different domains) were assessed pre- and post-therapy/WL. The results reveal an intervention effect on two of four measures of delusions and on implicit self-esteem. Nevertheless, the intervention effect on delusions was not mediated by implicit self-esteem. Changes in explicit self-schemas and reasoning biases did also not mediate the intervention effects on delusions. More focused interventions may be required to produce change in reasoning and self-schemas that have the potential to carry over to delusions.

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