Abstract:
OBJECTIVES:To evaluate the preload dependence of femoral maximal change in pressure over time (dP/dtmax) during volume expansion in preload dependent and independent critically ill patients. DESIGN:Retrospective database analysis. SETTING:Two adult polyvalent ICUs. PATIENTS:Twenty-five critically ill patients with acute circulatory failure. INTERVENTIONS:Thirty-five fluid infusions of 500 mL normal saline. MEASUREMENTS AND MAIN RESULTS:Changes in femoral dP/dtmax, systolic, diastolic, and pulse femoral arterial pressure were obtained from the pressure waveform analysis using the PiCCO2 system (Pulsion Medical Systems, Feldkirchen, Germany). Stroke volume index was obtained by transpulmonary thermodilution. Statistical analysis was performed comparing results before and after volume expansion and according to the presence or absence of preload dependence (increases in stroke volume index ≥ 15%). Femoral dP/dtmax increased by 46% after fluid infusion in preload-dependent cases (mean change = 510.6 mm Hg·s; p = 0.005) and remained stable in preload-independent ones (mean change = 49.2 mm Hg·s; p = 0.114). Fluid-induced changes in femoral dP/dtmax correlated with fluid-induced changes in stroke volume index in preload-dependent cases (r = 0.618; p = 0.032), but not in preload-independent ones. Femoral dP/dtmax strongly correlated with pulse and systolic arterial pressures and with total arterial stiffness, regardless of the preload dependence status (r > 0.9 and p < 0.001 in all cases). CONCLUSIONS:Femoral dP/dtmax increased with volume expansion in case of preload dependence but not in case of preload independence and was strongly related to pulse pressure and total arterial stiffness regardless of preload dependence status. Therefore, femoral dP/dtmax is not a load-independent marker of left ventricular contractility and should be not used to track contractility in critically ill patients.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Vaquer S,Chemla D,Teboul JL,Ahmad U,Cipriani F,Oliva JC,Ochagavia A,Artigas A,Baigorri F,Monnet Xdoi
10.1097/CCM.0000000000004515subject
Has Abstractpub_date
2020-10-01 00:00:00pages
1487-1493issue
10eissn
0090-3493issn
1530-0293journal_volume
48pub_type
杂志文章abstract:OBJECTIVE:Early assessment of neurologic recovery is often challenging in survivors of cardiac arrest. Further, little is known about when to assess neurologic status in comatose, postarrest patients receiving therapeutic hypothermia. We sought to evaluate timing of prognostication in cardiac arrest survivors who recei...
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doi:10.1097/CCM.0b013e3182372f93
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abstract::The conjunctival oxygen monitor reflects oxygen tension of the internal carotid artery without introducing the heating artifact characteristic of transcutaneous monitors. It is now being used in the ICU and the operating room to measure accurately and continuously Po2 and temperature of conjunctival tissue. We examine...
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abstract:OBJECTIVES:To evaluate the ability of central venous-to-arterial carbon dioxide pressure difference, central venous oxygen saturation, and the combination of these two parameters to detect extubation failure in critically ill patients. DESIGN:Multicentric, prospective, observational study. SETTING:Three ICUs. PATIEN...
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journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
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更新日期:2002-07-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:1993-05-01 00:00:00
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更新日期:1988-04-01 00:00:00
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更新日期:2021-02-01 00:00:00
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更新日期:2001-05-01 00:00:00
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更新日期:2015-09-01 00:00:00
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更新日期:2020-10-01 00:00:00
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更新日期:2003-06-01 00:00:00
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更新日期:2020-12-01 00:00:00
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