Ventriculo-Arterial Coupling Analysis Predicts the Hemodynamic Response to Norepinephrine in Hypotensive Postoperative Patients: A Prospective Observational Study.

Abstract:

OBJECTIVES:The objectives of the present study were to evaluate, in patients with persistent arterial hypotension in the immediate postcardiac surgery period, the effects of norepinephrine infusion on ventriculo-arterial coupling, its determinants: arterial elastance and end-systolic ventricular elastance, and to test the ability of arterial elastance to end-systolic ventricular elastance ratio to predict stroke volume increases. DESIGN:Prospective observational study. SETTING:Cardiac-vascular surgical ICU. PATIENTS:Twenty-eight postoperative cardiac surgery patients, in whom physicians decided to administer norepinephrine infusion, were included. MEASUREMENTS AND MAIN RESULTS:Arterial pressure, stroke volume index, cardiac index, indexed total peripheral resistance, arterial compliance, arterial elastance, and end-systolic ventricular elastance, were measured before and after norepinephrine infusion. We estimated ventriculo-arterial coupling by the arterial elastance to end-systolic ventricular elastance ratio and defined stroke volume responders by a stroke volume increase greater than or equal to 15%. Twenty-two of the 28 subjects had altered ventriculo-arterial coupling (1.87 [1.57-2.51] vs 1.1 [1-1.18]). Fifteen of the 28 subjects (54%) were stroke volume responders. At baseline, stroke volume responders had similar arterial pressure, higher indexed total peripheral resistance, arterial elastance, arterial elastance to end-systolic ventricular elastance ratio (2.21 [1.69-2.89] vs 1.33 [1.1-1.56]; p < 0.05), and lower arterial compliance, indexed total peripheral resistance and cardiac index. Norepinephrine significantly increased arterial pressure in all subjects. In stroke volume responders, norepinephrine increased arterial elastance, end-systolic ventricular elastance, cardiac index, and improved arterial elastance/end-systolic ventricular elastance coupling. The baseline arterial elastance to end-systolic ventricular elastance ratio predicted stroke volume responsiveness (area under the curve [95% CI], 0.87 [0.71-1]; p < 0.0001). CONCLUSIONS:In patients with arterial hypotension norepinephrine increased end-systolic ventricular elastance and arterial elastance. The effects of norepinephrine on stroke volume depend on baseline ventriculo-arterial coupling. Although norepinephrine infusion corrects arterial hypotension in all subjects, increase of stroke volume occurred only in subjects with altered ventriculo-arterial coupling.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Guinot PG,Longrois D,Kamel S,Lorne E,Dupont H

doi

10.1097/CCM.0000000000002772

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

e17-e25

issue

1

eissn

0090-3493

issn

1530-0293

journal_volume

46

pub_type

杂志文章
  • Increased serum nitrite and nitrate concentrations in children with the sepsis syndrome.

    abstract:OBJECTIVES:To measure total serum nitrite and nitrate concentrations in children with the sepsis syndrome as an indicator of endogenous nitric oxide production. To determine if there is an association between total serum nitrite and nitrate concentrations and vascular responsiveness to norepinephrine. DESIGN:A prospec...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199505000-00010

    authors: Wong HR,Carcillo JA,Burckart G,Shah N,Janosky JE

    更新日期:1995-05-01 00:00:00

  • The unassisted respiratory rate/tidal volume ratio accurately predicts weaning outcome in postoperative patients.

    abstract:OBJECTIVE:To evaluate the accuracies of the respiratory rate/tidal volume ratio (rate/volume ratio), minute volume, and negative inspired force in predicting weaning outcome in postoperative mechanically ventilated patients. DESIGN:A prospective, observational study. SETTING:Surgical intensive care unit of a 270-bed ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199702000-00010

    authors: Jacob B,Chatila W,Manthous CA

    更新日期:1997-02-01 00:00:00

  • Pulmonary embolism during and after pregnancy.

    abstract:BACKGROUND:Venous thromboembolic disease is among the most common causes of morbidity and mortality during pregnancy. The clinical evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and the normal pregnant state makes this evaluation even more challenging. DIAGNOSIS:Objective testing ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccm.0000183157.15533.4c

    authors: Stone SE,Morris TA

    更新日期:2005-10-01 00:00:00

  • Administration of tetrahydrobiopterin improves the microcirculation and outcome in an ovine model of septic shock.

    abstract:OBJECTIVE:Supplementation with tetrahydrobiopterin, a nitric oxide synthase cofactor, may reduce microvascular endothelial dysfunction in severe sepsis. We studied whether tetrahydrobiopterin administration exerts beneficial effects in an ovine septic shock model. DESIGN:Randomized animal study. SETTING:University ho...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31825b88ba

    authors: He X,Su F,Velissaris D,Salgado DR,de Souza Barros D,Lorent S,Taccone FS,Vincent JL,De Backer D

    更新日期:2012-10-01 00:00:00

  • Danger of using core/peripheral temperature gradient as a guide to therapy in shock.

    abstract::During the treatment of 26 shocked patients, measurements were made of the central blood to peripheral skin temperature gradient. No significant correlation was found between this gradient and cardiac index (CI), or systemic vascular resistance (SVR) or its index (SVRI). There was no significant correlation between th...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198709000-00010

    authors: Woods I,Wilkins RG,Edwards JD,Martin PD,Faragher EB

    更新日期:1987-09-01 00:00:00

  • Stroke as a complication of carotid sinus massage.

    abstract::A 77-yr-old white man recovering from aortobiiliac bypass surgery suffered a sudden stroke within 30 min after carotid sinus massage was performed in an attempt to treat supraventricular tachycardia. Even though carotid digital subtraction angiography and angiograms were negative for carotid artery disease, we believe...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198510000-00022

    authors: Bastulli JA,Orlowski JP

    更新日期:1985-10-01 00:00:00

  • Bradyarrhythmias, temporary and permanent pacing.

    abstract::Bradycardia is common in critical care units. It may be transient, asymptomatic and of little consequence, or life-threatening. Bradycardia may result from abnormalities of the sinus node, atrioventricular node, or the His-Purkinje system. It may also be precipitated by drug effects or enhanced vagal tone. Proper diag...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/00003246-200010001-00003

    authors: Kaushik V,Leon AR,Forrester JS Jr,Trohman RG

    更新日期:2000-10-01 00:00:00

  • Healthcare climate: a framework for measuring and improving patient safety.

    abstract:OBJECTIVES:Reviews of patient safety efforts suggest that technical/administrative change must be augmented by global factors such as organizational culture and climate. The objective was to outline a comprehensive model for healthcare climate and test one of its elements, the nursing subclimate, in terms of several pa...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/01.CCM.0000262404.10203.C9

    authors: Zohar D,Livne Y,Tenne-Gazit O,Admi H,Donchin Y

    更新日期:2007-05-01 00:00:00

  • Short-Latency Positive Peak Following N20 Somatosensory Evoked Potential Is Superior to N20 in Predicting Neurologic Outcome After Out-of-Hospital Cardiac Arrest.

    abstract:OBJECTIVES:The absence of N20 somatosensory evoked potential after cardiac arrest is related to poor outcome. However, discrimination between the low-amplitude and the absence of N20 is challenging. P25 and P30 are short-latency positive peaks with latencies between 25 and 30 ms following N20 (P25/30). P25/30 is eviden...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003083

    authors: Kim SW,Oh JS,Park J,Jeong HH,Kim JH,Wee JH,Oh SH,Choi SP,Park KN,Cerebral Resuscitation and Outcome evaluation Within catholic Network (CROWN) Investigators.

    更新日期:2018-06-01 00:00:00

  • Capillary Leukocytes, Microaggregates, and the Response to Hypoxemia in the Microcirculation of Coronavirus Disease 2019 Patients.

    abstract:OBJECTIVES:In this study, we hypothesized that coronavirus disease 2019 patients exhibit sublingual microcirculatory alterations caused by inflammation, coagulopathy, and hypoxemia. DESIGN:Multicenter case-controlled study. SETTING:Two ICUs in The Netherlands and one in Switzerland. PATIENTS:Thirty-four critically i...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000004862

    authors: Favaron E,Ince C,Hilty MP,Ergin B,van der Zee P,Uz Z,Wendel Garcia PD,Hofmaenner DA,Acevedo CT,van Boven WJ,Akin S,Gommers D,Endeman H

    更新日期:2021-01-07 00:00:00

  • Maximum infusion rates and CVP accuracy during high-flow delivery through multilumen catheters.

    abstract::Flow rates and pressure recording accuracy were compared for Argyle 14-, 16-, and 18-ga double-lumen and Edwards 7-Fr triple-lumen CVP catheters. Physiologic saline solution was pressure-infused into dogs through one lumen and CVP was measured via the other lumen. CVP accuracy was unaltered by simultaneous rapid infus...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198507000-00017

    authors: Ikeda S,Schweiss JF

    更新日期:1985-07-01 00:00:00

  • Early experience with continuous arteriovenous hemofiltration in critically ill pediatric patients.

    abstract::The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198612000-00014

    authors: Leone MR,Jenkins RD,Golper TA,Alexander SR

    更新日期:1986-12-01 00:00:00

  • Biomarkers increase detection of active smoking and secondhand smoke exposure in critically ill patients.

    abstract:OBJECTIVES:The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181fa4196

    authors: Hsieh SJ,Ware LB,Eisner MD,Yu L,Jacob P 3rd,Havel C,Goniewicz ML,Matthay MA,Benowitz NL,Calfee CS

    更新日期:2011-01-01 00:00:00

  • Early recovery after closed traumatic head injury: somatosensory evoked potentials and clinical findings.

    abstract:OBJECTIVE:To determine the ability of somatosensory evoked potentials (SEP) compared with clinical findings to monitor and predict recovery in patients suffering from closed head injury with predominantly diffuse axonal injury (DAI). DESIGN:Prospective cohort study. SETTING:Neurologic intensive care unit (ICU) of a u...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200103000-00005

    authors: Claassen J,Hansen HC

    更新日期:2001-03-01 00:00:00

  • Bioelectrical Impedance Measurements for Assessment of Kidney Function in Critically Ill Patients.

    abstract:OBJECTIVES:To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease,...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000004033

    authors: de Jong LAA,Otten-Helmers AG,Spronk PE,van Kan HJM

    更新日期:2019-12-01 00:00:00

  • Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage.

    abstract:OBJECTIVE:To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients. DESIGN:Retrospective analysis of all subarachnoid hemorrhage admissions. SETTINGS:Neurocritical care unit. PATIENTS:All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014. INTERVENTIO...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000002497

    authors: Sadan O,Singbartl K,Kandiah PA,Martin KS,Samuels OB

    更新日期:2017-08-01 00:00:00

  • Resuscitation from experimental heatstroke by hyperbaric oxygen therapy.

    abstract:OBJECTIVE:Heatstroke is characterized by hyperthermia, vasoplegic shock, and cerebral ischemia and hypoxia. Hyperbaric oxygen (HBO) has been shown to reduce brain ischemia and behavioral dysfunction during cerebral artery occlusion. The efficacy of HBO therapy for resuscitation from heatstroke remains to be determined ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000159193.42628.e8

    authors: Tsai HM,Gao CJ,Li WX,Lin MT,Niu KC

    更新日期:2005-04-01 00:00:00

  • Insulin reduces the multiple organ injury and dysfunction caused by coadministration of lipopolysaccharide and peptidoglycan independently of blood glucose: role of glycogen synthase kinase-3beta inhibition.

    abstract:OBJECTIVE:Insulin reduces morbidity and mortality among critically ill patients, but the molecular mechanisms of its effect remain unknown. Insulin is a well-known inhibitor of glycogen synthase kinase-3, which may play an important role in systemic inflammation and shock. Here we investigate the role of blood glucose ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000215457.83953.E3

    authors: Dugo L,Collin M,Allen DA,Murch O,Foster SJ,Yaqoob MM,Thiemermann C

    更新日期:2006-05-01 00:00:00

  • Dobutamine: a hemodynamic evaluation in pulmonary embolism shock.

    abstract::Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less t...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198512000-00004

    authors: Jardin F,Genevray B,Brun-Ney D,Margairaz A

    更新日期:1985-12-01 00:00:00

  • Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis.

    abstract:OBJECTIVE:To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion. DESIGN:Observational, experimental study. SETTING:University-affiliated large animal laboratory. SUBJECTS:Ten fasted, anesthetized, mechanically ventilated, male pigs randomized to a sham group (n = 3) or to...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181b029c1

    authors: Verdant CL,De Backer D,Bruhn A,Clausi CM,Su F,Wang Z,Rodriguez H,Pries AR,Vincent JL

    更新日期:2009-11-01 00:00:00

  • A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis.

    abstract:OBJECTIVE:To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis. DESIGN:Prospective observational study. SETTING:EDs of ten academic medical centers. PATIENTS:There were 971 patients enrolled. INCLUSION CRITERIA:1) ED p...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/CCM.0b013e318192fd9d

    authors: Shapiro NI,Trzeciak S,Hollander JE,Birkhahn R,Otero R,Osborn TM,Moretti E,Nguyen HB,Gunnerson KJ,Milzman D,Gaieski DF,Goyal M,Cairns CB,Ngo L,Rivers EP

    更新日期:2009-01-01 00:00:00

  • Effect of carboxyhemoglobin on the accuracy of mixed venous oximetry monitors in dogs.

    abstract:OBJECTIVE:To assess the accuracy of mixed venous hemoglobin oxygen saturation estimated, using in vivo pulmonary artery reflectance oximetry with ranging concentrations of carboxyhemoglobin. DESIGN:Criterion standard, a comparison of an alternative test to the "gold standard." SETTING:Laboratory animal facility of a ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199407000-00022

    authors: Haney M,Tait AR,Tremper KK

    更新日期:1994-07-01 00:00:00

  • Perceptions of a critically ill patient experiencing therapeutic paralysis in an ICU.

    abstract::Prolonged therapeutic paralysis with pancuronium is commonly used in ICUs to facilitate mechanical ventilation of patients with respiratory failure. Sedation is usually given concomitantly to reduce patient discomfort, but assessment of its adequacy is made difficult by the paralysis. We recently cared for a former IC...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198401000-00018

    authors: Parker MM,Schubert W,Shelhamer JH,Parrillo JE

    更新日期:1984-01-01 00:00:00

  • Effect of increased radiant warmer power output on state of hydration in the critically ill neonate.

    abstract::To correlate radiant warmer bed power output with state of hydration in the critically ill infant, warmer power input was measured by a wattmeter and recorded by an on-line computer every 5 sec for 2 periods of 8-24 h each in 11 newborns with respiratory distress syndrome (mean birth weight 1.42 kg, mean gestational a...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198210000-00012

    authors: Engle WD,Baumgart S,Fox WW,Polin RA

    更新日期:1982-10-01 00:00:00

  • Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs.

    abstract:OBJECTIVE:Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment. DESIGN:Mixed-methods study. SETT...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/CCM.0000000000002099

    authors: Wysham NG,Hua M,Hough CL,Gundel S,Docherty SL,Jones DM,Reagan O,Goucher H,Mcfarlin J,Cox CE

    更新日期:2017-04-01 00:00:00

  • Late diagnosis of ornithine transcarbamylase defect in three related female patients: polymorphic presentations.

    abstract:OBJECTIVE:To describe three female patients of one family with different phenotypes of the same mutation of the ornithine transcarbamylase gene. X-linked inherited ornithine transcarbamylase deficiency is the most frequent urea cycle disorder. Many of the hemizygous males die during the neonatal period. Women, who are ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200201000-00035

    authors: Legras A,Labarthe F,Maillot F,Garrigue MA,Kouatchet A,Ogier de Baulny H

    更新日期:2002-01-01 00:00:00

  • Amino acid clearances and daily losses in patients with acute renal failure treated by continuous arteriovenous hemodialysis.

    abstract:OBJECTIVE:To determine daily amino acid and total protein losses in patients with acute renal failure receiving total parenteral nutrition (TPN) during treatment by continuous arteriovenous hemofiltration with hemodialysis (CAVHD). DESIGN:Prospective, nonrandomized study. SETTING:Patients in the ICU of a regional nep...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199112000-00012

    authors: Davies SP,Reaveley DA,Brown EA,Kox WJ

    更新日期:1991-12-01 00:00:00

  • Influence of interleukin-10 polymorphisms on interleukin-10 expression and survival in critically ill patients.

    abstract:OBJECTIVE:To determine the functionality of identified polymorphisms in the promoter and upstream regions of the interleukin-10 gene in terms of release of interleukin-10 from lipopolysaccharide-stimulated whole blood from healthy volunteers and to evaluate the relationship of interleukin-10 polymorphisms to interleuki...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200301000-00005

    authors: Lowe PR,Galley HF,Abdel-Fattah A,Webster NR

    更新日期:2003-01-01 00:00:00

  • The ups and downs of heart rate.

    abstract:OBJECTIVE:To review the physiology of the regulation and determinants of heart rate and the significance in the management of critically ill patients. DATA SOURCES:The MEDLINE database, references from selected articles, and the author's personal database. DATA SYNTHESIS:This review begins with the regulation of card...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0b013e318232e50c

    authors: Magder SA

    更新日期:2012-01-01 00:00:00

  • Acute oxygenation response to inhaled nitric oxide when combined with high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome.

    abstract:OBJECTIVE:To prospectively evaluate the oxygenation effect of inhaled nitric oxide (INO) delivered during high-frequency oscillatory ventilation in adult patients with the acute respiratory distress syndrome and oxygenation failure. DESIGN Prospective, clinical study. SETTING:Intensive care unit of a university teachi...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000049953.86613.02

    authors: Mehta S,MacDonald R,Hallett DC,Lapinsky SE,Aubin M,Stewart TE

    更新日期:2003-02-01 00:00:00