Validation and Critical Evaluation of the Effective Arterial Elastance in Critically Ill Patients
| Autor: | Christian Richard, Xavier Monnet, Pablo Mercado, Mathieu Jozwiak, François Dépret, Jean-Emmanuel Alphonsine, Jean-Louis Teboul, Sandrine Millasseau, Denis Chemla |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Critical Illness Heart Ventricles Cardiac index Critical Care and Intensive Care Medicine 03 medical and health sciences Ventricular Dysfunction Left 0302 clinical medicine Internal medicine medicine.artery Ventricular Pressure Medicine Humans Arterial Pressure Prospective Studies Radial artery Prospective cohort study business.industry 030208 emergency & critical care medicine Stroke Volume Stroke volume Middle Aged Catheter Blood pressure medicine.anatomical_structure 030228 respiratory system Case-Control Studies Breathing Cardiology Vascular resistance Female business |
| Zdroj: | Critical care medicine. 47(4) |
| ISSN: | 1530-0293 |
| Popis: | OBJECTIVES First, to validate bedside estimates of effective arterial elastance = end-systolic pressure/stroke volume in critically ill patients. Second, to document the added value of effective arterial elastance, which is increasingly used as an index of left ventricular afterload. DESIGN Prospective study. SETTING Medical ICU. PATIENTS Fifty hemodynamically stable and spontaneously breathing patients equipped with a femoral (n = 21) or radial (n = 29) catheter were entered in a "comparison" study. Thirty ventilated patients with invasive hemodynamic monitoring (PiCCO-2; Pulsion Medical Systems, Feldkirchen, Germany), in whom fluid administration was planned were entered in a " dynamic" study. INTERVENTIONS In the "dynamic" study, data were obtained before/after a 500 mL saline administration. MEASUREMENTS AND MAIN RESULTS According to the "cardiocentric" view, end-systolic pressure was considered the classic index of left ventricular afterload. End-systolic pressure was calculated as 0.9 × systolic arterial pressure at the carotid, femoral, and radial artery level. In the "comparison" study, carotid tonometry allowed the calculation of the reference effective arterial elastance value (1.73 ± 0.62 mm Hg/mL). The femoral estimate of effective arterial elastance was more accurate and precise than the radial estimate. In the "dynamic" study, fluid administration increased stroke volume and end-systolic pressure, whereas effective arterial elastance (femoral estimate) and systemic vascular resistance did not change. Effective arterial elastance was related to systemic vascular resistance at baseline (r = 0.89) and fluid-induced changes in effective arterial elastance and systemic vascular resistance were correlated (r = 0.88). In the 15 fluid responders (cardiac index increases ≥ 15%), fluid administration increased end-systolic pressure and decreased effective arterial elastance and systemic vascular resistance (each p < 0.05). In the 15 fluid nonresponders, end-systolic pressure increased (p < 0.05), whereas effective arterial elastance and systemic vascular resistance remained unchanged. CONCLUSIONS In critically ill patients, effective arterial elastance may be reliably estimated at bedside (0.9 × systolic femoral pressure/stroke volume). We support the use of this validated estimate of effective arterial elastance when coupled with an index of left ventricular contractility for studying the ventricular-arterial coupling. Conversely, effective arterial elastance should not be used in isolation as an index of left ventricular afterload. |
| Databáze: | OpenAIRE |
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