real-time-assessment-spinal-cord-microperfusion-porcine-model

Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion

Spinal cord injury is a devastating complication of aortic repair. Despite developments for the prevention and treatment of spinal cord injury, its ...

University Medical Center Hamburg-Eppendorf

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The aim of this study was to assess whether thermodilution-derived parameters of right and left ventricular cardiac function (right ventricular ejection fraction, global ejection fraction, cardiac function index) are able to track changes of cardiac contractile function and whether they are influenced by substantial preload reduction.

Thermodilution-derived indices for assessment of left and right ventricular cardiac function in normal and impaired cardiac function.

Le but de cette &eacute;tude &eacute;tait d&#39;&eacute;valuer si les param&egrave;tres thermodilution d&eacute;riv&eacute;e de la fonction cardiaque ventriculaire droite et gauche (fraction d&#39;&eacute;jection ventriculaire droite, la fraction d&#39;&eacute;jection globale, indice de la fonction cardiaque) sont en mesure de suivre l&#39;&eacute;volution de la fonction contractile cardiaque et savoir si elles sont influenc&eacute;es par la r&eacute;duction substantielle de la pr&eacute;charge.

Des indices d&eacute;riv&eacute;s thermodilution pour &eacute;valuation de cardiaque ventriculaire droit et gauche fonctionnent dans des conditions normales et alt&eacute;ration de la fonction cardiaque.

Ziel dieser Studie war es zu beurteilen, ob Thermodilution abgeleiteten Parameter des rechten und linken Ventrikels Herzfunktion (rechtsventrikul&auml;re Ejektionsfraktion, globale Auswurffraktion, Herzfunktion Index) in der Lage sind, &Auml;nderungen der kontraktilen Herzfunktion und ob sie durch erhebliche Verringerung der Vorspannung beeinflusst werden nachverfolgt.

Thermodilution abgeleitete Indizes f&uuml;r die Beurteilung der Links- und rechtsventrikul&auml;ren kardiologische in Normal und beeintr&auml;chtigt die Herzfunktion.

Lo scopo di questo studio era di valutare parametri derivati per termodiluizione di destra e di sinistra cardiaco funzione ventricolare (frazione di eiezione ventricolare destra, frazione di eiezione globale, indice di funzione cardiaca) sono in grado di tenere traccia delle modifiche della funzione contrattile cardiaca e se sono influenzati da una sostanziale riduzione del precarico.

Derivati per termodiluizione indici per la valutazione del ventricolo destro e sinistro cardiaco funzionano nel normale e alterata funzione cardiaca.

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El objetivo de este estudio fue evaluar si los par&aacute;metros de termodiluci&oacute;n derivada de la funci&oacute;n cardiaca ventricular derecho e izquierdo (fracci&oacute;n de eyecci&oacute;n del ventr&iacute;culo derecho, fracci&oacute;n de eyecci&oacute;n global, &iacute;ndice de la funci&oacute;n cardiaca) son capaces de seguir los cambios de la funci&oacute;n contr&aacute;ctil cardiaca y si est&aacute;n influenciados por la reducci&oacute;n sustancial de la precarga.

Derivados de termodiluci&oacute;n &iacute;ndices para la evaluaci&oacute;n de cardiaco ventricular izquierda y derecha funcionan en condiciones normales y alteraci&oacute;n de la funci&oacute;n cardiaca.

Severe acute pancreatitis (SAP) remains a life-threatening disease with classic etiology of systemic inflammatory response and mortality between 30 and 50 %. The aim of the present study is to compare two different treatment strategies of goal-directed hemodynamic management and evaluate their impact on survival, microcirculation, tissue oxygenation, and histopathologic damage in acute pancreatitis in a prospective animal study.

The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis.

The thermodilution curve assessed by transpulmonary thermodilution is the basis for calculation of global end-diastolic volume index (GEDI) and extravascular lung water index (EVLWI). Until now, it was unclear whether the method is affected by 1-lung ventilation. Therefore, aim of our study was to evaluate the impact of 1-lung ventilation on the thermodilution curve and assessment of GEDI and EVLWI.

An assessment of global end-diastolic volume and extravascular lung water index during one-lung ventilation: is transpulmonary thermodilution usable?

The aim of this study was to evaluate the ability of static, volumetric, and dynamic parameters of cardiac preload to predict volume responsiveness during one-lung ventilation (OLV).

Prediction of volume-responsiveness during one-lung ventilation: a comparison of static, volumetric, and dynamic parameters of cardiac preload.

In severe acute pancreatitis, the administration of fluids in the presence of positive fluid responsiveness is associated with better outcome when compared to guiding therapy on central venous pressure. We compared the effects of such consequent maximization of stroke volume index with a regime using individual values of stroke volume index assessed prior to severe acute pancreatitis induction as therapeutic hemodynamic goals.

Individualized early goal-directed therapy in systemic inflammation: is full utilization of preload reserve the optimal strategy?

Assessment of pulmonary edema is a key factor in monitoring and guidance of therapy in critically ill patients. To date, methods available at the bedside for estimating the physiologic correlate of pulmonary edema, extravascular lung water, often are unreliable or require invasive measurements. The aim of the present study was to develop a novel approach to reliably assess extravascular lung water by making use of the functional imaging capabilities of electrical impedance tomography.

Electrical impedance tomography (EIT) for quantification of pulmonary edema in acute lung injury.

In order to assess the occurrence of blood congestion in the liver during liver resection, we aimed to evaluate the influence of a positive-end-expiratory-pressure (PEEP) and positioning of patients on central venous pressure (CVP) and venous hepatic blood flow parameters. We further analyzed correlations between CVP and venous hepatic blood flow parameters.

The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection.

Functional imaging by thoracic electrical impedance tomography (EIT) is a non-invasive approach to continuously assess central stroke volume variation (SVV) for guiding fluid therapy. The early available data were from healthy lungs without injury-related changes in thoracic impedance as a potentially influencing factor. The aim of this study was to evaluate SVV measured by EIT (SVV) against SVV from pulse contour analysis (SVV) in an experimental animal model of acute lung injury at different lung volumes.

Electrical impedance tomography for non-invasive assessment of stroke volume variation in health and experimental lung injury.

Phenylephrine is an α1-adrenergic receptor agonist widely used to treat perioperative hypotension. Its other hemodynamic effects, in particular on preload and contractility, remain controversial. We, therefore, investigated the effect of continuously applied phenylephrine on central hemodynamics in eight mechanically ventilated domestic pigs. Mean arterial pressure (MAP) was increased in steps by 50%, and 100% using phenylephrine. Besides stroke volume (SV), cardiac output (CO), and MAP, mean systemic vascular resistance (SVR) and dynamic arterial elastance (Ea) were assessed for characterization of afterload. Changes in preload were assessed by central venous pressure (CVP), global end-diastolic volume (GEDV), mean systemic filling pressure analog (Pmsfa), pulse pressure variation (PPV), and stroke volume variation (SVV). Further, cardiac function index (CFI), global ejection fraction and dPmax were measured as markers of preload dependent contractility. MAP, SV, and CO significantly increased following both interventions, as did SVR. In contrast, Ea did not show significant changes. Although the volumetric preload variable GEDV increased after the first step of phenylephrine, this was not reflected by significant changes in CVP or Pmsfa. CFI and dPmax significantly increased after both steps. Phenylephrine does not only affect cardiac afterload, but also increases effective preload. In contrast to CVP and Pmsfa, this effect can be monitored by GEDV. Further, phenylephrine affects contractility.

Article	Year
Thermodilution-derived indices for assessment of left and right ventricular cardiac function in normal and impaired cardiac function. Critical care medicine\| PubMed ID: 21572331	2011
The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis. Intensive care medicine\| PubMed ID: 23287870	2013
An assessment of global end-diastolic volume and extravascular lung water index during one-lung ventilation: is transpulmonary thermodilution usable? Anesthesia and analgesia\| PubMed ID: 23592603	2013
Prediction of volume-responsiveness during one-lung ventilation: a comparison of static, volumetric, and dynamic parameters of cardiac preload. Journal of cardiothoracic and vascular anesthesia\| PubMed ID: 23972740	2013
Individualized early goal-directed therapy in systemic inflammation: is full utilization of preload reserve the optimal strategy? Critical care medicine\| PubMed ID: 25402295	2014
Electrical impedance tomography (EIT) for quantification of pulmonary edema in acute lung injury. Critical care (London, England)\| PubMed ID: 26796635	2016
The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection. Journal of clinical monitoring and computing\| PubMed ID: 28012012	2017
Electrical impedance tomography for non-invasive assessment of stroke volume variation in health and experimental lung injury. British journal of anaesthesia\| PubMed ID: 28039243	2017
Assessment of central hemodynamic effects of phenylephrine: an animal experiment. Journal of clinical monitoring and computing\| PubMed ID: 30264219	2019

Constantin J. C. Trepte

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