Acute and Critical Care

Original Article

CPR/Resuscitation
Measurement of mean systemic filling pressure after severe hemorrhagic shock in swine anesthetized with propofol-based total intravenous anesthesia: implications for vasopressor-free resuscitation: Athanasios Chalkias, Anastasios Koutsovasilis, Eleni Laou, Apostolos Papalois, Theodoros Xanthos; Acute Crit Care. 2020;35(2):93-101. Published online April 20, 2020; DOI: https://doi.org/10.4266/acc.2019.00773

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Background
Mean systemic filling pressure (Pmsf) is a quantitative measurement of a patient’s volume status and represents the tone of the venous reservoir. The aim of this study was to estimate Pmsf after severe hemorrhagic shock and cardiac arrest in swine anesthetized with propofol-based total intravenous anesthesia, as well as to evaluate Pmsf’s association with vasopressor-free resuscitation.
Methods
Ten healthy Landrace/Large-White piglets aged 10–12 weeks with average weight 20±1 kg were used in this study. The protocol was divided into four distinct phases: stabilization, hemorrhagic, cardiac arrest, and resuscitation phases. We measured Pmsf at 5–7.5 seconds after the onset of cardiac arrest and then every 10 seconds until 1 minute postcardiac arrest. During resuscitation, lactated Ringers was infused at a rate that aimed for a mean right atrial pressure of ≤4 mm Hg. No vasopressors were used.
Results
The mean volume of blood removed was 860±20 ml (blood loss, ~61%) and the bleeding time was 43.2±2 minutes while all animals developed pulseless electrical activity. Mean Pmsf was 4.09±1.22 mm Hg, and no significant differences in Pmsf were found until 1 minute postcardiac arrest (4.20±0.22 mm Hg at 5–7.5 seconds and 3.72±0.23 mm Hg at 55– 57.5 seconds; P=0.102). All animals achieved return of spontaneous circulation (ROSC), with mean time to ROSC being 6.1±1.7 minutes and mean administered volume being 394±20 ml.
Conclusions
For the first time, Pmsf was estimated after severe hemorrhagic shock. In this study, Pmsf remained stable during the first minute post-arrest. All animals achieved ROSC with goal-directed fluid resuscitation and no vasopressors.

Citations

Citations to this article as recorded by

COMPARISON BETWEEN ACTIVE ABDOMINAL COMPRESSION-DECOMPRESSION CARDIOPULMONARY RESUSCITATION AND STANDARD CARDIOPULMONARY RESUSCITATION IN ASPHYCTIC CARDIAC ARREST RATS WITH MULTIPLE RIB FRACTURES
Zhichu Dai, Sisen Zhang, Hongyu Wang, Liwei He, Jiankun Liao, Xuanyu Wu
Shock.2024; 61(2): 266. CrossRef
Effects of Vasopressin Receptor Agonists during the Resuscitation of Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Experimental and Clinical Studies
Eleni Laou, Nikolaos Papagiannakis, Androniki Papadopoulou, Theodora Choratta, Minas Sakellakis, Mariachiara Ippolito, Ioannis Pantazopoulos, Andrea Cortegiani, Athanasios Chalkias
Journal of Personalized Medicine.2023; 13(7): 1143. CrossRef
Hemodynamic Effects of Cardiovascular Medications in a Normovolemic and Hemorrhaged Yorkshire-cross Swine Model
Jacob H Cole, Scott B Hughey, Phillip G Geiger, Kamala J Rapp-Santos, Gregory J Booth
Comparative Medicine.2022; 72(1): 38. CrossRef
Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study
Athanasios Chalkias, Eleni Laou, Nikolaos Papagiannakis, Giolanda Varvarousi, Dimitrios Ragias, Anastasios Koutsovasilis, Demosthenes Makris, Dimitrios Varvarousis, Nicoletta Iacovidou, Ioannis Pantazopoulos, Theodoros Xanthos
Intensive Care Medicine Experimental.2022;[Epub] CrossRef
Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock
Athanasios Chalkias, Eleni Laou, Nikolaos Papagiannakis, Vaios Spyropoulos, Evaggelia Kouskouni, Kassiani Theodoraki, Theodoros Xanthos
Journal of Personalized Medicine.2022; 12(5): 724. CrossRef
A Critical Appraisal of the Effects of Anesthetics on Immune-system Modulation in Critically Ill Patients With COVID-19
Athanasios Chalkias, Erin F. Barreto, Eleni Laou, Konstantina Kolonia, Marc H. Scheetz, Konstantinos Gourgoulianis, Ioannis Pantazopoulos, Theodoros Xanthos
Clinical Therapeutics.2021; 43(3): e57. CrossRef
Resuscitative Effect of Centhaquine (Lyfaquin®) in Hypovolemic Shock Patients: A Randomized, Multicentric, Controlled Trial
Anil Gulati, Dinesh Jain, Nilesh Radheshyam Agrawal, Prashant Rahate, Rajat Choudhuri, Soumen Das, Deba Prasad Dhibar, Madhav Prabhu, Sameer Haveri, Rohit Agarwal, Manish S. Lavhale
Advances in Therapy.2021; 38(6): 3223. CrossRef
A Multicentric, Randomized, Controlled Phase III Study of Centhaquine (Lyfaquin®) as a Resuscitative Agent in Hypovolemic Shock Patients
Anil Gulati, Rajat Choudhuri, Ajay Gupta, Saurabh Singh, S. K. Noushad Ali, Gursaran Kaur Sidhu, Parvez David Haque, Prashant Rahate, Aditya R. Bothra, Gyan P. Singh, Sanjiv Maheshwari, Deepak Jeswani, Sameer Haveri, Apurva Agarwal, Nilesh Radheshyam Agra
Drugs.2021; 81(9): 1079. CrossRef

Review

Cardiology/Infection
How Do I Integrate Hemodynamic Variables When Managing Septic Shock?: Olfa Hamzaoui, Jean-Louis Teboul; Korean J Crit Care Med. 2016;31(4):265-275. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00927

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Abstract PDF

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.

Citations

Citations to this article as recorded by

Enhancement in Performance of Septic Shock Prediction Using National Early Warning Score, Initial Triage Information, and Machine Learning Analysis
Hyoungju Yun, Jeong Ho Park, Dong Hyun Choi, Sang Do Shin, Myoung-jin Jang, Hyoun-Joong Kong, Suk Wha Kim
The Journal of Emergency Medicine.2021; 61(1): 1. CrossRef

Original Articles

Comparison of Impedance Cardiography with Thermodilution of Hemodynamic Parameters in Critically Ill Patients: Hyung Goo Kang, Sang Won Chung, Ki Hyun Byun, In Byung Kim; Korean J Crit Care Med. 2006;21(2):77-82.

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Abstract PDF: BACKGROUND
To evaluate the feasibility of noninvasive hemodynamic monitoring (impedance cardiography, ICG) in critically ill patients, we compared this technique with simultaneous invasive monitoring with a pulmonary artery thermodilution catheter.
METHODS
A prospective observational study was done comparing invasive monitoring and noninvasive monitoring in 12 critically ill patients. The cardiac output (CO), the stroke volume (SV) and the systemic vascular resistance (SVR) measured by using a standard thermodilution pulmonary artery catheter technique were compared with the corresponding measurements simultaneously using an ICG.
RESULTS
The value of CO, SV and SVR measured by ICG were closely correlated to those by the thermodilution methods [r: 0.659 (p<0.01), 0.536 (p<0.01), 0.738 (p<0.01)].
CONCLUSIONS
ICG can provide hemodynamic information previously available only by invasive monitoring with a thermodilution catheter.

Hemodynamic Effect of Pulmonary Artery Ligation during Pneumonectomy: Kwang Ho Lee, Hyun Kyo Lim, Eun Sung Jun, Young Bok Lee, Kyung Bong Yoon, Jae Chan Choi, Soon Yul Kim, Ryung Choi; Korean J Crit Care Med. 2000;15(2):88-92.

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Abstract PDF: BACKGROUND
Pulmonary artery ligation during pneumonectomy increase the pulmonary blood flow of dependent lung and may increase the pulmonary arterial pressure and pulmonary vascular resistance. The purpose of this study is to evaluate the hemodynamic effect of pulmonary artery ligation during pneumonectomy.
METHODS
Nine patients who were supposed to receive pneumonectomy were studied. Hemodynamic measurements were performed following two lung ventilation (TLV), one lung ventilation (OLV), after pulmonary artery ligation and after pneumonectomy.
RESULTS
There is no significant differences in heart rate, systemic arterial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index and pulmonary vascular resistance index. Arterial oxygen tension significantly reduced during OLV and increased after pulmonary artery ligation and after pneumonectomy.
CONCLUSIONS
These results suggest that pulmonary artery ligation during pneumonectomy may not affect the cardiopulmonary hemodynamics.

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