Torres LL, Poblano MM, Tendillo CF, Mondragón LT, Magdaleno LG, Mendoza EJ

Language: Spanish
References: 9
Page: 216-225
PDF size: 175.67 Kb.

ABSTRACT

Introduction: Hemodynamic monitoring is essential in the critical patient; the evaluation of ventricular function is important and is commonly assessed by echocardiography. The pulse wave analysis systems can also monitor cardiac function in a continuous fashion with variables like the fraction of expulsion overall and dP/dt_máx. The dP/dt_máx is usually estimated over the first 20 ms of the intraventricular pressure upstroke. Whereas peripheral artery derived dP/dt_máx is actually measured after aortic valve opening, it occurs during the left ventricular ejection phase. The fraction of expulsion is a dependent variable preload. The intra-abdominal hypertension produced hemodynamic changes that can affect these hemodynamic variables.
Objectives: To analyze GEF and femoral dP/dt_máx variations in different levels of intra-abdominal hypertension in normovolemic porcine models.
Methods: We used three pigs, York-Landrace 50-50, weighing approximately 35 kg, an intraperitoneal catheter was placed and a progressive volume of saline 0.9% solution was infused to increase intra-abdominal pressure. The intra-abdominal hypertension baseline was 5 mmHg with increase by 5 mmHg every 10 minutes up to 30 mmHg.
Results: A total of 180 measurements were performed. We obtained measurements of hemodynamic variables of preload, global end diastolic volume, stroke volume variation and contractility, GEF and femoral dP/dt_máx, with the system PiCCO® (Pulsion Medical Systems AG, Munich, Germany). Statistical analysis was performed by ANOVA, considering significant p less than 0.05. We used the SPSS v.18.
Conclusions: In our animal model the progressive increase of the intra-abdominal hypertension induced changes in measurement the contractility variables. These variables are dependent of the preload state, so these results should be taken with caution, since changes may be secondary to changes induced directly as a result of increased intra-abdominal hypertension on preloading and not on contractility.

REFERENCES

1. Piacentini E, Ferrer PC. Hipertensión intraabdominal y síndrome compartimental abdominal. Enferm Infecc Microbiol Clin. 2010;28(Supl. 2):2-10.

2. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190-1206.

3. Lee Cm. Abdominal compartment syndrome. Curr Opin Crit Care. 2009;15:154-162.

4. Hall JE. Tratado de fisiología médica. 12 ed. ElSevier; 2011.

5. PiCCO Broshure (Pulsion Medical Sistem).

6. Aguilar FG, Belda J, Perel A. PiCCO plus: monitorización cardiopulmonar mínimamente invasiva. Rev Esp Anestesiol Reanim. 2008;55:90-100.

7. De Hert SG, Robert D, Cromheecke S, Michard F, Nijs J, Rodrigus IE. Evaluation of left ventricular function in anesthetized patients using femoral artery dP/dt(max). J Cardiothorac Vasc Anesth. 2006;20:325-30.

8. Scolletta S, Bodson L, Donadello K, Taccone FS, Devigili A, Vincent JL, De Backer D. Assessment of left ventricular function by pulse wave analysis in critically ill patients.Intensive Care Med. 2013;39:1025-33.

9. Morimont P, Lambermont B. Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved. BMC Cardiovascular Disorders. 2012;12:13.