Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

BMC Cardiovascular Disorders

Vincent D'Orio²  Geoffrey Chase¹  Nathalie Janssen²  Thomas Desaive³  Bernard Lambermont⁴  Philippe Morimont⁴ 

[1] Mechanical Engineering Department, University of Canterbury, Christchurch, New Zealand;Emergency Department, University Hospital of Liège, Liège, Belgium;Faculty of Sciences, University of Liège, Liège, Belgium;Medical Intensive Care Unit, University Hospital of Liège, Liège, Belgium

关键词: Endotoxin-induced shock;    Preload responsiveness;    Septic cardiomyopathy;    Aortic pressure;    Left ventricular function;   

Others  :  1085263
DOI  :  10.1186/1471-2261-12-13

 received in 2011-09-01, accepted in 2012-03-01,  发布年份 2012

【 摘 要 】

Background

Peak first derivative of femoral artery pressure (arterial dP/dt_max) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dt_max is reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.

Methods

Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dt_max was compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.

Results

Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r = 0.51; p < 0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV) ≤ 11% (r = 0.77; p < 0.001).

Conclusion

While arterial dP/dt_max and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dt_max was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV ≤ 11%, was achieved.

【 授权许可】

   
2012 Morimont et al; licensee BioMed Central Ltd.

【 图 表 】

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