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

BMC Cardiovascular Disorders

Research Article

Vincent D'Orio¹  Nathalie Janssen¹  Thomas Desaive²  Geoffrey Chase³  Philippe Morimont⁴  Bernard Lambermont⁴ 

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

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

DOI  :  10.1186/1471-2261-12-13

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

来源: Springer

【 摘 要 】

BackgroundPeak first derivative of femoral artery pressure (arterial dP/dtmax) 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/dtmax is reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.MethodsVentricular 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/dtmax was compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.ResultsEndotoxin-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).ConclusionWhile arterial dP/dtmax and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dtmax was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV ≤ 11%, was achieved.

【 授权许可】

CC BY   
© Morimont et al; licensee BioMed Central Ltd. 2012