Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study

被引：14

作者：

Chalkias, Athanasios ^{[1
,2
,3
,12
]}

Laou, Eleni ^{[1
]}

Papagiannakis, Nikolaos ^{[4
]}

Varvarousi, Giolanda ^{[5
]}

Ragias, Dimitrios ^{[1
]}

Koutsovasilis, Anastasios ^{[6
]}

Makris, Demosthenes ^{[7
]}

Varvarousis, Dimitrios ^{[8
]}

Iacovidou, Nicoletta ^{[3
,9
]}

Pantazopoulos, Ioannis ^{[3
,10
]}

Xanthos, Theodoros ^{[3
,11
]}

机构：

[1] Univ Thessaly, Fac Med, Dept Anesthesiol, Larisa, Greece

[2] Outcomes Res Consortium, Cleveland, OH 44195 USA

[3] Hellen Soc Cardiopulm Resuscitat, Athens, Greece

[4] Natl & Kapodistrian Univ Athens, Eginit Univ Hosp, Med Sch, Dept Neurol 1, Athens, Greece

[5] Alexandra Hosp, Dept Anesthesiol, Div Obstet, Athens, Greece

[6] Nikaia Gen Hosp, Dept Internal Med 3, Piraeus, Greece

[7] Univ Thessaly, Fac Med, Dept Crit Care Med, Larisa, Greece

[8] Asklepeion Gen Hosp, Dept Cardiol, Athens, Greece

[9] Natl & Kapodistrian Univ Athens, Aretaieio Hosp, Med Sch, Neonatal Dept, Athens, Greece

[10] Univ Thessaly, Fac Med, Dept Emergency Med, Larisa, Greece

[11] European Univ Cyprus, Sch Med, Nicosia, Cyprus

[12] Univ Hosp Larisa, Dept Anesthesiol, Biopolis, Larisa 41110, Greece

来源：

INTENSIVE CARE MEDICINE EXPERIMENTAL | 2022年 / 10卷 / 01期

关键词：

Mean circulatory filling pressure; Venous return; Vascular capacitance hemodynamics; Shock; Resuscitation; Cardiac arrest; Hypoxemia; Hypercapnia; SYSTEMIC FILLING PRESSURE; RESUSCITATION COUNCIL GUIDELINES; CARDIAC-ARREST; VASCULAR CAPACITANCE; CARDIOPULMONARY ARREST; BLOOD-VOLUME; HYPERCAPNIA; HYPOXIA; CATECHOLAMINES; PROPOFOL;

D O I：

10.1186/s40635-022-00440-z

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Mean circulatory filling pressure (Pmcf) provides information on stressed volume and is crucial for maintaining venous return. This study investigated the Pmcf and other determinants of venous return in dysrhythmic and asphyxial circulatory shock and arrest. Methods: Twenty Landrace/Large-White piglets were allocated into two groups of 10 animals each. In the dysrhythmic group, ventricular fibrillation was induced with a 9 V cadmium battery, while in the asphyxia group, cardiac arrest was induced by stopping and disconnecting the ventilator and clamping the tracheal tube at the end of exhalation. Mean circulatory filling pressure was calculated using the equilibrium mean right atrial pressure at 5-7.5 s after the onset of cardiac arrest and then every 10 s until 1 min post-arrest. Successful resuscitation was defined as return of spontaneous circulation (ROSC) with a MAP of at least 60 mmHg for a minimum of 5 min. Results: After the onset of asphyxia, a Delta Pmca increase of 0.004 mmHg, 0.01 mmHg, and 1.26 mmHg was observed for each mmHg decrease in PaO2, each mmHg increase in PaCO2, and each unit decrease in pH, respectively. Mean Pmcf value in the ventricular fibrillation and asphyxia group was 14.81 +/- 0.5 mmHg and 16.04 +/- 0.6 mmHg (p < 0.001) and decreased by 0.031 mmHg and 0.013 mmHg (p < 0.001), respectively, for every additional second passing after the onset of cardiac arrest. With the exception of the 5-7.5 s time interval, post-cardiac arrest right atrial pressure was significantly higher in the asphyxia group. Mean circulatory filling pressure at 5 to 7.5 s after cardiac arrest predicted ROSC in both groups, with a cut-off value of 16 mmHg (AUC = 0.905, p < 0.001). Conclusion: Mean circulatory filling pressure was higher in hypoxic hypercapnic conditions and decreased at a lower rate after cardiac arrest compared to normoxemic and normocapnic state. A Pmcf cut-off point of 16 mmHg at 5-7.5 s after cardiac arrest can highly predict ROSC.

引用

页数：17

共 56 条

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