Bedside Assessment of the Microvascular Venous Compartment in Cardiac Surgery Patients With Valvular Diseases Undergoing Cardiopulmonary Bypass

Blasi, R. A. De; Romagnoli, Stefano; Rocco, Monica

doi:10.1053/j.jvca.2016.06.001

Cited by 4 publications

(11 citation statements)

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“…The answer is derived from the results of two studies in which the NIRS methodology was applied in critically ill patients and in those who had undergone cardiac surgery. 6,7 In these studies, the evaluation of changes in the venular compartment was crucial for understanding the effects of volume loading and extracorporeal pump on tissue perfusion. In addition, we collected unpublished data on patients with trauma or sepsis that highlighted the importance of in vivo monitoring of the venular compartment for comprehending the effects of treatments.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the volume values matched those previously reported. 7 ANOVA showed significant changes in msfp (p < 0.001) when comparing sets of measurements at rest and during exercise, showing a progressive increase in msfp from rest to 10% and 20% MVC. The changes in the shape of the P-V curve due to exercise resulted in no change in volume (p = 0.440).…”

Section: Measurements In Healthy Participantsmentioning

confidence: 94%

“…We applied it in two clinical conditions by obtaining data that conform to pathophysiology. 6,7 Unfortunately, this method of calculation has not yet been fully validated with a gold standard because the limitations of the previous methods do not allow us to consider any of those as a gold standard.…”

Section: Introductionmentioning

confidence: 99%

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Validation of the mean systemic filling pressure assessment with preserved arterial blood flow by comparing two methods of calculation

Blasi

Finazzi

2021

Preprint

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Significance: We developed a method for measuring in vivo venular volumes and pressures in the limbs using near-infrared spectroscopy (NIRS).Aim: 36 We aimed to validate the NIRS methodology by comparing two independent methods of calculation based on different physiological approaches.Approach: Pressure-volumes curves were recorded following graded venous occlusion on the forearm. Values from a multi-phase model (method 1) were compared with data derived from a resistor-capacitance calculation model (method 2) based on arterial pressure and venous compliance. We tested these methods on 10 healthy participants at rest and during exercise and on 6 severely ill patients.Results: Pressure-volume curves measured by method 1 were comparable with those calculated by method 2. Venular volumes calculated using method 1 correlated linearly with those calculated using method 2 both in participants (R2 = 0.98, p < 0.001) and in patients (R2 = 0.94, p < 0.001). The Bland-Altman test showed a good agreement between methods with few values out of the range of ± 1.96 SD.Conclusions: Our findings showed that the NIRS methodology may be valid for the assessment of venular bed with no flow interruption. Further research will be required to confirm the relevance of methodology in the clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Measurements In Healthy Participantsmentioning

confidence: 94%

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Validation of the mean systemic filling pressure assessment with preserved arterial blood flow by comparing two methods of calculation

Blasi

Finazzi

2021

Preprint

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“…Pacientes portadores de cardiopatia isquêmica apresentam uma alteração da regulação entre a oferta e a demanda de oxigênio, levando, entre outras complicações, à angina e, consequentemente, ao desuso da musculatura periférica, prejudicando sua perfusão e a sua capacidade ao exercício [15][16][17] . Portanto, acredita-se que o elevado estresse físico e inflamatório causado pela cirurgia cardíaca seja capaz de prejudicar ainda mais a perfusão capilar 13 .…”

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“…No pós-operatório, a fim de aumentar a concentração de oxigênio tecidual, uma das medidas adotadas é aumentar a sua oferta. Porém, esse quando dissolvido não é capaz de aumentar sua saturação, tendo como efeitos colaterais a vasoconstrição e o aumento do estresse oxidativo, podendo agravar a resposta inflamatória sistêmica e, consequentemente, aumentar a morbimortalidade 17,18 .…”

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Capacidade Funcional E Força Muscular Respiratória Como Preditores De Complicações Em Pacientes Submetidos À Revascularização Miocárdica

Lunardi¹,

Costa²

2020

Cad Edu Saude e Fis

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Com o avanço dos métodos terapêuticos, a cirurgia de revascularização do miocárdio (CRVM) vem sendo realizada cada vez mais tardiamente. Desse modo, faz-se necessária uma avaliação prévia mais específica em busca dos pacientes mais vulneráveis a complicações pós-operatórias (PO), para avaliar se o desempenho no teste de caminhada de 6 minutos (TC6) e a pressão inspiratória máxima (PImáx) são capazes de predizer a ocorrência das principais complicações em pacientes submetidos à CRVM. Foi feita a análise de prontuários eletrônicos de um hospital referência em cardiologia, no período de julho a setembro de 2018. A análise estatística foi realizada utilizando os softwares Statistica 10 e Statistical Package of Social Sciences (SPSS) 20.0. Nível de significância p<0,05. Foram avaliados 25 prontuários, a maioria do sexo masculino, com idade média de 61,64 anos ± 8,82. A distância média percorrida foi de 355,77 m ± 87,461 e a PImáx foi de -62 cmH2O ± 29,297. Cada participante teve, em média, pelo menos duas complicações no PO (1,92 ± 1,187), sendo a hipocalemia (p=0,016) e o deficit perfusional (p=0,03) as que apresentaram correlação com a distância percorrida. Com relação à força muscular respiratória, a amostra se correlacionou apenas com as complicações pulmonares (p=0,002). O baixo desempenho no TC6 parece estar relacionado com o desenvolvimento de hipocalemia e deficit perfusional. Pacientes com força muscular > -48cmH2O apresentam maior risco de desenvolvimento de complicações pulmonares. Ademais, quanto menor a PImáx, maior o número de complicações pulmonares.

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Validation of the mean systemic filling pressure assessment with preserved arterial blood flow by comparing two methods of calculation

Blasi

Finazzi

2021

Sci Rep

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We developed a method for measuring in vivo venular volumes and the mean systemic filling pressure in the limbs using near-infrared spectroscopy (NIRS). We aimed to validate the NIRS methodology by comparing two independent methods of calculation based on different physiological approaches. Pressure–volumes (P–V) curves were recorded following graded venous occlusion on the forearm. Values from a P–V curves analysis model (method 1) were compared with data derived from a resistor-capacitance calculation model (method 2) based on arterial pressure and venous compliance. We tested these methods on 10 healthy participants at rest and during exercise and on 6 severely ill patients. Results from method 1 were comparable with those calculated by method 2. Venular volumes calculated using method 1 correlated linearly with those calculated using method 2 both in participants (R2 = 0.98) and in patients (R2 = 0.94). A good agreement between methods was shown with few values out of the range of ± 1.96 standard deviation. Our findings added mathematical consistency for the NIRS methodology validation in the venular P–V assessment with no flow interruption. Further research will be required to confirm the relevance of the methodology in the clinical setting.

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Bedside Assessment of the Microvascular Venous Compartment in Cardiac Surgery Patients With Valvular Diseases Undergoing Cardiopulmonary Bypass

Abstract: Cardiac surgery patients have a limited blood volume reserve for venous return due to a reduced microvascular bed capacitance. This study demonstrated that during CPB a positive fluid balance induced an extravascular pressure increase and further reduced blood volume reserve.

Cited by 4 publications

References 50 publications

Validation of the mean systemic filling pressure assessment with preserved arterial blood flow by comparing two methods of calculation

Validation of the mean systemic filling pressure assessment with preserved arterial blood flow by comparing two methods of calculation

Capacidade Funcional E Força Muscular Respiratória Como Preditores De Complicações Em Pacientes Submetidos À Revascularização Miocárdica

Validation of the mean systemic filling pressure assessment with preserved arterial blood flow by comparing two methods of calculation

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