Dynamic Arterial Elastance Is Associated With the Vascular Waterfall in Patients Treated With Norepinephrine: An Observational Study

Abstract

Introduction: It has been suggested that dynamic arterial elastance (Eadyn) can predict decreases in arterial pressure in response to changing norepinephrine levels. The objective of this study was to determine whether Eadyn is correlated with determinants of the vascular waterfall [critical closing pressure (CCP) and systemic arterial resistance (SARi)] in patients treated with norepinephrine.Materials and Methods: Patients treated with norepinephrine for vasoplegia following cardiac surgery were studied. Vascular and flow parameters were recorded immediately before the norepinephrine infusion and then again once hemodynamic parameters had been stable for 15 min. The primary outcomes were Eadyn and its associations with CCP and SARi. The secondary outcomes were the associations between Eadyn and vascular/flow parameters.Results: At baseline, all patients were hypotensive with Eadyn of 0.93 [0.47;1.27]. Norepinephrine increased the arterial blood pressure, cardiac index, CCP, total peripheral resistance (TPRi), arterial elastance, and ventricular elastance and decreased Eadyn [0.40 (0.30;0.60)] and SARi. Eadyn was significantly associated with arterial compliance (CA), CCP, and TPRi (p < 0.05).Conclusion: In patients with vasoplegic syndrome, Eadyn was correlated with determinants of the vascular waterfall. Eadyn is an easy-to-read functional index of arterial load that can be used to assess the patient’s macro/microcirculatory status.Clinical Trial Registration:ClinicalTrials.gov #NCT03478709.

Esmolol response in septic shock patients in relation to vascular waterfall phenomenon measured by critical closure pressure and mean systemic filling pressure: a prospective observational study

“…Consequently, by explaining the pressure gradient between arteriolar closure pressure Pcc and the mean venous filling pressure Pmsf at the level of small veins, vascular waterfall phenomenon is an important discovery in the study of the microcirculation system, and with the further research of many scholars this phenomenon can be measured stably and reliably. In recent years, more and more studies have been conducted to explore and explain related circulation problems by measuring vascular waterfall, which is an important bridge between the study of macrocirculation and microcirculation [ 15 ]. Therefore, in this paper, the hemodynamic response to esmolol in septic shock patients was studied utilizing bedside measurement of Pcc and Pmsf.…”

Ventriculo-Arterial Coupling Is Associated With Oxygen Consumption and Tissue Perfusion in Acute Circulatory Failure

“…Algorithms using the monitoring dynamic arterial elastance were proposed in ICU and they demonstrated that early weaning of norepinephrine may be associated with better tissue perfusion (12,35). As the dynamic arterial elastance was shown to be correlated with V-A coupling and microcirculation (36,37), the connection with VO 2 in our study might contribute with a new puzzle piece. One advantage of V-A coupling is that it can be non-invasively measured at bedside.…”

Optimizing left ventricular-arterial coupling during the initial resuscitation in septic shock – a pilot prospective randomized study

“…Of note, compared with the usual care, the improvement of VAC in the VAC-optimized group was primarily caused by a decreased Ea value that resulted from a slightly lower infused dose of NE. It has been demonstrated that NE has extensive effects on the resistive (i.e., total peripheral resistance) and pulsatile component (i.e., arterial compliance) of arterial load and thus alters arterial elastance [18,28,29]. Therefore, increased arterial load by a high dose of NE could lead to ventricular-arterial uncoupling.…”