Dynamic filling index: a novel parameter to monitor circulatory filling during minimized extracorporeal bypass

Simons, Antoine P.; Reesink, Koen D.; Lancé, Marcus D.; Veen, Frederik H. van der; Jong, Dick S de; Weerwind, Patrick W.

doi:10.1016/j.ejcts.2009.03.045

Cited by 10 publications

(17 citation statements)

References 19 publications

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“…Therefore, changes in central venous pressure may in some cases not reflect true changes in cardiac preload. The DFI is a measure of on-pump venous volume [7], and changes in DFI during reduced unloading (i.e. reduced ELS flow) could be a more reliable measure than central venous pressure.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale

Simons

Lancé

Reesink

et al. 2010

J Cardiothorac Surg

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We describe a case of a patient assisted by extracorporeal life support, in which we obtained the dynamic filling index, a measure for venous volume during extracorporeal life support, and used this index to assess cardiac load-responsiveness during acute reloading. While reloading, the obtained findings on cardiac pump function by the dynamic filling index were supported by trans-esophageal echocardiography and standard pressure measurement. This suggests that the dynamic filling index can be used to assess cardiac load-responsiveness during extracorporeal life support.

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Section: Discussionmentioning

confidence: 99%

“…DFI measurement uses periodical, transient reductions (-100 rpm) of pump speed, each lasting approximately 10 seconds, superimposed on the steady state pump speed. The resultant changes in bypass flow are used to calculate the DFI as Δflow/Δspeed (Figure 3 in [7]). When venous volume increases the DFI increases, and vice versa.…”

Section: Introductionmentioning

confidence: 99%

Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale

Simons

Lancé

Reesink

et al. 2010

J Cardiothorac Surg

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“…After stabilization of bypass flow, manual pump control was switched to computer control and an initial DFI value was measured using three consecutive pump speed manipulations. 12 The DFI threshold was calculated as DFI threshold =½ * DFI initial , and entered into the program. An acute reduction in DV was induced by acute withdrawal of 0.5 litres of blood from the circulation (approximately 10-15% of the total blood volume) via the ELS, using the arterial line.…”

Section: Experimental Protocolmentioning

confidence: 99%

“…10 In a recent study, we demonstrated that small changes in DV, as reflected by the slope of the speed-flow curve (Figure 1 right) can be determined by measuring the dynamic filling index (DFI). 12 This index proved more sensitive to changes in DV than direct haemodynamic and pump-related parameters. Continuous monitoring of DV during ELS provides the possibility of running a reserve-driven control scheme, based on what flow the ELS circuit may deliver at a certain instant rather than what the circuit ideally should deliver (demand-driven).…”

Section: Introductionmentioning

confidence: 98%

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Reserve-driven flow control for extracorporeal life support: proof of principle

Simons

Reesink²,

Lancé³

et al. 2010

Perfusion

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Extracorporeal life support systems lack volume-buffering capacity. Therefore, any decrease in venous intravascular volume available for drainage may result in acutely reduced support flow. We recently developed a method to quantify drainable volume and now conceived a reserve-driven pump control strategy, which is different from existing pressure or flow servo control schemes. Here, we give an outline of the algorithm and present animal experimental data showing proof of principle. With an acute reduction in circulatory volume (10-15%), pump flow immediately dropped from 4.1 to 1.9 l/min. Our pump control algorithm was able to restore bypass flow to 3.2 l/min (about 80% of the original level) and, thereby, reduced the duration of the low-flow condition. This demonstrates that a reserve-driven pump control strategy, based on the continuous monitoring of drainable volume, may maintain extracorporeal circulatory support flow, despite serious changes in filling conditions.

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Effect of Parameter Variations on the Hemodynamic Response Under Rotary Blood Pump Assistance

et al. 2012

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Numerical models, able to simulate the response of the human cardiovascular system (CVS) in the presence of an implantable rotary blood pump (IRBP), have been widely used as a predictive tool to investigate the interaction between the CVS and the IRBP under various operating conditions. The present study investigates the effect of alterations in the model parameter values, that is, cardiac contractility, systemic vascular resistance, and total blood volume on the efficiency of rotary pump assistance, using an optimized dynamic heart-pump interaction model previously developed in our laboratory based on animal experimental measurements obtained from five canines. The effect of mean pump speed and the circulatory perturbations on left and right ventricular pressure volume loops, mean aortic pressure, mean cardiac output, pump assistance ratio, and pump flow pulsatility from both the greyhound experiments and model simulations are demonstrated. Furthermore, the applicability of some of the previously proposed control parameters, that is, pulsatility index (PI), gradient of PI with respect to pump speed, pump differential pressure, and aortic pressure are discussed based on our observations from experimental and simulation results. It was found that previously proposed control strategies were not able to perform well under highly varying circulatory conditions. Among these, control algorithms which rely on the left ventricular filling pressure appear to be the most robust as they emulate the Frank-Starling mechanism of the heart.

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Dynamic filling index: a novel parameter to monitor circulatory filling during minimized extracorporeal bypass

Cited by 10 publications

References 19 publications

Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale

Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale

Reserve-driven flow control for extracorporeal life support: proof of principle

Effect of Parameter Variations on the Hemodynamic Response Under Rotary Blood Pump Assistance

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