Use of perfusion index to detect hemodynamic changes in endotoxemic pigs

Endo, Yusuke; Miyasho, Taku; Imahase, Hisashi; Kawamura, Yoshio; Sakamoto, Yuichiro; Yamashita, Kazuto

doi:10.1111/vec.12985

Cited by 4 publications

(2 citation statements)

References 42 publications

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“…Endo and colleagues infused LPS at a constant rate of 80 µg/kg/hour. While direct PAC data were not available, interestingly, changes were not observed in HR, MAP, or CVP relative to their baseline values, or a control cohort, during the course of the experiment, while SVR (using PiCCO to estimate CO) only declined after 60 minutes, with normalization by 90 minutes [ 7 ]. As these authors point out, a dynamic change in LPS infusion rate is necessary to model sepsis in these pigs, as was intentionally done in this experiment [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Fluid Pre-loading on Vital Signs and Hemodynamic Parameters in a Porcine Model of Lipopolysaccharide-Induced Endotoxemia

Bergman¹,

Kiberenge²,

Bianco³

et al. 2023

Cureus

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BackgroundAnimal models of distributive hypotension and resuscitation allow the assessment of hemodynamic monitoring modalities and resuscitation strategies. The fluid-first paradigm for resuscitation is currently being challenged with clinical trials. In this investigation, venous return and perfusion are assessed, and full hemodynamics are characterized, in a porcine model of endotoxemic hypotension with and without fluid pre-loading. MethodsTwo groups of six pigs had the induction of standardized endotoxemic hypotension ("critical hypotension"). Group 1 underwent four 10 cc/kg crystalloid boluses, and Group 2 was not fluid pre-resuscitated. Both groups underwent progressive norepinephrine (NE) up-titration to 0.25 mcg/kg/minute over 30 minutes. Vital signs, central parameters, and laboratory values were obtained at baseline, "critical hypotension," after each bolus and during NE administration. ResultsEndotoxemia decreased the systemic vascular resistance (SVR) in Group 1 (1031±106 dyn/s/cm -5 versus 738±258 dyn/s/cm -5 ; P=0.03) and Group 2 (1121±196 dyn/s/cm -5 versus 759±342 dyn/s/cm -5 ; P=0.003). In Group 1, the four fluid boluses decreased heart rate (HR), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) (P<0.05). No changes were observed in blood pressure, cardiac output (CO), or lactate. NE up-titration increased HR in Group 1 and decreased CVP in both groups. Higher final CVP (11 {3} versus 4 {4} mmHg; P=0.01) and PCWP (5 {1} versus 2 {2} mmHg; P=0.005) values were observed in Group 1 relative to Group 2, reflecting increased venous return. ConclusionsPorcine endotoxemic hypotension and resuscitation were robustly characterized. In this model, fluid loading improved venous return with NE, though perfusion (CO) was preserved by increased NE-induced chronotropy.

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Section: Discussionmentioning

confidence: 99%

“…While distinct from bacterial sepsis, endotoxemia due to bloodstream seeding with lipopolysaccharides (LPS) similarly produces low-SVR hypotension [ 6 , 7 ]. Models of endotoxemic shock have successfully been used to mimic the hemodynamic perturbations seen in septic shock [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Fluid Pre-loading on Vital Signs and Hemodynamic Parameters in a Porcine Model of Lipopolysaccharide-Induced Endotoxemia

Bergman¹,

Kiberenge²,

Bianco³

et al. 2023

Cureus

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Exploring oxygen reserve index for timely detection of deoxygenation in canine patients recovering from anesthesia

Zanusso,

De Benedictis,

Bellini

2024

Research in Veterinary Science

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Central Venous Waveform Analysis and Cardiac Output in a Porcine Model of Endotoxemic Hypotension and Resuscitation

Bergman

Kiberenge

Mohammed

et al. 2022

Journal of the American College of Surgeons

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BACKGROUND: Cardiac output (CO) is a valuable proxy for perfusion, and governs volume responsiveness during resuscitation from distributive shock. The underappreciated venous system has nuanced physiology that confers valuable hemodynamic information. In this investigation, deconvolution of the central venous waveform by the fast Fourier transformation (FFT) algorithm is performed to assess its ability to constitute a CO surrogate in a porcine model of endotoxemia-induced distributive hypotension and resuscitation. STUDY DESIGN: Ten pigs were anesthetized, catheterized, and intubated. A lipopolysaccharides infusion protocol was used to precipitate low systemic vascular resistance hypotension. Four crystalloid boluses (10 cc/kg) were then given in succession, after which heart rate, mean arterial pressure, thermodilution-derived CO, central venous pressure (CVP), and the central venous waveform were collected, the last undergoing fast Fourier transformation analysis. The amplitude of the fundamental frequency of the central venous waveform’s cardiac wave (f0-CVP) was obtained. Heart rate, mean arterial pressure, CVP, f0-CVP, and CO were plotted over the course of the boluses to determine whether f0-CVP tracked with CO better than the vital signs, or than CVP itself. RESULTS: Distributive hypotension to a 25% mean arterial pressure decrement was achieved, with decreased systemic vascular resistance (mean 918 ± 227 [SD] dyne/s/cm-5 vs 685 ± 180 dyne/s/cm-5; p = 0.038). Full hemodynamic parameters characterizing this model were reported. Slopes of linear regression lines of heart rate, mean arterial pressure, CVP, f0-CVP, and CO were –2.8, 1.7, 1.8, 0.40, and 0.35, respectively, demonstrating that f0-CVP values closely track with CO over the 4-bolus range. CONCLUSIONS: Fast Fourier transformation analysis of the central venous waveform may allow real-time assessment of CO during resuscitation from distributive hypotension, possibly offering a venous-based approach to clinical estimation of volume responsiveness.

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Use of perfusion index to detect hemodynamic changes in endotoxemic pigs

Cited by 4 publications

References 42 publications

The Effect of Fluid Pre-loading on Vital Signs and Hemodynamic Parameters in a Porcine Model of Lipopolysaccharide-Induced Endotoxemia

The Effect of Fluid Pre-loading on Vital Signs and Hemodynamic Parameters in a Porcine Model of Lipopolysaccharide-Induced Endotoxemia

Exploring oxygen reserve index for timely detection of deoxygenation in canine patients recovering from anesthesia

Central Venous Waveform Analysis and Cardiac Output in a Porcine Model of Endotoxemic Hypotension and Resuscitation

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