Validity and success rate of noninvasive mean arterial blood pressure measurements in cf‐LVAD patients: A technical review

Lankheet, Steven; Pieterse, Martijn M.; Rijnhout, Robin; Tuerlings, Emma; Oppelaar, Anne-Marie; Laake, Linda W. van; Ramjankhan, Faiz; Westerhof, Berend E.; Oerlemans, M. I. F. J.

doi:10.1111/aor.14367

Cited by 5 publications

(9 citation statements)

References 31 publications

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“…Um estudo de coorte longitudinal prospectivo realizado por Li e colaboradores (2020) buscou avaliar em 589 pacientes com DAV a correlação entre a aferição da pressão arterial utilizando o doppler como método não invasivo, preciso e confiável onde foi visto que a PA medida pela técnica é uma aproximação altamente precisa da PAM do paciente, devendo assim ser utilizada como escolha para a aferição. Existem, com base na literatura, várias técnicas para a medição não invasiva da PAM nos portadores de DAV além do doppler como oximetria de pulso, braçadeira de volume do manguito do dedo ou desinflação lenta do manguito do braço, porém a mais utilizada é a aferição da PA utilizando o método doppler (Lankheet et al, 2022).…”

Section: Posicionamentounclassified

Determinação da pressão arterial em portadores de ventrículo artificial fluxo contínuo: Relato de prática

Santos

Silva²,

Viana³

et al. 2023

RSD

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O objetivo da pesquisa é relatar o procedimento de determinação da pressão arterial em pacientes portadores de ventrículo artificial de fluxo contínuo. Trata-se de um estudo descritivo, exploratório, do tipo relato de experiência. A prática profissional especializada e baseada em evidência permitiu observar que a utilização desse procedimento entre os pacientes portadores de ventrículo artificial de fluxo contínuo é passível de ser executada pela equipe de enfermagem, previamente treinada. O mecanismo da bomba de fluxo continua altera o mecanismo de verificação da pressão arterial, pois modifica a presença de pulsatilidade. A técnica mais recomendada para este perfil de pacientes, de forma não invasiva, é através da utilização de doppler vascular para verificação da pressão arterial média. Portanto, em ascensão nos últimos anos a utilização de ventrículo artificial é uma alternativa terapêutica utilizada em nosso meio e requer cuidados específicos, a medida da pressão é um deles e de grande importância. Este estudo permitiu elencar os cuidados e orientações aos profissionais e pacientes.

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Section: Posicionamentounclassified

Determinação da pressão arterial em portadores de ventrículo artificial fluxo contínuo: Relato de prática

Santos

Silva²,

Viana³

et al. 2023

RSD

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“…Its magnitude reflects the amount of assistance provided by the LVAD; when the left ventricle contracts, the PI increases the flow transiently in the LVAD. This value is key to interpreting Doppler blood pressures (DopBP), which will be discussed later in this chapter [16,19,25].…”

Section: External Components Of the Lvadmentioning

confidence: 99%

“…Blood pressure and mean arterial pressure (MAP) can be monitored by an arterial line or Doppler device [3,4,8,11,16,25]. Arterial lines are the gold standard for an LVAD patient undergoing general anesthesia [16,19] .The waveform will have a somewhat flat appearance related to low pulse pressure [3]. The use of Doppler devices for blood pressure monitoring are recommended for smaller cases that involve local anesthesia or IV sedation/MAC.…”

Section: Intraoperative Phasementioning

confidence: 99%

“…If the patient has a palpable pulse, the Doppler pressure is associated with systolic pressure. In the absence of a palpable pulse the noted Anesthesia for Non-cardiac Surgery for the LVAD Patient DOI: http://dx.doi.org/10.5772/intechopen.111491 pressure is associated with the mean arterial pressure [19,25]. The Doppler pressure has been shown to correlate with arterial lines 88% of the time [14].…”

Section: Intraoperative Phasementioning

confidence: 99%

“…The Doppler pressure has been shown to correlate with arterial lines 88% of the time [14]. MAPs should be kept around 70-80 mmHg to prevent pump malfunction while ensuring end organ perfusion [4,8,11,14,16,19,20,25,26,31]. Slow cuff method is another effective technique, but it is not widely available [16,19].…”

Section: Intraoperative Phasementioning

confidence: 99%

See 2 more Smart Citations

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Kathryn¹,

Silvonek²

2023

Updates in Anesthesia - The Operating Room and Beyond

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Heart failure is poorly tolerated and end stage heart failure (classified as New York Heart Association (NYHA) class IV) has a two-year survival with medical therapy that approaches 0%. Innovation in this sphere has yielded mechanical therapies, principally the left ventricular assist device (LVAD). In the last decade one-year survival rates of Left ventricular assist device patients have increased from 52–83%. As this therapy is more commonly used to treat advanced heart failure, coupled with the increase in patient survival after implantation, patients are increasingly encountered in the peri-operative arena requiring anesthesia for non-cardiac surgeries. The goal of this chapter is to provide the non-cardiac trained anesthesia provider a primer on what an LVAD is, how it functions, the physiological changes that occur with implantation, and considerations for administering anesthesia to patients with LVADs for non-cardiac surgery. Review of articles from 2018 to 2022 found from a search on PubMed and Google Scholar using the keywords: “Left Ventricular Assist Device”, “LVAD”, “anesthesia”, “non-cardiac surgery”, “Doppler blood pressure measurement”, “VAD coordinator”. Non-cardiac trained anesthesia providers can safely administer the anesthetics to LVAD patients undergoing non-cardiac surgery as long as appropriate considerations are taken.

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British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres

Akhtar,

Baston,

Berman

et al. 2024

Intensive Care Med

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An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-024-07382-y.

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Validity and success rate of noninvasive mean arterial blood pressure measurements in cf‐LVAD patients: A technical review

Cited by 5 publications

References 31 publications

Determinação da pressão arterial em portadores de ventrículo artificial fluxo contínuo: Relato de prática

Determinação da pressão arterial em portadores de ventrículo artificial fluxo contínuo: Relato de prática

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres

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