Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study
Abstract Background The objectives of the present study was to evaluate the effect of fluid challenge (FC) on ventriculo-arterial (V-A) coupling, its determinants: arterial elastance and ventricular elastance, and ability to predict fluid responsiveness. Methods Thirty patients admitted to cardio-th...
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doaj-af8dd45e11c34dd59e0f19f169ca75772020-11-25T02:31:03ZengBMCBMC Anesthesiology1471-22532020-07-012011910.1186/s12871-020-01087-7Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational studyPierre Huette0Osama Abou-Arab1Dan Longrois2Pierre-Grégoire Guinot3Anaesthesiology and Critical Care Department, Amiens University HospitalAnaesthesiology and Critical Care Department, Amiens University HospitalAnaesthesiology and Critical Care Department, Bichat Claude Bernard Hospital and INSERM1148Anaesthesiology and Critical Care Department, Dijon University HospitalAbstract Background The objectives of the present study was to evaluate the effect of fluid challenge (FC) on ventriculo-arterial (V-A) coupling, its determinants: arterial elastance and ventricular elastance, and ability to predict fluid responsiveness. Methods Thirty patients admitted to cardio-thoracic ICU in whom the physician decided to perform FC were included. Arterial pressure, cardiac output, arterial elastance, and ventricular elastance, were measured before and after FC with 500 ml of lactated Ringer’s solution. Fluid responders were defined as patients with more than a 15% increase in stroke volume. V-A coupling was evaluated by the arterial elastance to ventricular elastance ratio. Results Twenty-three (77%) of the 30 patients included in the study were fluid responders. Before FC, responders had higher arterial elastance and arterial elastance to ventricular elastance ratio. FC significantly increased mean arterial pressure, stroke volume and cardiac output, and significantly decreased systemic vascular resistance, arterial elastance and consequently the arterial elastance to ventricular elastance ratio. Changes in arterial elastance were correlated with changes in stroke volume, systemic vascular resistance, and arterial compliance. Baseline arterial elastance to ventricular elastance ratio over 1.4 predicted fluid responsiveness (area under the curve [95% confidence interval]: 0.84 [0.66–1]; p < 0.0001). Conclusions Fluid responsiveness patients had V-A coupling characterized by increase arterial elastance to ventricular elastance ratio, in relation to an increase arterial elastance. Fc improved the V-A coupling ratio by decreasing arterial elastance without altering ventricular elastance. Arterial elastance changes were related to those of systemic vascular resistance (continue component) and of arterial compliance (pulsatile component).http://link.springer.com/article/10.1186/s12871-020-01087-7Ventricular-arterial couplingFluid therapyCardiac outputICU |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Pierre Huette Osama Abou-Arab Dan Longrois Pierre-Grégoire Guinot |
spellingShingle |
Pierre Huette Osama Abou-Arab Dan Longrois Pierre-Grégoire Guinot Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study BMC Anesthesiology Ventricular-arterial coupling Fluid therapy Cardiac output ICU |
author_facet |
Pierre Huette Osama Abou-Arab Dan Longrois Pierre-Grégoire Guinot |
author_sort |
Pierre Huette |
title |
Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study |
title_short |
Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study |
title_full |
Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study |
title_fullStr |
Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study |
title_full_unstemmed |
Fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study |
title_sort |
fluid expansion improve ventriculo-arterial coupling in preload-dependent patients: a prospective observational study |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2020-07-01 |
description |
Abstract Background The objectives of the present study was to evaluate the effect of fluid challenge (FC) on ventriculo-arterial (V-A) coupling, its determinants: arterial elastance and ventricular elastance, and ability to predict fluid responsiveness. Methods Thirty patients admitted to cardio-thoracic ICU in whom the physician decided to perform FC were included. Arterial pressure, cardiac output, arterial elastance, and ventricular elastance, were measured before and after FC with 500 ml of lactated Ringer’s solution. Fluid responders were defined as patients with more than a 15% increase in stroke volume. V-A coupling was evaluated by the arterial elastance to ventricular elastance ratio. Results Twenty-three (77%) of the 30 patients included in the study were fluid responders. Before FC, responders had higher arterial elastance and arterial elastance to ventricular elastance ratio. FC significantly increased mean arterial pressure, stroke volume and cardiac output, and significantly decreased systemic vascular resistance, arterial elastance and consequently the arterial elastance to ventricular elastance ratio. Changes in arterial elastance were correlated with changes in stroke volume, systemic vascular resistance, and arterial compliance. Baseline arterial elastance to ventricular elastance ratio over 1.4 predicted fluid responsiveness (area under the curve [95% confidence interval]: 0.84 [0.66–1]; p < 0.0001). Conclusions Fluid responsiveness patients had V-A coupling characterized by increase arterial elastance to ventricular elastance ratio, in relation to an increase arterial elastance. Fc improved the V-A coupling ratio by decreasing arterial elastance without altering ventricular elastance. Arterial elastance changes were related to those of systemic vascular resistance (continue component) and of arterial compliance (pulsatile component). |
topic |
Ventricular-arterial coupling Fluid therapy Cardiac output ICU |
url |
http://link.springer.com/article/10.1186/s12871-020-01087-7 |
work_keys_str_mv |
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