Hemodynamic Parameters in the Assessment of Fluid Status in a Porcine Hemorrhage and Resuscitation Model.
Hemodynamic Parameters in the Assessment of Fluid Status in a Porcine Hemorrhage and Resuscitation Model.
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DOI：
10.1097/aln.0000000000003724
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发表时间：
2021-04-01
期刊：
影响因子：
8.8
通讯作者：
Alvis BD
中科院分区：
文献类型：
--
作者：
Wise ES;Hocking KM;Polcz ME;Beilman GJ;Brophy CM;Sobey JH;Leisy PJ;Kiberenge RK;Alvis BD
测量术中出血期间的液体状态具有挑战性，但液体超负荷的检测和量化要困难得多。使用出血和过度复苏的猪模型，假设集中获得的血流动力学参数将比外周获得的生命体征更准确地预测容量状态。 8头麻醉母猪以30毫升/分钟的速度失血至400毫升。每100 mL出血后，获取生命体征（心率、收缩压[SBP]、平均动脉压[MAP]、舒张压[DBP]、脉压、脉压变化）和中心获得的血流动力学参数（平均肺动脉压[MPAP]、肺毛细血管楔压[PCWP]、中心静脉压[CVP]和心输出量[CO]）。血容量恢复，并用 2,500 mL 晶体对猪进行过度复苏，每次推注 500 mL 后收集参数。分别分析出血和复苏阶段以确定体积范围内参数之间的差异。评估出血或过度复苏期间参数的一致性。在出血过程中，失血 100 mL 后，观察到生命体征 SBP、DBP、MAP 相对于基线正常血容量的变化。中心血流动力学参数 MPAP 和 PCWP 在失血 200 mL 后发生变化，CVP 在失血 300 mL 后发生变化。在复苏容量超负荷过程中，观察到 500 mL 复苏后 MPAP 和 CVP、1,000 mL 复苏后 PCWP 和 2,500 mL 复苏后 CO 相对于基线正常血容量的变化。与出血相比，过度复苏期间生命体征参数没有变化。在出血 (r2=0.99) 和容量超负荷 (r2=0.98) 方面观察到与 PCWP 最强的线性相关性。肺毛细血管楔压是追踪出血和过度复苏的最准确参数，表明对微创 PCWP 等效物的临床需求尚未得到满足。
Measuring fluid status during intraoperative hemorrhage is challenging, but detection and quantification of fluid overload is far more difficult. Using a porcine model of hemorrhage and over-resuscitation, it is hypothesized that centrally obtained hemodynamic parameters will predict volume status more accurately than peripherally obtained vital signs. Eight anesthetized female pigs were hemorrhaged at 30 mL/min to a blood loss of 400 mL. After each 100 mL of hemorrhage, vital signs (heart rate, systolic blood pressure [SBP], mean arterial pressure [MAP], diastolic blood pressure [DBP], pulse pressure, pulse pressure variation) and centrally obtained hemodynamic parameters (mean pulmonary artery pressure [MPAP], pulmonary capillary wedge pressure [PCWP], central venous pressure [CVP] and cardiac output [CO]) were obtained. Blood volume was restored, and the pigs were over-resuscitated with 2,500 mL of crystalloid, collecting parameters after each 500 mL bolus. Hemorrhage and resuscitation phases were analyzed separately to determine differences among parameters over the range of volume. Conformity of parameters during hemorrhage or over-resuscitation was assessed. Over the course of hemorrhage, changes from baseline euvolemia were observed in vital signs SBP, DBP, MAP after 100 mL of blood loss. Central hemodynamic parameters MPAP and PCWP were changed after 200 mL blood loss, and CVP, after 300 mL of blood loss. Over the course of resuscitative volume overload, changes were observed from baseline euvolemia in MPAP and CVP after 500 mL resuscitation, in PCWP after 1,000 mL resuscitation and CO after 2,500 mL resuscitation. In contrast to hemorrhage, vital sign parameters did not change during over-resuscitation. The strongest linear correlation was observed with PCWP in both hemorrhage (r2=0.99) and volume overload (r2=0.98). Pulmonary capillary wedge pressure is the most accurate parameter to track both hemorrhage and over-resuscitation, demonstrating the unmet clinical need for a less-invasive PCWP equivalent.