Relationships of Intraosseous and Systemic Pressure Waveforms in a Swine Model
Relationships of Intraosseous and Systemic Pressure Waveforms in a Swine Model
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DOI：
10.1111/acem.12432
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发表时间：
2014-08-01
影响因子：
4.4
通讯作者：
Hanson, Chris E.
中科院分区：
文献类型：
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作者：
De Lorenzo, Robert A.;Ward, John A.;Hanson, Chris E.
背景 尽管一些人关注使用骨内 (IO) 导管来获取实验室样本，但对于获取其他形式的临床数据的潜力却知之甚少。 IO 压力 (IOP) 与全身血流动力学压力（例如平均动脉压 (MAP) 和中心静脉压 (CVP)）之间的关系尚未得到广泛研究。目的 目的是探讨通过 IO 导管和放置在动脉和中心静脉循环中的血管内导管测量的血流动力学参数（血压）之间的关系。方法 8头体重30～45kg的猪，采用短效镇静剂，用带套囊的气管插管插管，2%～3%异氟烷麻醉。将血管内导管放入股动脉或颈动脉以及股动脉或颈静脉中进行 MAP 和 CVP 测量。 IO导管，15mm用于胸骨，25mm用于长骨，经皮放置到近端胫骨、近端股骨、近端肱骨、右近端尺骨和/或胸骨中。记录正常血压、低血压和高血压期间的压力。结果 所有八只动物的基线全身压平均值（范围）如下：MAP=66.5（55.6 至 76.7）mmHg，胫骨 IOP=17.4（9.3 至 34.5）mmHg，股骨 IOP =18.4（3.3 至 33.1）mmHg，肱骨 IOP=15.7（2.8 至 28.9） mmHg，尺骨 IOP=16.0（7.9 至 25.6）mmHg，胸骨 IOP=5.7（-0.5 至 47.9）mmHg，CVP=2.7mmHg（-3.3 至 7.9）mmHg。股骨 IOP 和平均 MAP 之间存在最佳中值相关性 (r=0.65)。 IOP 和 MAP 之间的四个最高相关性与平均股骨 IOP 相关。只有 1 个 IO 位点的 CVP 相关系数超过 0.50。长骨往往与 MAP 相关性更好，胸骨往往与 CVP 相关性更好。在主动上升的压力阶段观察到非线性，这可以通过滞后模型来解释。结论 IOP 与 MAP 或 CVP 之间的关系因部位而异，MAP 和 CVP 往往分别由股骨和胸骨估计。与主动升高的压力的关系是非线性的，并且提出了滞后模型来解释相变。需要进一步的实验来完善 IOP 与 MAP 和 CVP 的关系，并评估这些测量提供临床相关信息的潜力。
Background Despite some focus on the use of intraosseous (IO) catheters to obtain laboratory samples, very little is known about the potential for obtaining other forms of clinical data. Largely unstudied is the relationship between IO pressures (IOPs) and systemic hemodynamic pressures such as mean arterial pressure (MAP) and central venous pressures (CVP). Objectives The objective was to explore the relationship between hemodynamic parameters (blood pressures) measured through an IO catheter and intravascular catheters placed in the arterial and central venous circulation. Methods Eight pigs (Sus scrofa) weighing 30 to 45kg were sedated with a short-acting agent, intubated with a cuffed endotracheal tube, and anesthetized with 2% to 3% isoflurane. Intravascular catheters were placed into the femoral or carotid artery and the femoral or jugular vein for MAP and CVP measurements. IO catheters, 15mm for the sternum and 25mm for the long bones, were placed percutaneously into the proximal tibia, proximal femur, proximal humerus, right proximal ulna, and/or sternum. Pressures were recorded during normotension, hypotension, and hypertension. Results Averaged across all eight animals, the means (ranges) for baseline systemic pressures were as follows: MAP=66.5 (55.6 to 76.7) mmHg, tibia IOP=17.4 (9.3 to 34.5) mmHg, femur IOP =18.4 (3.3 to 33.1) mmHg, humerus IOP=15.7 (2.8 to 28.9) mmHg, ulna IOP=16.0 (7.9 to 25.6) mmHg, sternum IOP=5.7 (-0.5 to 47.9) mmHg, and CVP=2.7mmHg (-3.3 to 7.9) mmHg. The best median correlation occurred between femur IOP and mean MAP (r=0.65). The four highest correlations between IOP and MAP were associated with mean femur IOP. Only one IO site had a correlation coefficient over 0.50 for CVP. The long bones tended to correlate better with the MAP and the sternum tended to correlate better with the CVP. Nonlinearity was observed in the actively rising pressure phases, which can be explained by a hysteresis model. Conclusions The relationship between IOP and MAP or CVP is variable by site, with the MAP and CVP tending to be estimated by the femur and sternum, respectively. The relationship to actively rising pressures is nonlinear and a hysteresis model is proposed to explain the phase change. Further experimentation is needed to refine the IOP relationship to the MAP and CVP and assess the potential of these measurements to provide clinically relevant information.