What question did this study set out to answer?

To determine whether arterial dP/dtmax reliably reflects left ventricular contractility across varying hemodynamic conditions during endotoxin-induced shock and catecholamine administration.

March 1, 2012BMC Cardiovascular DisordersOpen Access

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

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Why the study?

Does arterial dP/dtmax accurately reflect left ventricular contractility (Ees) during shock and catecholamine infusion in a pig model?

Key Points

To determine whether arterial dP/dtmax reliably reflects left ventricular contractility across varying hemodynamic conditions during endotoxin-induced shock and catecholamine administration.
Continuously measured ventricular pressure-volume loops via conductance catheters and invasive arterial blood pressure via fluid-filled catheters in 6 anesthetized, mechanically ventilated pigs.
Induced septic shock using endotoxin infusion followed by transient catecholamine administration, comparing arterial dP/dtmax against end-systolic elastance (Ees).
Across all hemodynamic states, arterial dP/dtmax and Ees exhibited a statistically significant correlation (r = 0.51; p < 0.001) but poor overall agreement.
Under conditions of adequate vascular filling defined by pulse pressure variation ≤ 11%, the relationship improved markedly, demonstrating high correlation (r = 0.77; p < 0.001) and good agreement.

Structured PICO

Does arterial dP/dtmax accurately reflect left ventricular contractility (Ees) during shock and catecholamine infusion in a pig model?

Population

6 healthy pure Pietran pigs of either sex weighing 16 to 28 kg, anaesthetized and mechanically ventilated.

Intervention

Endotoxin infusion to induce shock, followed by transient catecholamine (dobutamine and norepinephrine) administration.

Comparator

Basal conditions (before endotoxin infusion).

Outcome

Correlation and agreement between arterial dP/dtmax and end-systolic elastance (Ees) under various hemodynamic conditions and levels of vascular filling.surrogate

Arterial dP/dtmax accurately reflects left ventricular contractility during shock only when adequate vascular filling (PPV ≤11%) is achieved.

Limitations

Use of a fluid-filled catheter could be a source of discrepancy between arterial dP/dtmax and Ees.
Heart rate variability was not significant enough to analyze its influence on arterial dP/dtmax.

Discussion

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Implication

Arterial dP/dtmax reflects Ees in porcine shock only with adequate filling; leaves open its utility as a contractility surrogate pending human data.

Cite This Study

Morimont et al. (2012) studied this question.

synapsesocial.com/papers/6a19c637196cd56b09eab29c https://doi.org/10.1186/1471-2261-12-13

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Implication

Arterial dP/dtmax reflects Ees in porcine shock only with adequate filling; leaves open its utility as a contractility surrogate pending human data.

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider