Why the study?
Dynamic arterial elastance has been proposed to assess functional arterial load, but its evolution during volume expansion and neosynephrine infusion in hypotensive, preload-responsive patients required evaluation.
Does baseline dynamic arterial elastance predict pressure response to volume expansion in mechanically ventilated patients in the operating room?
Does baseline dynamic arterial elastance predict pressure response to volume expansion in mechanically ventilated patients in the operating room?
Dynamic arterial elastance decreases following volume expansion and vasopressor infusion, and serves as a moderate predictor of arterial pressure response to volume expansion in mechanically ventilated patients.
Eadyn evolution during volume expansion and vasopressors warrants caution in preload-responsive patients; leaves open its utility for guiding therapy.
BACKGROUND: Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variations and stroke volume variations, has been proposed to assess functional arterial load. We evaluated the evolution of Eadyn during volume expansion and the effects of neosynephrine infusion in hypotensive and preload-responsive patients. METHODS: In this prospective bicentre study, we included 56 mechanically ventilated patients in the operating room. Each patient had volume expansion and neosynephrine infusion. Stroke volume and stroke volume variations were obtained using esophageal Doppler, and pulse pressure variations were measured through the arterial line. Pressure response to volume expansion was defined as an increase in mean arterial pressure (MAP) ≥ 10%. RESULTS: Twenty-one patients were pressure responders to volume expansion. Volume expansion induced a decrease in Eadyn (from 0.69 [0.58-0.85] to 0.59 [0.42-0.77]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after volume expansion were related to age, history of arterial hypertension, net arterial compliance and effective arterial elastance. Eadyn value before volume expansion > 0.65 predicted a MAP increase ≥ 10% with a sensitivity of 76% (95% CI 53-92%) and a specificity of 60% (95% CI 42-76%). Neosynephrine infusion induced a decrease in Eadyn (from 0.67 [0.48-0.80] to 0.54 [0.37-0.68]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after neosynephrine infusion were only related to heart rate. CONCLUSION: Eadyn is a potential sensitive marker of arterial tone changes following vasopressor infusion.
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Courson et al. (2019) studied this question.
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