Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study.

Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE

Original Publication: London : Nature Publishing Group, copyright 2011-

Echocardiography*; Arteries/*diagnostic imaging ; Monitoring, Physiologic/*methods ; Norepinephrine/*administration & dosage ; Shock/*drug therapy; Aged ; Arterial Pressure/drug effects ; Arteries/drug effects ; Blood Pressure/drug effects ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Elasticity/drug effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stroke Volume/drug effects

The purpose of this study was to determine whether dynamic elastance E Adyn derived from echocardiographic measurements of stroke volume variations can predict the success of a one-step decrease of norepinephrine dose. In this prospective single-center study, 39 patients with vasoplegic syndrome treated with norepinephrine and for whom the attending physician had decided to decrease norepinephrine dose and monitored by thermodilution were analyzed. E Adyn is the ratio of pulse pressure variation to stroke volume variation and was calculated from echocardiography stroke volume variations and from transpulmonary thermodilution. Pulse pressure variation was obtained from invasive arterial monitoring. Responders were defined by a decrease in mean arterial pressure (MAP) > 10% following norepinephrine decrease. The median decrease in norepinephrine was of 0.04 [0.03-0.05] µg kg ^-1  min ^-1 . Twelve patients (31%) were classified as pressure responders with a median decrease in MAP of 13% [12-15%]. E Adyn was lower in pressure responders (0.40 [0.24-0.57] vs 0.95 [0.77-1.09], p < 0.01). E Adyn was able to discriminate between pressure responders and non-responders with an area under the curve of 0.86 (CI 95% [0.71 to1.0], p < 0.05). The optimal cut-off was 0.8. E Adyn calculated from the echocardiographic estimation of the stroke volume variation and the invasive arterial pulse pressure variation can be used to discriminate pressure response to norepinephrine weaning. Agreement between E Adyn calculated from echocardiography and thermodilution was poor. Echocardiographic E Adyn might be used at bedside to optimize hemodynamic treatment.

Crit Care. 2015 Jan 19;19:14. (PMID: 25598221)
Br J Anaesth. 2014 Apr;112(4):660-4. (PMID: 24366723)
Intensive Care Med. 2017 May;43(5):643-651. (PMID: 28120005)
Front Physiol. 2020 Apr 06;11:284. (PMID: 32327999)
J Am Coll Cardiol. 2001 Dec;38(7):2028-34. (PMID: 11738311)
BMC Anesthesiol. 2020 Jul 17;20(1):171. (PMID: 32680470)
Intensive Care Med. 2015 Sep;41(9):1638-47. (PMID: 26160727)
Intensive Care Med. 2017 Mar;43(3):304-377. (PMID: 28101605)
Br J Anaesth. 2006 Nov;97(5):605-10. (PMID: 17012308)
Eur Heart J. 2015 May 21;36(20):1223-30. (PMID: 25732762)
Crit Care Med. 2018 Jan;46(1):e17-e25. (PMID: 29019850)
Chest. 2018 Jan;153(1):55-64. (PMID: 28866112)
Crit Care. 2011;15(1):R15. (PMID: 21226909)
J Clin Monit Comput. 2020 Oct;34(5):893-901. (PMID: 31599374)
Intensive Care Med. 2018 Jun;44(6):833-846. (PMID: 29868972)
Circ Res. 1985 Apr;56(4):586-95. (PMID: 3978773)
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1462-1468. (PMID: 32029030)
Intensive Care Med. 2017 May;43(5):633-642. (PMID: 28204860)
Br J Anaesth. 2013 Jan;110(1):28-33. (PMID: 22918700)
Intensive Care Med. 2018 Jan;44(1):12-21. (PMID: 29260272)
Br J Anaesth. 2018 Sep;121(3):534-540. (PMID: 30115250)

X4W3ENH1CV (Norepinephrine)

Date Created: 20210203 Date Completed: 20211112 Latest Revision: 20211112

20250114

PMC7854654

10.1038/s41598-021-82408-9

33531562