Hemodynamic response and oxygen transport in pigs resuscitated with maleimide-polyethylene glycol-modified hemoglobin (MP4)

2004 ◽  
Vol 96 (5) ◽  
pp. 1843-1853 ◽  
Author(s):  
Dan Drobin ◽  
B. Thomas Kjellstrom ◽  
Elisabeth Malm ◽  
Ashok Malavalli ◽  
Jeff Lohman ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Polyethylene Glycol ◽  
Systemic Vascular Resistance ◽  
Blood Volume ◽  
Vascular Resistance ◽  
Hemodynamic Response ◽  
Ringer Solution ◽  
Blood Substitutes ◽  
Pulmonary Pressure ◽  
Low Concentrations

Cell-free Hb increases systemic and pulmonary pressure and resistance and reduces cardiac output and heart rate in animals and humans, effects that have limited their clinical development as “blood substitutes.” The primary aim of this study was to evaluate the hemodynamic response to infusion of several formulations of a new polyethylene glycol (PEG)-modified human Hb [maleimide PEG Hb (MalPEGHb)] in swine, an animal known to be sensitive to Hb-induced vasoconstriction. Anesthetized animals underwent controlled hemorrhage (50% of blood volume), followed by resuscitation (70% of shed volume) with 10% pentastarch (PS), 4% MalPEG-Hb in lactated Ringer (MP4), 4% MalPEG-Hb in pentastarch (HS4), 2% MalPEG-Hb in pentastarch (HS2), or 4% stroma-free Hb in lactated Ringer solution (SFH). Compared with baseline, restoration of blood volume after resuscitation was similar and not significantly different for the PS (103%), HS2 (99%), HS4 (106%), and MP4 (87%) animals but significantly less for the SFH animals (66%) ( P < 0.05). All solutions that contained MalPEG-Hb restored mean arterial and pulmonary pressure and cardiac output. Systemic vascular resistance was unchanged, and pulmonary arterial pressure and resistance were increased slightly. Both systemic and pulmonary vascular resistance increased significantly in animals that received SFH, despite less adequate blood volume restoration. Oxygen consumption was maintained in all animals that received MalPEG-Hb, but not PS. Base excess improved only with MalPEG-Hb and PS, but not SFH. Red blood cell O2 extraction was significantly increased in animals that received Hb, regardless of formulation. These data demonstrate resuscitation with MalPEG-human Hb without increasing systemic vascular resistance and support our previous observations in animals suggesting that the efficacy of low concentrations of PEG-Hb in the plasma results from reduced vasoconstriction.

Hemodynamic response patterns to acute behavioral stressors resemble those to cocaine

2001 ◽  
Vol 281 (6) ◽  
pp. R1778-R1786 ◽  
Author(s):  
Mark M. Knuepfer ◽  
Robert M. Purcell ◽  
Qi Gan ◽  
Khoi M. Le
Keyword(s):  
Cardiac Output ◽  
Cold Stress ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Cold Water ◽  
Hemodynamic Response ◽  
Suitable Model ◽  
Response Patterns ◽  
Water Exposure ◽  
Air Jet

Hemodynamic responses to cocaine vary greatly between animals, and the variability is related to the incidence of cocaine-induced cardiomyopathies and hypertension. The variability in cardiac output and systemic vascular resistance responses to cocaine in individuals is correlated with the responses to acute startle (air jet). This experiment was designed to determine whether responses to cocaine and to air jet are related to those evoked by a conditioned stimulus (tone preceding foot shock) and to an unconditioned stimulus (cold water). We verified the relationship in hemodynamic response patterns between cocaine and cold stress using selective receptor antagonists. Rats were instrumented with a pulsed Doppler flow probe on the ascending aorta for determination of cardiac output and with an arterial cannula for recording arterial pressure and heart rate. After recovery, some rats were tested multiple times with four different stimuli: air jet (6 trials), 15-s tone preceding 1-s foot shock (12 trials), cold water exposure (1 cm deep for 1 min, 4–12 trials), and cocaine (5 mg/kg iv, 4–6 trials) while hemodynamic parameters were recorded. Each stimulus was capable of eliciting a pressor response that was associated with variable changes in cardiac output. The cardiac output response to cocaine was correlated with the initial responses to each stressor in individual rats. Responses evoked by cold stress were most similar to those elicited by cocaine. Furthermore, nicardipine (25 μg/kg iv) or atropine methylbromide (0.5 mg/kg iv) pretreatment prevented the cardiac output differences to acute cold stress, as noted after cocaine administration. On the other hand, propranolol (1 mg/kg iv) exacerbated both the decrease in cardiac output and the stress-induced increase in systemic vascular resistance as previously reported with cocaine. Therefore, the initial response to cold water exposure is a reliable method of evoking characteristic hemodynamic response patterns that, as seen with cocaine, may provide a suitable model for identifying the causes for predilection to stress-induced cardiovascular disease.

Splanchnic and systemic haemodynamic response to volume changes in patients with cirrhosis and portal hypertension

1999 ◽  
Vol 96 (5) ◽  
pp. 475-481 ◽  
Author(s):  
Panagiotis VLAVIANOS ◽  
Padraik MAC MATHUNA ◽  
Roger WILLIAMS ◽  
David WESTABY
Keyword(s):  
Cardiac Output ◽  
Portal Hypertension ◽  
Systemic Vascular Resistance ◽  
Blood Volume ◽  
Vascular Resistance ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Haemodynamic Response ◽  
Volume Depletion ◽  
Compensated Cirrhosis

We investigated the haemodynamic response to volume depletion and subsequent repletion in patients with cirrhosis and portal hypertension. Twelve patients with compensated cirrhosis and portal hypertension were included in the study. The haemodynamic changes occurring after removal of approx. 15% of the blood volume, and subsequently after isovolume repletion with colloid, were assessed. Baseline haemodynamic measurements showed increased cardiac output and a systemic vascular resistance at the lower limit of normal. The hepatic venous pressure gradient (HVPG) was increased, at 18 mmHg. After depletion, arterial pressure, cardiac output and all right-heart-sided pressures decreased, and systemic vascular resistance increased. HVPG decreased to 16.0 mmHg. All the above changes were statistically significant. After blood volume restitution, the haemodynamic values returned to baseline. In particular, an increase in HVPG was shown in four out of the twelve patients (two with ascites and two without), which was small in three of them. However, HVPG remained the same as or lower than the baseline in the other eight patients. Patients with cirrhosis and portal hypertension exhibit an abnormal haemodynamic response to blood volume depletion. After volume repletion, no increase in the portal pressure was noted in this group of patients as a whole, although four out of the twelve patients did show an increase, possibly due to extensive collateral circulation.

Hemodynamic abnormalities in sodium monofluoroacetate intoxication

1999 ◽  
Vol 18 (6) ◽  
pp. 351-353 ◽  
Author(s):  
Chih-Hsien Chi ◽  
Tin-Kwang Lin ◽  
Kuan-Wen Chen
Keyword(s):  
Cardiac Output ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Clinical Case ◽  
Hemodynamic Response ◽  
Inotropic Support ◽  
First Report ◽  
Predictors Of Mortality ◽  
Survival Case

Hypotension is one of the most important predictors of mortality in sodium monofluoroacetate (SMFA) intoxication. This paper reports the hemodynamic response in one fatal and another survival case of SMFA intoxication. Despite correction of hypovolemia and with inotropic support, the patients remained in shock. Hemodynamic observations have provided evidence that shock after SMFA intoxication is due to diminished systemic vascular resistance and increased cardiac output. This is the first report in which such an invasive hemodynamic investigation has been recorded in a clinical case of SMFA intoxication.

Blood Volume and the Carotid Baroreceptor Reflex in Conscious Rabbits

1981 ◽  
Vol 61 (s7) ◽  
pp. 173s-175s ◽  
Author(s):  
J. Ludbrook ◽  
I. B. Faris ◽  
G. G. Jamieson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Systemic Vascular Resistance ◽  
Blood Volume ◽  
Vascular Resistance ◽  
Baroreceptor Reflex ◽  
Phase Lag ◽  
Carotid Baroreceptor ◽  
Conscious Rabbits

1. The effects of acute blood volume change in conscious rabbits on a.c. gain of the carotid baroreceptor reflex with respect to heart rate, blood pressure, cardiac output and systemic vascular resistance were studied. 2. With acute, isohaemic increase in blood volume by 20% and 40% the only consistent trend was a decrease in gain for systemic vascular resistance. 3. With acute reduction in blood volume there was a consistent tendency for gain for heart rate to fall. With 20% reduction in blood volume, gain for cardiac output fell but gain for systemic vascular resistance rose and its phase-lag became shorter, so that gain for blood pressure was unaltered. The enhanced gain for systemic vascular resistance was not sustained with 35% reduction in blood volume, so that gain for blood pressure fell. 4. Thus control of blood pressure by the carotid sinus reflex is remarkably unaffected by acute change in blood volume, and is impaired only when there is depression of gain for cardiac output without a concomitant rise in gain for systemic vascular resistance.

scholarly journals Hemodynamic abnormalities during muscle metaboreflex activation in patients with type 2 diabetes mellitus

2019 ◽  
Vol 126 (2) ◽  
pp. 444-453 ◽  
Author(s):  
Silvana Roberto ◽  
Raffaele Milia ◽  
Azzurra Doneddu ◽  
Virginia Pinna ◽  
Girolamo Palazzolo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiac Output ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Blood Pressure Response ◽  
Pressure Response

Metaboreflex is a reflex triggered during exercise or postexercise muscle ischemia (PEMI) by metaboreceptor stimulation. Typical features of metaboreflex are increased cardiac output (CO) and blood pressure. Patients suffering from metabolic syndrome display hemodynamic abnormalities, with an exaggerated systemic vascular resistance (SVR) and reduced CO response during PEMI-induced metaboreflex. Whether patients with type 2 diabetes mellitus (DM2) have similar hemodynamic abnormalities is unknown. Here we contrast the hemodynamic response to PEMI in 14 patients suffering from DM2 (age 62.7 ± 8.3 yr) and in 15 age-matched controls (CTLs). All participants underwent a control exercise recovery reference test and a PEMI test to obtain the metaboreflex response. Central hemodynamics were evaluated by unbiased operator-independent impedance cardiography. Although the blood pressure response to PEMI was not significantly different between the groups, we found that the SVR and CO responses were reversed in patients with DM2 as compared with the CTLs (SVR: 392.5 ± 549.6 and −14.8 ± 258.9 dyn·s−1·cm−5; CO: −0.25 ± 0.63 and 0.46 ± 0.50 l/m, respectively, in DM2 and in CTL groups, respectively; P < 0.05 for both). Of note, stroke volume (SV) increased during PEMI in the CTL group only. Failure to increase SV and CO was the consequence of reduced venous return, impaired cardiac performance, and augmented afterload in patients with DM2. We conclude that patients with DM2 have an exaggerated vasoconstriction in response to metaboreflex activation not accompanied by a concomitant increase in heart performance. Therefore, in these patients, blood pressure response to the metaboreflex relies more on SVR increases rather than on increases in SV and CO. NEW & NOTEWORTHY The main new finding of the present investigation is that subjects with type 2 diabetes mellitus have an exaggerated vasoconstriction in response to metaboreflex activation. In these patients, blood pressure response to the metaboreflex relies more on systemic vascular resistance than on cardiac output increments.

The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study

1994 ◽  
Vol 3 (5) ◽  
pp. 382-386 ◽  
Author(s):  
CL Ostrow ◽  
E Hupp ◽  
D Topjian
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Critically Ill ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Critically Ill Patients ◽  
Hemodynamic Parameters ◽  
Trendelenburg Position ◽  
Dependent Variables ◽  
Preliminary Study

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.

L-propionylcarnitine increases postischemic blood flow but does not affect recovery of energy charge

1991 ◽  
Vol 261 (1) ◽  
pp. H172-H180 ◽  
Author(s):  
L. M. Sassen ◽  
K. Bezstarosti ◽  
W. J. Van der Giessen ◽  
J. M. Lamers ◽  
P. D. Verdouw
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Output ◽  
Systemic Vascular Resistance ◽  
Arterial Blood Pressure ◽  
Vascular Resistance ◽  
Contractile Function ◽  
Energy Charge ◽  
Left Ventricular ◽  
Arterial Blood

Effects of pretreatment with L-propionylcarnitine (50 mg/kg, n = 9) or saline (n = 10) were studied in open-chest anesthetized pigs, in which ischemia was induced by decreasing left anterior descending coronary artery blood flow to 20% of baseline. After 60 min of ischemia, myocardium was reperfused for 2 h. In both groups, flow reduction abolished contractile function of the affected myocardium and caused similar decreases in ATP (by 55%) and energy charge [(ATP + 0.5ADP)/(ATP + ADP + AMP); decrease from 0.91 to 0.60], mean arterial blood pressure (by 10-24%), the maximum rate of rise in left ventricular pressure (by 26-32%), and cardiac output (by 20-30%). During reperfusion, “no-reflow” was attenuated by L-propionylcarnitine, because myocardial blood flow returned to 61 and 82% of baseline in the saline- and L-propionylcarnitine-treated animals, respectively. Cardiac output of the saline-treated animals further decreased (to 52% of baseline), and systemic vascular resistance increased from 46 +/- 3 to 61 +/- 9 mmHg.min.l-1, thereby maintaining arterial blood pressure. In L-propionylcarnitine-treated pigs, cardiac output remained at 75% of baseline, and systemic vascular resistance decreased from 42 +/- 3 to 38 +/- 4 mmHg.min.l-1. In both groups, energy charge but not the ATP level of the ischemic-reperfused myocardium tended to recover, whereas the creatine phosphate level showed significantly more recovery in saline-treated animals. We conclude that L-propionylcarnitine partially preserved vascular patency in ischemic-reperfused porcine myocardium but had no immediate effect on “myocardial stunning.” Potential markers for long-term recovery were not affected by L-propionylcarnitine.

scholarly journals Augmentation of Electrocardiographic QRS R-Amplitude Precedes Radiocontrast-Induced Hypotension during Mobile Computed Tomography Scanning

2019 ◽  
Vol 8 (4) ◽  
pp. 505
Author(s):  
Hye-Mee Kwon ◽  
Sung-Hoon Kim ◽  
Hee-Sun Park ◽  
Yong-Seok Park ◽  
Young-Jin Moon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Output ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Adverse Reactions ◽  
Artery Aneurysm ◽  
Ct Scanning ◽  
Hemodynamic Changes ◽  
Computed Tomography Scanning ◽  
Mobile Ct

Although intravenous administration of contrast media may trigger a variety of adverse reactions, sedated patients undergoing computed tomography (CT) scanning usually are not able to report their symptoms, which may delay detection of adverse reactions. Furthermore, changes in vital signs cannot be typically measured during mobile CT scanning, which worsens the situation. We aimed to characterize contrast-related hemodynamic changes that occur during mobile CT scanning and predict sudden hypotension based on subtle but robust changes in the electrocardiogram (ECG). We analyzed the digitized hemodynamic data of 20 consecutive patients who underwent clipping of a cerebral artery aneurysm and contrast-enhanced CT scanning following the surgical procedure. Hemodynamic variables, including ECG findings, invasive blood pressure (BP), pulse oximetry results, capnography findings, cardiac output, and systemic vascular resistance, were monitored simultaneously. We measured morphological changes in ECG-derived parameters, including the R–R interval, ST height, and QRS R-amplitude, on a beat-to-beat basis, and evaluated the correlation between those parameters and hemodynamic changes. After the radiocontrast injection, systolic BP decreased by a median 53 mmHg from baseline and spontaneously recovered after 63 ± 19 s. An increase in QRS R-amplitude (median 0.43 mV) occurred 25 ± 10 s before hypotension developed. The receiver operating characteristic curve showed that a 16% increase in QRS R-amplitude can predict a decrease in systolic BP of >25% (area under the curve 0.852). Increased cardiac output (median delta 2.7 L/min from baseline) and decreased systemic vascular resistance (median delta 857 dyn·s/cm5 from baseline) were also observed during hypotension. During mobile CT scanning, profound but transient hypotension can be observed, associated with decreased vascular resistance. Augmentation of QRS R-amplitude from an ECG represents a sensitive surrogate for onset of a hypotensive episode after contrast injection, thereby serving as a simple and continuous noninvasive hemodynamic monitoring tool.

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