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PubMed1994

Two-dimensional echocardiogram in hemodynamically stable victims of penetrating precordial trauma.

UNLABELLED: Hemodynamically stable patients with penetrating precordial trauma present a diagnostic dilemma. Previous reports utilizing subxiphoid pericardial windows as the diagnostic measure demonstrated negative rates ranging from 75-82%. In an effort to decrease the high rate of negative invasive procedures, the following study was undertaken. PROTOCOL: All hemodynamically stable victims with penetrating precordial trauma were evaluated using emergent echocardiogram over a one year period at Grady Memorial Hospital. If the echocardiogram was negative for the presence of pericardial fluid, the patient was observed for 24 hours. If pericardial fluid was detected, the patient underwent a subxiphoid pericardial window. Patients requiring immediate surgery for other reasons, i.e. peritonitis, underwent a pericardial window during the procedure without preoperative echocardiogram. RESULTS: Fifty-three patients were entered into the study. The injuries sustained included 40 stab wounds, 11 gunshot wounds and 2 shotgun injuries. Two echocardiograms (8%) demonstrated > 20cc of fluid and were followed by pericardial windows. The remaining 51 patients did well without the need for pericardial window. Nine additional hemodynamically stable patients underwent pericardial windows without preoperative echocardiograms. Only one of these was positive with a cardiac injury proven at sternotomy. CONCLUSION: Echocardiogram is a sensitive noninvasive method of evaluating hemodynamically stable victims of penetrating chest wounds in proximity to the heart.

Adolescent↗
PubMed1993

[Hemodynamic effects of low doses of chlorthalidone in patients with mild systemic arterial hypertension].

PURPOSE: To evaluate the hemodynamic effects of low doses of chlorthalidone (CHT) in patients with systemic arterial hypertension (SAH). METHODS: Eight patients with mild SAH, mean age of 52 +/- 8.9 years, 7 men, were studied. Clinical evaluation, systolic (SBP) and diastolic (DBP) blood pressure and heart rate (HR), in supine and standing positions, were obtained before and every two weeks, first two in placebo, during 12 weeks. Laboratory data, hemogram, sodium, potassium, urea, creatinine, glucose, hepatic aminotransferases and urinalysis, were done and at end of study. Hemodynamic monitorization was performed by Swan-Ganz catheter in pulmonary artery to obtain RAP and PAWP, in mmHg. Cardiac output (CO) was obtained by thermodilution method. Systemic vascular resistance (SVR) arose from variables above. Hemodynamic variables were measured at 2nd and 12th weeks during treatment with 50mg of chlorthalidone each 48 h. RESULTS: A significant reduction of SBP (p = 0.005 and p = 0.003), DBP (p < 0.0001 and p < 0.0001), respectively in supine and standing positions. HR did not show statistical difference. At hemodynamic monitoring was observed a significative reduction of SVR (p < 0.02), but not with CO. CONCLUSION: Chlorthalidone in low dosis was effective to treat mild SAH, basically by lowering SVR.

Adult↗
PubMed1993

Differential control by arterial and portal noradrenaline of hepatic carbohydrate metabolism: evidence for an indirect hemodynamic mechanism.

In an earlier study it was found (a) that arterial noradrenaline caused increases in glucose and lactate output slower in onset, smaller in peak height and clearly longer in duration than those caused by portal noradrenaline and (b) that arterial noradrenaline was extracted to a much greater extent than portal noradrenaline. It is possible that the differences in the actions of arterial and portal noradrenaline were due to the different hemodynamic changes; arterial noradrenaline reduced hepatic flow more strongly and with different kinetics than did portal noradrenaline. Therefore the effects of arterial and portal noradrenaline were investigated in isolated rat liver, single-pass perfused through both the hepatic artery (100 cm H2O, 30% flow) and the portal vein (15 cm H2O, 70% flow), after inhibition of the hemodynamic alterations by the Ca2+ antagonist nifedipine. We found (a) that nifedipine inhibited the hemodynamic changes by arterial noradrenaline strongly and those by portal noradrenaline slightly, (b) that the remaining hemodynamic alterations in the presence of high concentrations of the Ca2+ antagonist (100 mumol/L)--slight decrease in portal flow with unaffected arterial flow--were essentially identical after arterial and portal application of noradrenaline, (c) that the pronounced kinetic differences in the alterations by arterial and portal noradrenaline of glucose and lactate balance were diminished by 50 mumol/L nifedipine and abolished by 100 mumol/L of the Ca2+ antagonist and (d) that the different hepatic extractions of arterial and portal noradrenaline were greatly reduced and almost equalized by nifedipine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Influence of posture changes on hemodynamics under fentanyl-diazepam anesthesia--effects of nitrous oxide].

Patients for myocardial revascularization were divided into 50% oxygen-50% nitrogen group (group A) and 50% oxygen-50% nitrous oxide group (group B) according to the kind of gas administered after the induction of anesthesia. Anesthetic induction was carried out with fentanyl and diazepam in both groups. With sufficient hemodynamic stabilization following the induction of anesthesia, the hemodynamic parameters were measured in supine position for baseline data (BASELINE). The operating table was kept at Trendelenburg position (TREND), i.e., head down position, to measure hemodynamic parameters. Next, the operating table was kept at Fowler position (FOW), i.e., head up position, and hemodynamic parameters were measured. Heart rate was little influenced by posture change in both groups. While mean arterial pressure, mean pulmonary arterial pressure, central venous pressure and pulmonary capillary wedge pressure increased significantly in TREND in both groups, and decreased significantly in FOW. Cardiac index increased significantly in TREND in group A, but no such change occurred in group B. In FOW, cardiac index showed no significant change in group A, but decreased significantly in group B. Systemic vascular resistance was little influenced by posture change in both groups. This study suggests that it is necessary to exert a great caution in administering nitrous oxide when posture change is needed under fentanyl-diazepam anesthesia.

Anesthesia↗
PubMed1993

Mitral valve prolapse: left ventricular hemodynamics in patients with chest pain, dyspnea or both.

Patients with mitral valve prolapse may present with chest pain and dyspnea. Left ventricular hemodynamics as a cause for these symptoms have not been completely evaluated in these patients. The present study was undertaken to investigate left ventricular hemodynamics in symptomatic patients with mitral valve prolapse. One hundred and three patients with mitral valve prolapse (female 72, male 31, age 56 +/- 11 years) had diagnostic cardiac catheterization for evaluation of chest pain (n = 44), dyspnea (n = 10) and for chest pain plus dyspnea (n = 49). All patients had diagnostic auscultatory findings and angiographic documentation of mitral valve prolapse. Patients with coronary artery disease and mitral regurgitation greater than mild were excluded from the study. Left ventricular end diastolic pressures before (chest pain 9.3 +/- 3.7 mmHg; dyspnea 8.2 +/- 4.2 mmHg; chest pain plus dyspnea 9.3 +/- 4.1 mmHg) and after left ventriculography (chest pain 11.6 +/- 5.5 mmHg; dyspnea 10.2 +/- 2.3 mmHg; chest pain plus dyspnea 11.7 +/- 5.6 mmHg) were normal in the majority of patients and similar in all three groups. Likewise, the left ventricular end diastolic volume index (chest pain 72.0 +/- 16 cm3, dyspnea 69.1 +/- 20 cm3, chest pain plus dyspnea 70.0 +/- 16 cm3) and ejection fraction (chest pain 64.0 +/- 8.4%, dyspnea 64.1 +/- 6.1%, chest pain plus dyspnea 64.3 +/- 6.1%) were normal in the majority of patients and similar in the three groups. Symptomatic patients with mitral valve prolapse without significant mitral regurgitation had normal left ventricular hemodynamics, and their symptoms cannot be explained on the basis of hemodynamic abnormalities alone.

Adult↗
PubMed1993

[Surgical treatment for mitral valve defects with preponderance of mitral stenosis and high pulmonary vascular resistance. Clinical and hemodynamic observations 6 months after valve replacement].

10 patients with isolated or predominant mitral stenosis (mean mitral valve area 0.9 cm) and high preoperative values of pulmonary vascular resistance (mean 7.2 Wood units) were chosen for further hemodynamic postoperation evaluation. The patients had normal function of the aortic valve and no significant stenosis of coronary arteries. Hemodynamic evaluation was done by floating Swan-Ganz catheter preoperatively at rest and 6 months after mitral valve replacement at rest and during bicycle cycloergometer test in the supine position. Significant improvement in NYHA class was noted. Preoperatively 6 patients were in NYHA III class, 4 in NYHA IV class. After mitral valve replacement 4 patients were in class III and 6 in class II. Before mitral valve replacement only 3 patients were able to perform 25 Watt test. After surgery all except one performed at least 25 W. There was a significant decrease of pulmonary vascular resistance from 7.2 +/- 2.2 preoperatively to 3.1 +/- 1.9 Wood units at rest after the operation. Post operation during exercise pulmonary vascular resistance attained 4.2 +/- 1.9 Wood units. These changes were due to a fall in mean pulmonary artery pressure 49 +/- 13 at rest preoperatively to 25 +/- 6 mm Hg (rest) and 43 +/- 14 mm Hg (23 W) postoperatively and a rise in stroke volume index from 24 +/- 7 ml (m2) beat preoperatively to 32 +/- 9 at rest and 33 +/- 6 (25 W) postoperatively. Despite clinical and hemodynamic improvement there was no full recovery of pulmonary hemodynamics.

Adult↗
PubMed1993

[The hemodynamic and ventilatory effects between Trendelenburg and reverse Trendelenburg position during laparoscopy with CO2-insufflation].

Thirty ASA class I female patients underwent gynecologic pelvioscopy and laparoscopic cholecystectomy were included in this study. All of them received general anesthesia and certain volume of CO2 pneumoperitoneum. We evaluated the effect of positioning (Trendelenburg as group I and reverse Trendelenburg as group II) on hemodynamic parameters and ventilation. The hemodynamic parameters, ventilation, and arterial blood gas were determined at the following stages: (1) after 10 minutes of normoventilation and before CO2 pneumoperitoneum (as control), (2) 5 minutes after CO2 pneumoperitoneum and positioning, (3) 25 minutes after positioning, (4) 50 minutes after positioning, (5) 10 minutes after resumption of supine position and decompression of abdomen. Arterial blood pressure, heart rate, minute volume, end-tidal CO2, oxygen saturation and blood gas analysis were taken during normoventilation. We found that there was no statistical difference between either group in respect to hemodynamic parameters. For the ventilation, both groups had appropriate SpO2 during the period of CO2 pneumoperitoneum, but PaCO2 was significantly increased in group I 25 min after CO2 pneumoperitoneum and Trendelenburg positioning. Nonetheless, end-tidal CO2 was not significantly increased. pH value and PaCO2 did respectively decrease and increase significantly in group I 50 min after Trendelenburg position. However, no change was found in end-tidal CO2. All data were not significantly different after resumption of supine position and decompression of abdomen. Conclusively, except that pH and PaCO2 had changed after a period of Trendelenburg positioning with CO2 pneumoperitoneum, the patients who underwent laparoscopic surgery with normoventilation have no hemodynamic and respiratory change.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[A comparative evaluation of the hemodynamic effects of nitrosorbide, korinfar, obzidan and spesikor in blockade of the left branch of the bundle of His].

The paper deals with hemodynamic parameters in the greater and lesser circulations in patients with CHD concurrent with left bundle branch block. Based on the results of clinical and instrumental studies involving electrocardiography, phonocardiography and echocardiographic techniques, the authors provide early objective measures for diagnosing the hemodynamic changes occurred with development of left bundle branch block. The authors make a comparative assessment of hemodynamic effects produced by single administration of nitrosorbide, corinfar, obsidan, and spesicor in the patients examined. Nitrosorbide and corinfar improve left ventricular contractility, reduce the degree of pulmonary hypertension and right cardiac overload, while obsidan and spesicor aggravate the hemodynamic changes in patients who have CHD and left bundle branch block.

Adult↗
PubMed1993

[Hemodynamic changes in waking rats with acute streptozotocin diabetes after administration of the combined V2/V1 vasopressin antagonist].

The hemodynamic effect of combined V2/V1 arginine vasopressin (AVP) antagonist in conscious rats with acute 24 hour streptozotocin (STZ)--induced diabetes was studied using the microsphere technique. The rats were made diabetic with a single intravenous injection of STZ (60 mg/kg). One day after STZ administration the hemodynamic parameters in the experimental animals were measured before and 10 minutes after AVP antagonist injection (50 mg/kg, i.v.). The hemodynamic alterations observed post-antagonist included: 1) an increase in the total peripheral resistance (1.84 +/- 0.15 vs. 1.31 +/- 0.12 mm Hg/ml/min per 100 g before antagonist administration, p < 0.05), 2) a decrease in the cardiac index (49.0 +/- 3.1 vs. 68.7 +/- 5.2 ml/min/100 g before antagonist administration, p < 0.05) and stroke volume (0.40 +/- 0.03 vs. 0.57 +/- 0.06 ml before antagonist administration, p < 0.05), 3) a significant (p < 0.05) decrease in the blood flow to the skin, skeletal muscle, stomach, small intestine and kidneys. The mean arterial pressure and heart rate remained unchangeable post-antagonist. These data suggest that AVP is responsible, at least in part, for prominent hemodynamic alterations observed in conscious rats with 24 hour STZ-induced diabetes.

Acute Disease↗
PubMed1993

Systemic hemodynamics, renal function and hormonal levels during inhibition of neutral endopeptidase 3.4.24.11 and angiotensin-converting enzyme in conscious dogs with pacing-induced heart failure.

The systemic hemodynamic, renal and hormonal responses to SQ 28,603 (N-[2-(mercaptomethyl)-1-oxo-3-phenylpropyl]-beta-alanine) the selective inhibitor of neutral endopeptidase 3.4.24.11, the angiotensin-converting enzyme inhibitor captopril and their combination were determined in conscious dogs after 1 or 3 weeks of rapid ventricular pacing. Coadministration of captopril (100 or 10 mumol/kg i.v.) and SQ 28,603 (10 mumol/kg i.v.) significantly reduced mean arterial pressure, systemic vascular resistance and renal vascular resistance and increased cardiac output, stroke volume and renal blood flow in the conscious dogs paced for 1 week. This pattern of hemodynamic improvement was not predicted by the activity of the individual inhibitors. The combination of inhibitors did not significantly increase sodium excretion because of the variability introduced by the depressor activity; however, the pressure-natriuresis curve was steeper and shifted leftward, indicating that sodium excretion was maintained at lower renal perfusion pressures. The increases in urinary and plasma levels of cyclic GMP and atrial natriuretic peptide stimulated by SQ 28,603 were not affected by captopril. The data indicated that the hemodynamic and renal responses produced by SQ 28,603, presumably by elevating atrial natriuretic peptide levels, were enhanced by suppression of angiotensin II or that the combination of inhibitors protected other vasodilator/natriuretic peptides from degradation. Qualitatively similar responses to SQ 28,603, captopril and the combination of inhibitors were obtained in dogs paced for 3 weeks. In summary, the combined angiotensin-converting enzyme and neutral endopeptidase 3.4.24.11 inhibitors improved systemic hemodynamics and maintained renal function in conscious dogs with pacing-induced heart failure.

Alanine↗
PubMed1993

Echocardiographic vs hemodynamic monitoring during isometric exercise in patients with coronary artery disease.

BACKGROUND: Isometric exercise is able to induce myocardial asynergies in patients with coronary artery disease as demonstrated by noninvasive monitoring performed during stimulation. AIMS OF THE STUDY: In the present study, a combined echocardiographic and hemodynamic monitoring of left ventricular contractility has been conducted in order to verify, with invasive and noninvasive techniques, the ability of isometric exercise in inducing transient myocardial ischemic phenomena. METHODS: The study population was composed of 20 patients with angiographic evidence of significant coronary stenosis (> or = 50%), and 10 subjects with normal coronary angiograms. All 30 subjects admitted to the study underwent an isometric exercise stress during echocardiographic and hemodynamic monitoring of left ventricular contractility. RESULTS: Nine out of 20 patients with coronary disease showed regional asynergy during the test (Group I). The remaining 11 patients showed normal myocardial contractility (Group II). None of the 10 control subjects showed mechanical signs of ischemia during the test. Left ventricular end diastolic pressure significantly increased in both Group I (10 +/- 2 to 24 +/- 4 mmHg) and Group II (12 +/- 3 to 26 +/- 3 mmHg) (p < 0.01) while it remained unchanged in the control group (9 +/- 2 to 13 +/- 2 mmHg; p = NS); dp/dt increase (% basal) was significantly higher in the control group (45 +/- 6%) than in either Group I (25 +/- 3%) or Group II (26 +/- 3%) (p < 0.01). CONCLUSIONS: Isometric exercise was able to induce left ventricular asynergies due to regional myocardial ischemia. Hemodynamic contractility monitoring easily distinguished the control subjects from the patients with coronary disease but was not able to discriminate patients with handgrip-induced regional asynergy. Thus, the echocardiographic technique offers more detailed information about regional myocardial function than do the common hemodynamic contractility indexes.

Adult↗
PubMed1996

The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical status.

BACKGROUND: High pressure gradients occurring through normally functioning prosthetic valves appear to be related to a mismatch between the effective orifice area of the prosthesis and the patient's body surface area. OBJECTIVE: To determine whether prosthesis-patient mismatch affects clinical and hemodynamic status, a group of patients with a bioprosthetic heart valve in the aortic position was prospectively evaluated at 6.2+/-4.4 years after implantation by transthoracic Doppler echocardiography. METHODS: Manufacturer-derived in vitro valve areas were available in 61 patients allowing classification into two subgroups, with or without mismatch, based on a valve area at implantation indexed for body surface area 0.85 cm2/m2 or less, or greater than 0.85 cm2/m2. Clinical and hemodynamic parameters evaluated at follow-up included New York Heart Association (NYHA) class distribution, mean transprosthetic gradient, prosthetic valve area and cardiac index. RESULTS: Prosthesis-patient mismatch was present in 32 of 61 patients (52%). Although NYHA class of the patients was similar in both groups, hemo-dynamic performance of the aortic bioprostheses was worse in patients with mismatch than in patients with no mismatch, as indicated by a higher mean gradient (22+/-9 versus 15+/-8 mm Hg, P=0.002) and a lower cardiac index (3.0+/-0.7 versus 3.4+/-0.7 L/min/m2, P=0.04). The prevalence and severity of intrinsic prosthetic dysfunction were similar in both groups. Despite similar NYHA functional class distribution in both groups, the occurrence of syncope, acute pulmonary edema and angina pectoris was significantly higher in patients with mismatch (50% versus 21%, P=0.017). CONCLUSIONS: Prosthesis-patient mismatch is associated with worse hemodynamic performance and higher prevalence of adverse clinical events. However, mismatch did not promote accelerated hemodynamic or structural deterioration of the bioprosthesis.

Angina Pectoris↗
PubMed1995

Angiovideo-assisted hemodynamic correction of varicose veins.

OBJECTIVE: Evaluation of the feasibility and utility of angioscopy in the hemodynamic correction (French acronyms is CHIVA) of primary varicose veins disease. EXPERIMENTAL DESIGN: Prospective evaluation of 25 patients, undergoing hemodynamic correction of primary varicose disease with intraoperative videoangioscopic guide. Patients have been selected according to criteria emerged from a prospective study that we had previously conducted. Follow-up lasted 1 year (range 8-18 months). SETTING: Department of Surgery, University of Ferrara, Italy. Institutional practice. One-day surgery. PATIENTS: Their selection has been carried out in our Vascular Laboratory. The adopted clinical criteria of selection were: Primary varicose disease of the long saphenous vein territory, no previous thrombophlebitis and/or sclerotherapy. Doppler cw and Duplex criteria followed were: competent deep venous system, long saphenous vein diameter minor than 10 mm and incompetent perforating veins diameter minor than 4 mm. INTERVENTIONS: 25 hemodynamic corrections according to the CHIVA method described by Franceschi. An angioscope, introduced through a distal collateral of the long saphenous vein, permitted the precise interruption of the venous-venous shunts and of the superficial venous system, just below the perforators chosen as re-entry points in the deep venous system. MEASURES: Clinical: varices and symptomatology reduction. Duplex and Doppler cw: detection of the superficial blood flow re-entry, in the deep venous system, through the perforators and identification of recurrences or new refluxes. Pre and postoperative Ambulatory Venous Pressure and Refilling Time have also been measured. RESULTS: In 20 patients symptoms and varices relief were recorded (80%), in 5 patients varices reduction was observed only during walking (20%). In 2 of these latter patients there was no re-entry through the perforators, with a recurrent sapheno-femoral reflux in 1 of them. Early complications recorded were: 2 long saphenous vein thrombosis (8%); 7 ecchimosis (28%) when heparine/saline solution had been used for angioscopic clearance. CONCLUSIONS: Intraoperative angioscopy is feasible and useful when the hemodynamic situation is complex and the Duplex map is difficult to be interpreted by the surgeon. In this series the second look percentage rate has been minor compared to the percentage rates published so far by other authors.

Adolescent↗
PubMed1996

Urinary PCO2 for hemodynamically unstable patients.

BACKGROUND: Gastric intramural pH (pHi) derived from gastric PCO2 has been successfully used to assess splanchnic ischemia for patients with unstable hemodynamics, but with some limitations. Urinary bladder, also an easily accessible hollow viscus, should provide as a useful route for the same purpose. However, no study has used urinary PCO2 to evaluate the adequacy of perfusion in critically ill patients. METHODS: Fifty patients admitted to intensive care unit were included and divided into hemodynamically stable and unstable groups. Several parameters such as arterial pressure, dopamine dosage, heart rate, serum lactate, arterial blood gas, urinary PCO2, and concentrations of Na, K and Cl in urine were measured. Patients with some other renal or pre-renal conditions that might affect urinary PCO2 were excluded. RESULTS: Urinary PCO2 was markedly higher (78.6 +/- 9.9 vs. 43.1 +/- 1.7 mmHg, p < 0.0001) in unstable group. Serum anion gap level, dopamine dosage and heart rate were significantly higher and PaO2/FiO2 ratio as well as mean arterial pressure was lower in unstable group. Serum lactate, arterial pH and other parameters failed to distinguish between groups. Dopamine dosage significantly correlated with urinary PCO2 (r = 0.5357, p = 0.0149) in unstable group. CONCLUSIONS: With careful selection of patients, urinary PCO2 can effectively differentiate hemodynamically unstable patients from stable ones. It also correlates significantly with dopamine dosage in patients with unstable hemodynamics.

Aged↗
PubMed1977

Relationship of systemic and intrarenal hemodynamics in cirrhosis.

The relationship between systemic and renal hemodynamics was studied in 20 patients with advanced cirrhosis of the liver. Cardiac output was assessed by an indicator dilution technique, and both mean renal blood flow and intrarenal blood flow distribution were determined by the 133Xe washout method. Ten patients had elevated cardiac outputs (7.14 to 13.58 L/min; HCO group), seven patients had normal cardiac ouptputs (5.16 to 6.78; NCO group), and three had low cardiac outputs (3.65 to 4.1; LCO group). Renal hemodynamics did not correlate with cardiac output (r = 0.051; N.S.), since comparable reductions in mean renal blood flow occurred in both the LCO and HCO patients. Similarly, the degree of cortical ischemia, as assessed by percentage flow to the rapid flow component (C1%), did not correlate with cardiac output (r = 0.007; N.S.). Vasomotor instability as assessed by intrapatient variability of sequential xenon washout studies occurred frequently, and its magnitude did not correlate with cardiac output (r = -0.069; N.S.). These studies demonstrate that the abnormalities of intrarenal blood flow in cirrhosis are independent of alterations in cardiac output. Furthermore, the finding of marked intrarenal hemodynamic instability in the majority of patients with cirrhosis suggests that caution should be exercised in interpreting studies assessing the efficacy of vasoactive agents on renal hemodynamics in this disease, since the changes attributed to treatment may merely reflect spontaneous change.

Acute Kidney Injury↗
PubMed1996

Ultrafiltration after cardiopulmonary bypass in children: effects on hemodynamics, cytokines and complement.

OBJECTIVES: The purpose of the study was to evaluate the clinical and hemodynamic effect of intraoperative extracorporeal ultrafiltration (UF) and its potential in reducing the plasma concentration of circulating cytokines and complement activation products following open heart surgery in children. METHODS: Eighteen children with congenital heart disease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurements of circulating cytokines (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF), and its soluble receptor (sTNF receptor)), and complement factors (C3 activation products (C3a and C3bc) and terminal complement complex (TCC)) were obtained before, during and up to 48 h after cardiopulmonary bypass (CPB). A pulmonary artery thermodilution catheter was introduced preoperatively for hemodynamic monitoring. RESULTS: Postoperative hemodynamics were similar in both groups. Plasma levels of IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly perioperatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples in concentrations similar to the plasma levels. Complement activating products were not detected in the ultrafiltration samples except for small amounts of C3a in two cases. Compared to the control group the plasma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significantly after 15 min of UF but there was no significant difference between the two groups postoperatively. CONCLUSIONS: In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occasionally detected in the ultrafiltrate but we were unable to demonstrate reduction of these or any of the other markers tested in the group subjected to ultrafiltration.

Cardiopulmonary Bypass↗
PubMed1995

[Hemodynamic effects of milrinone on patients with chronic congestive heart failure: a multicenter study. Cooperative Group for Phase II Clinical Trial of Milrinone].

In this multicenter, randomized, double-blind, cross-over, placebo-controlled trial, hemodynamic effects of domestic milrinone were studied in 57 patients with functional class III or IV chronic congestive heart failure. The baseline values of hemodynamic parameters were measured with standard method through Swan-Ganz catheter. During intravenous infusion of milrinone or placebo, the changes of hemodynamic parameters were monitored throughout the procedure. Compared with the baseline values, cardiac index increased from 2.20 +/- 0.64 to 2.95 +/- 0.71L/min.m2 (P < 0.05) and pulmonary capillary wedge pressure fell from 22.7 +/- 7.64 to 15.56 +/- 8.13 mmHg (P < 0.05) during intravenous infusion of milrinone. The placebo had no effects on hemodynamics in this group of patients. Milrinone has both inotropic and vasodilative effects on patients with chronic congestive heart failure.

Adolescent↗
PubMed1996

Effect of backrest position on hemodynamic and right ventricular measurements in critically ill adults.

BACKGROUND: Hemodynamic measurements are often obtained with the patient in a flat, supine position. Reports suggest that these measurements can be reliably obtained at backrest elevations from 0 degree to 45 degrees. However, no study has been performed to evaluate the effects of position change on all the measurements that can be obtained via a pulmonary artery catheter. OBJECTIVE: To investigate the effects of backrest elevation of 0 degree, 30 degrees, and 45 degrees on measurements obtained via a pulmonary artery catheter. METHOD: Thirty-nine patients in an ICU at a university-based hospital, who required a pulmonary artery catheter, were studied. A single-group, repeated-measures design was used. Hemodynamic and volumetric measurements were obtained from all subjects. RESULTS: Repeated-measures analysis of variance revealed that differences in cardiac index were statistically significant, and differences in cardiac output approached statistical significance. However, examination of the means of these measurements indicates a clinically nonsignificant difference in these values. No statistically or clinically significant differences were found for the other hemodynamic or volumetric measurements studied related to the order of backrest elevation. CONCLUSION: Findings support the hypothesis that a patient need not be placed flat to obtain accurate hemodynamic and volumetric measurements. Results of this study are consistent with those of previous research and extend previous results to include the volumetric measurements of end-diastolic volume index and right ejection fraction. In addition, the use of mechanical ventilation and vasoactive drugs did not alter the accuracy of the measurements at backrest elevations from 0 degree to 45 degrees.

Adolescent↗