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

Abstract The purpose of this study was to determine whether dynamic elastance EAdyn 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 synd...

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Autores principales:	Maxime Nguyen, Osama Abou-Arab, Stéphane Bar, Hervé Dupont, Bélaïd Bouhemad, Pierre-Grégoire Guinot
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/da1d7c1c0fd4402dadf2e7987f381453
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spelling	oai:doaj.org-article:da1d7c1c0fd4402dadf2e7987f3814532021-12-02T14:06:11ZEchocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study10.1038/s41598-021-82408-92045-2322https://doaj.org/article/da1d7c1c0fd4402dadf2e7987f3814532021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-82408-9https://doaj.org/toc/2045-2322Abstract The purpose of this study was to determine whether dynamic elastance EAdyn 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. EAdyn 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%]. EAdyn was lower in pressure responders (0.40 [0.24–0.57] vs 0.95 [0.77–1.09], p < 0.01). EAdyn was able to discriminate between pressure responders and non-responders with an area under the curve of 0.86 (CI95% [0.71 to1.0], p < 0.05). The optimal cut-off was 0.8. EAdyn 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 EAdyn calculated from echocardiography and thermodilution was poor. Echocardiographic EAdyn might be used at bedside to optimize hemodynamic treatment.Maxime NguyenOsama Abou-ArabStéphane BarHervé DupontBélaïd BouhemadPierre-Grégoire GuinotNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maxime Nguyen Osama Abou-Arab Stéphane Bar Hervé Dupont Bélaïd Bouhemad Pierre-Grégoire Guinot Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study
description	Abstract The purpose of this study was to determine whether dynamic elastance EAdyn 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. EAdyn 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%]. EAdyn was lower in pressure responders (0.40 [0.24–0.57] vs 0.95 [0.77–1.09], p < 0.01). EAdyn was able to discriminate between pressure responders and non-responders with an area under the curve of 0.86 (CI95% [0.71 to1.0], p < 0.05). The optimal cut-off was 0.8. EAdyn 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 EAdyn calculated from echocardiography and thermodilution was poor. Echocardiographic EAdyn might be used at bedside to optimize hemodynamic treatment.
format	article
author	Maxime Nguyen Osama Abou-Arab Stéphane Bar Hervé Dupont Bélaïd Bouhemad Pierre-Grégoire Guinot
author_facet	Maxime Nguyen Osama Abou-Arab Stéphane Bar Hervé Dupont Bélaïd Bouhemad Pierre-Grégoire Guinot
author_sort	Maxime Nguyen
title	Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study
title_short	Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study
title_full	Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study
title_fullStr	Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study
title_full_unstemmed	Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study
title_sort	echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/da1d7c1c0fd4402dadf2e7987f381453
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Echocardiographic measure of dynamic arterial elastance predict pressure response during norepinephrine weaning: an observational study

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