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Peripheral vascular decoupling in porcine endotoxic shock

Hatib, F and Jansen, JRC and Pinsky, MR (2011) Peripheral vascular decoupling in porcine endotoxic shock. Journal of Applied Physiology, 111 (3). 853 - 860. ISSN 8750-7587

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Abstract

Cardiac output measurement from arterial pressure waveforms presumes a defined relationship between the arterial pulse pressure (PP), vascular compliance (C), and resistance (R). Cardiac output estimates degrade if these assumptions are incorrect. We hypothesized that sepsis would differentially alter central and peripheral vasomotor tone, decoupling the usual pressure wave propagation from central to peripheral sites. We assessed arterial input impedance (Z), C, and R from central and peripheral arterial pressures, and aortic blood flow in an anesthetized porcine model (n = 19) of fluid resuscitated endotoxic shock induced by endotoxin infusion (7 μg·kg ·h increased to 14 and 20 μg·kg ·h every 10 min and stopped when mean arterial pressure <40 mmHg or Sv < 45%). Aortic, femoral, and radial artery pressures and aortic and radial artery flows were measured. Z was calculated by FFT of flow and pressure data. R and C were derived using a two-element Windkessel model. Arterial PP increased from aortic to femoral and radial sites. During stable endotoxemia with fluid resuscitation, aortic and radial blood flows returned to or exceeded baseline while mean arterial pressure remained similarly decreased at all three sites. However, aortic PP exceeded both femoral and radial arterial PP. Although Z, R, and C derived from aortic and radial pressure and aortic flow were similar during baseline, Z increases and C decreases when derived from aortic pressure whereas Z decreases and C increases when derived from radial pressure, while R decreased similarly with both pressure signals. This central-to-peripheral vascular tone decoupling, as quantified by the difference in calculated Z and C from aortic and radial artery pressure, may explain the decreasing precision of peripheral arterial pressure profile algorithms in assessing cardiac output in septic shock patients and suggests that different algorithms taking this vascular decoupling into account may be necessary to improve their precision in this patient population. © 2011 the American Physiological Society. -1 -1 -1 -1 O2


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Hatib, F
Jansen, JRC
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 September 2011
Date Type: Publication
Journal or Publication Title: Journal of Applied Physiology
Volume: 111
Number: 3
Page Range: 853 - 860
DOI or Unique Handle: 10.1152/japplphysiol.00066.2011
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 8750-7587
PubMed Central ID: 3174791
PubMed ID: 21700890
Date Deposited: 07 Mar 2012 20:59
Last Modified: 30 Mar 2021 14:56
URI: http://d-scholarship.pitt.edu/id/eprint/11372

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