Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis
Background The same principle behind pulse wave analysis can be applied on the pulmonary artery (PA) pressure waveform to estimate right ventricle stroke volume (RVSV). However, the PA pressure waveform might be influenced by the direct transmission of the intrathoracic pressure changes throughout the respiratory cycle caused by mechanical ventilation (MV), potentially impacting the reliability of PA pulse wave analysis ($ PA_{PWA} $). We assessed a new method that minimizes the direct effect of the MV on continuous PA pressure measurements and enhances the reliability of $ PA_{PWA} $ in tracking beat-to-beat RVSV. Methods Continuous PA pressure and flow were simultaneously measured for 2–3 min in 5 pigs using a high-fidelity micro-tip catheter and a transonic flow sensor around the PA trunk, both pre and post an experimental ARDS model. RVSV was estimated by $ PA_{PWA} $ indexes such as pulse pressure ($ SV_{PP} $), systolic area ($ SV_{SystAUC} $) and standard deviation ($ SV_{SD} $) beat-to-beat from both corrected and non-corrected PA signals. The reference RVSV was derived from the PA flow signal (SVref). Results The reliability of $ PA_{PWA} $ in tracking RVSV on a beat-to-beat basis was enhanced after accounting for the direct impact of intrathoracic pressure changes induced by MV throughout the respiratory cycle. This was evidenced by an increase in the correlation between SVref and RVSV estimated by $ PA_{PWA} $ under healthy conditions: rho between SVref and non-corrected $ SV_{SD} $ – 0.111 (0.342), corrected $ SV_{SD} $ 0.876 (0.130), non-corrected $ SV_{SystAUC} $ 0.543 (0.141) and corrected $ SV_{SystAUC} $ 0.923 (0.050). Following ARDS, correlations were SVref and non-corrected $ SV_{SD} $ – 0.033 (0.262), corrected $ SV_{SD} $ 0.839 (0.077), non-corrected $ SV_{SystAUC} $ 0.483 (0.114) and corrected $ SV_{SystAUC} $ 0.928 (0.026). Correction also led to reduced limits of agreement between SVref and $ SV_{SD} $ and $ SVSyst_{AUC} $ in the two evaluated conditions. Conclusions In our experimental model, we confirmed that correcting for mechanical ventilation induced changes during the respiratory cycle improves the performance of $ PA_{PWA} $ for beat-to-beat estimation of RVSV compared to uncorrected measurements. This was demonstrated by a better correlation and agreement between the actual SV and the obtained from $ PA_{PWA.} $.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Intensive Care Medicine Experimental - 12(2024), 1 vom: 09. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Santos, Arnoldo [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| Themen: |
Fluid responsiveness |
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| Anmerkungen: |
© The Author(s) 2024 |
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| doi: |
10.1186/s40635-024-00618-7 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
SPR055473555 |
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| 100 | 1 | |a Santos, Arnoldo |e verfasserin |0 (orcid)0000-0003-4797-9677 |4 aut | |
| 245 | 1 | 0 | |a Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis |
| 264 | 1 | |c 2024 | |
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| 520 | |a Background The same principle behind pulse wave analysis can be applied on the pulmonary artery (PA) pressure waveform to estimate right ventricle stroke volume (RVSV). However, the PA pressure waveform might be influenced by the direct transmission of the intrathoracic pressure changes throughout the respiratory cycle caused by mechanical ventilation (MV), potentially impacting the reliability of PA pulse wave analysis ($ PA_{PWA} $). We assessed a new method that minimizes the direct effect of the MV on continuous PA pressure measurements and enhances the reliability of $ PA_{PWA} $ in tracking beat-to-beat RVSV. Methods Continuous PA pressure and flow were simultaneously measured for 2–3 min in 5 pigs using a high-fidelity micro-tip catheter and a transonic flow sensor around the PA trunk, both pre and post an experimental ARDS model. RVSV was estimated by $ PA_{PWA} $ indexes such as pulse pressure ($ SV_{PP} $), systolic area ($ SV_{SystAUC} $) and standard deviation ($ SV_{SD} $) beat-to-beat from both corrected and non-corrected PA signals. The reference RVSV was derived from the PA flow signal (SVref). Results The reliability of $ PA_{PWA} $ in tracking RVSV on a beat-to-beat basis was enhanced after accounting for the direct impact of intrathoracic pressure changes induced by MV throughout the respiratory cycle. This was evidenced by an increase in the correlation between SVref and RVSV estimated by $ PA_{PWA} $ under healthy conditions: rho between SVref and non-corrected $ SV_{SD} $ – 0.111 (0.342), corrected $ SV_{SD} $ 0.876 (0.130), non-corrected $ SV_{SystAUC} $ 0.543 (0.141) and corrected $ SV_{SystAUC} $ 0.923 (0.050). Following ARDS, correlations were SVref and non-corrected $ SV_{SD} $ – 0.033 (0.262), corrected $ SV_{SD} $ 0.839 (0.077), non-corrected $ SV_{SystAUC} $ 0.483 (0.114) and corrected $ SV_{SystAUC} $ 0.928 (0.026). Correction also led to reduced limits of agreement between SVref and $ SV_{SD} $ and $ SVSyst_{AUC} $ in the two evaluated conditions. Conclusions In our experimental model, we confirmed that correcting for mechanical ventilation induced changes during the respiratory cycle improves the performance of $ PA_{PWA} $ for beat-to-beat estimation of RVSV compared to uncorrected measurements. This was demonstrated by a better correlation and agreement between the actual SV and the obtained from $ PA_{PWA.} $ | ||
| 650 | 4 | |a Stroke volume |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Right ventricle |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Mechanical ventilation |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Pulse wave analysis |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Heart lung interactions |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Fluid responsiveness |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Monge-García, M. Ignacio |e verfasserin |4 aut | |
| 700 | 1 | |a Borges, João Batista |e verfasserin |4 aut | |
| 700 | 1 | |a Retamal, Jaime |e verfasserin |4 aut | |
| 700 | 1 | |a Tusman, Gerardo |e verfasserin |4 aut | |
| 700 | 1 | |a Larsson, Anders |e verfasserin |4 aut | |
| 700 | 1 | |a Suarez-Sipmann, Fernando |e verfasserin |4 aut | |
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