OBJECTIVE: We studied the variable effects of norepinephrine infusion on cardiac output in postoperative cardiac surgical patients in whom norepinephrine increased mean arterial pressure. We hypothesized that the directional change in cardiac output would be determined by baseline cardiac function, as quantified by stroke volume variation, and the subsequent changes in mean systemic filling pressure and vasomotor tone. DESIGN: Intervention study. SETTING: ICU of a university hospital. PATIENTS: Sixteen mechanically ventilated postoperative cardiac surgery patients. INTERVENTIONS: Inspiratory holds were performed at baseline-1, during increased norepinephrine infusion, and baseline-2 conditions. MEASUREMENTS AND MAIN RESULTS: We measured mean arterial pressure, heart rate, central venous pressure, cardiac output, stroke volume variation and, with use of inspiratory hold maneuvers, mean systemic filling pressure, then calculated resistance for venous return and systemic vascular resistance. Increasing norepinephrine by 0.04 ± 0.02 μg·kg·min increased mean arterial pressure 20 mm Hg in all patients. Cardiac output decreased in ten and increased in six patients. In all patients mean systemic filling pressure, systemic vascular resistance and resistance for venous return increased and stroke volume variation decreased. Resistance for venous return and systemic vascular resistance increased more (p = 0.019 and p = 0.002) in the patients with a cardiac output decrease. Heart rate decreased in the patients with a cardiac output decrease (p = 0.002) and was unchanged in the patients with a cardiac output increase. Baseline stroke volume variation was higher in those in whom cardiac output increased (14.4 ± 4.2% vs. 9.1 ± 2.4%, p = 0.012). Stroke volume variation >8.7% predicted the increase in cardiac output to norepinephrine (area under the receiver operating characteristic curve 0.900). CONCLUSIONS: The change in cardiac output induced by norepinephrine is determined by the balance of volume recruitment (increase in mean systemic filling pressure), change in resistance for venous return, and baseline heart function. Furthermore, the response of cardiac output on norepinephrine can be predicted by baseline stroke volume variation.
OBJECTIVE: We studied the variable effects of norepinephrine infusion on cardiac output in postoperative cardiac surgical patients in whom norepinephrine increased mean arterial pressure. We hypothesized that the directional change in cardiac output would be determined by baseline cardiac function, as quantified by stroke volume variation, and the subsequent changes in mean systemic filling pressure and vasomotor tone. DESIGN: Intervention study. SETTING: ICU of a university hospital. PATIENTS: Sixteen mechanically ventilated postoperative cardiac surgery patients. INTERVENTIONS: Inspiratory holds were performed at baseline-1, during increased norepinephrine infusion, and baseline-2 conditions. MEASUREMENTS AND MAIN RESULTS: We measured mean arterial pressure, heart rate, central venous pressure, cardiac output, stroke volume variation and, with use of inspiratory hold maneuvers, mean systemic filling pressure, then calculated resistance for venous return and systemic vascular resistance. Increasing norepinephrine by 0.04 ± 0.02 μg·kg·min increased mean arterial pressure 20 mm Hg in all patients. Cardiac output decreased in ten and increased in six patients. In all patients mean systemic filling pressure, systemic vascular resistance and resistance for venous return increased and stroke volume variation decreased. Resistance for venous return and systemic vascular resistance increased more (p = 0.019 and p = 0.002) in the patients with a cardiac output decrease. Heart rate decreased in the patients with a cardiac output decrease (p = 0.002) and was unchanged in the patients with a cardiac output increase. Baseline stroke volume variation was higher in those in whom cardiac output increased (14.4 ± 4.2% vs. 9.1 ± 2.4%, p = 0.012). Stroke volume variation >8.7% predicted the increase in cardiac output to norepinephrine (area under the receiver operating characteristic curve 0.900). CONCLUSIONS: The change in cardiac output induced by norepinephrine is determined by the balance of volume recruitment (increase in mean systemic filling pressure), change in resistance for venous return, and baseline heart function. Furthermore, the response of cardiac output on norepinephrine can be predicted by baseline stroke volume variation.
Authors: Steven B Solomon; Irene Cortés-Puch; Junfeng Sun; Kenneth E Remy; Dong Wang; Jing Feng; Sameena S Khan; Derek Sinchar; Daniel B Kim-Shapiro; Harvey G Klein; Charles Natanson Journal: Transfusion Date: 2015-07-15 Impact factor: 3.157
Authors: Hollmann D Aya; Andrew Rhodes; Nick Fletcher; R Michael Grounds; Maurizio Cecconi Journal: J Clin Monit Comput Date: 2015-03-07 Impact factor: 2.502
Authors: Djillali Annane; Lamia Ouanes-Besbes; Daniel de Backer; Bin DU; Anthony C Gordon; Glenn Hernández; Keith M Olsen; Tiffany M Osborn; Sandra Peake; James A Russell; Sergio Zanotti Cavazzoni Journal: Intensive Care Med Date: 2018-06-04 Impact factor: 17.440
Authors: Sophie Dunberry-Poissant; Kim Gilbert; Caroline Bouchard; Frédérique Baril; Anne-Marie Cardinal; Sydnée L'Ecuyer; Mathieu Hylands; François Lamontagne; Guy Rousseau; Emmanuel Charbonney Journal: Intensive Care Med Exp Date: 2018-11-12