Sepsis Clinical Trial
Official title:
Clinical Assessment of Arterial Dynamic Elastance in ICU Patients, Dependent on Inotropic or Vasopressor Drugs.
The primary goal of the study is to determine Eadyn ( = PPV/SVV) as a functional measure of arterial load, in conjunction with other actual afterload indices, systemic vascular resistance and arterial elastance. A secondary aim is the assessment of the influences of vasopressors and inotropic drugs on Eadyn, as a parameter of ventriculo-arterial coupling.
Assessment of the cardiovascular status and haemodynamics comprise directly or indirectly
cardiac output, which is determined by left ventricular preload, contractility, afterload and
heart rate. Various haemodynamic monitors have been introduced in anaesthesia and ICU
practice, providing cardiac output either non-invasively or invasively. The combined use of
arterial pressure monitoring with these devices provides insight not only in cardiac output
but offers bedside assessment of most determinants of cardiovascular function. Both pulse
pressure variation (PPV) and stroke volume variation (SVV) have been described as dynamic
descriptors of fluid responsiveness, a measure allowing optimization of preloading conditions
if haemodynamics show signals of insufficient perfusion.
Arterial load can be assessed based on a two-element Windkessel model with a static and
dynamic component. The static part consists of a resistive element (systemic vascular
resistance: SVR = (MAP/C0)*80, with MAP, mean arterial pressure; CO, cardiac output) and a
pulsatile component (net arterial compliance C = SV/arterial pulse pressure with SV, stroke
volume). Arterial elastance is considered being an integrative variable, associating both
steady elements and heart rate (Ea = .9*SAP/SV with EA, arterial elastance; SAP, systolic
arterial pressure). The dynamic component Eadyn is the ratio of PPV and SVV during a
mechanical ventilator cycle, providing a functional assessment of ventriculo-arterial
coupling.
Combined use of arterial pressure tracing (or its non-invasive surrogate) and (non-) invasive
stroke volume actually may provide an interesting framework for haemodynamic monitoring and
subsequent optimization in many surgical, postoperative or ICU patients. This study aims to
copy as good as possible the handling and the way of management as in a clinical setting.
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