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Intensive Care Medicine

, Volume 41, Issue 7, pp 1247–1255 | Cite as

Effects of fluid administration on arterial load in septic shock patients

  • Manuel Ignacio Monge GarcíaEmail author
  • Pedro Guijo González
  • Manuel Gracia Romero
  • Anselmo Gil Cano
  • Chris Oscier
  • Andrew Rhodes
  • Robert Michael Grounds
  • Maurizio Cecconi
Original

Abstract

Purpose

To determine the effects of fluid administration on arterial load in critically ill patients with septic shock.

Methods

Analysis of septic shock patients monitored with an oesophageal Doppler and equipped with an indwelling arterial catheter in whom a fluid challenge was performed because of the presence of systemic hypoperfusion. Measures of arterial load [systemic vascular resistance, SVR = mean arterial pressure (MAP)/cardiac output (CO); net arterial compliance, C = stroke volume (SV)/arterial pulse pressure; and effective arterial elastance, Ea = 90 % of systolic arterial pressure/SV] were studied both before and after volume expansion (VE).

Results

Eighty-one patients were analysed, 54 (67 %) increased their CO by at least 10 % after VE (preload responders). In the whole population, 29 patients (36 %) increased MAP by at least 10 % from preinfusion level (pressure responders). In the preload responder group, only 24 patients (44 %) were pressure responders. Fluid administration was associated with a significant decrease in Ea [from 1.68 (1.11–2.11) to 1.57 (1.08–1.99) mmHg/mL; P = 0.0001] and SVR [from 1035 (645–1483) to 928 (654–1452) dyn s cm−5; P < 0.01]. Specifically, in preload responders in whom arterial pressure did not change, VE caused a reduction in Ea from 1.74 (1.22–2.24) to 1.55 (1.24–1.86) mmHg/mL (P < 0.0001), affecting both resistive [SVR: from 1082 (697–1475) to 914 (624–1475) dyn s cm−5; P < 0.0001] and pulsatile [C: from 1.11 (0.84–1.49) to 1.18 (0.99–1.44) mL/mmHg; P < 0.05] components. There was no relationship between preinfusion arterial load parameters and VE-induced increase in arterial pressure.

Conclusion

Fluid administration significantly reduced arterial load in critically patients with septic shock and acute circulatory failure, even when increasing cardiac output. This explains why some septic patients increase their cardiac output after fluid administration without improving blood pressure.

Keywords

Fluid therapy Septic shock Arterial pressure Cardiac output Arterial load Esophageal Doppler 

Abbreviations

AUC

Area under the receiver-operating characteristic curve

C

Net arterial compliance

CO

Cardiac output

DAP

Diastolic arterial pressure

EA

Effective arterial elastance

EAdyn

Dynamic arterial elastance

ESM

Electronic supplementary material

HES

Hydroxyethyl starch

IQR

Interquartile range

LSC

Least significant change

MAP

Mean arterial pressure

ROC

Receiver-operating characteristic

SAP

Systolic arterial pressure

SV

Stroke volume

SVR

Systemic vascular resistance

TAU

Arterial time constant

VE

Volume expansion

Notes

Conflicts of interests

MIMG is consultant for Edwards Lifesciences and received travel expenses from Deltex. AGC has received Honoraria from Edwards Lifesciences. AR has received Honoraria and is on the advisory board for LiDCO, Honoraria for Covidien, Edwards Lifesciences and Cheetah. MC in the last 5 years has received honoraria and/or travel expenses from Edwards Lifesciences, LiDCO, Cheetah, Bmeye, Masimo and Deltex. PGG, MGR, CO and RMG have no conflict of interest to declare.

Supplementary material

134_2015_3898_MOESM1_ESM.docx (158 kb)
Supplementary material 1 (DOCX 157 kb)

References

  1. 1.
    Starling MR (1993) Left ventricular-arterial coupling relations in the normal human heart. Am Heart J 125:1659–1666PubMedCrossRefGoogle Scholar
  2. 2.
    Sunagawa K, Maughan WL, Burkhoff D, Sagawa K (1983) Left ventricular interaction with arterial load studied in isolated canine ventricle. Am J Physiol 245:H773–H780PubMedGoogle Scholar
  3. 3.
    Chantler PD, Lakatta EG (2012) Arterial-ventricular coupling with aging and disease. Front Physiol 3:90PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Guarracino F, Baldassarri R, Pinsky MR (2013) Ventriculo-arterial decoupling in acutely altered hemodynamic states. Crit Care 17:213PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Asanoi H, Kameyama T, Ishizaka S, Nozawa T, Inoue H (1996) Energetically optimal left ventricular pressure for the failing human heart. Circulation 93:67–73PubMedCrossRefGoogle Scholar
  6. 6.
    Chantler PD, Lakatta EG, Najjar SS (2008) Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol 105:1342–1351PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR (2014) Ventriculoarterial decoupling in human septic shock. Crit Care 18:R80PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Vieillard-Baron A (2011) Septic cardiomyopathy. Ann Intensive Care 1:6PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Ochagavia A, Baigorri F, Mesquida J, Ayuela JM, Ferrandiz A, Garcia X, Monge MI, Mateu L, Sabatier C, Clau-Terre F, Vicho R, Zapata L, Maynar J, Gil A, Grupo de Trabajo de Cuidados Intensivos Cardiologicos y RCPdlS (2014) Hemodynamic monitoring in the critically patient. Recomendations of the Cardiological Intensive Care and CPR Working Group of the Spanish Society of Intensive Care and Coronary Units. Med Intensiva 38:154–169PubMedCrossRefGoogle Scholar
  10. 10.
    Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL, Vincent JL, Rhodes A (2014) Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795–1815PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric S (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228PubMedCrossRefGoogle Scholar
  12. 12.
    Westerhof N, Lankhaar JW, Westerhof BE (2009) The arterial Windkessel. Med Biol Eng Comput 47:131–141PubMedCrossRefGoogle Scholar
  13. 13.
    Segers P, Stergiopulos N, Westerhof N (2002) Relation of effective arterial elastance to arterial system properties. Am J Physiol Heart Circ Physiol 282:H1041–H1046PubMedCrossRefGoogle Scholar
  14. 14.
    Kelly RP, Ting CT, Yang TM, Liu CP, Maughan WL, Chang MS, Kass DA (1992) Effective arterial elastance as index of arterial vascular load in humans. Circulation 86:513–521PubMedCrossRefGoogle Scholar
  15. 15.
    Sunagawa K, Maughan WL, Sagawa K (1985) Optimal arterial resistance for the maximal stroke work studied in isolated canine left ventricle. Circ Res 56:586–595PubMedCrossRefGoogle Scholar
  16. 16.
    Chemla D, Antony I, Lecarpentier Y, Nitenberg A (2003) Contribution of systemic vascular resistance and total arterial compliance to effective arterial elastance in humans. Am J Physiol Heart Circ Physiol 285:H614–H620PubMedCrossRefGoogle Scholar
  17. 17.
    Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY (1992) Does radial artery pressure accurately reflect aortic pressure? Chest 102:1193–1198PubMedCrossRefGoogle Scholar
  18. 18.
    Hatib F, Jansen JR, Pinsky MR (2011) Peripheral vascular decoupling in porcine endotoxic shock. J Appl Physiol 111:853–860PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Monge Garcia MI, Romero MG, Cano AG, Rhodes A, Grounds RM, Cecconi M (2013) Impact of arterial load on the agreement between pulse pressure analysis and esophageal Doppler. Crit Care 17:R113PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Asanoi H, Sasayama S, Kameyama T (1989) Ventriculoarterial coupling in normal and failing heart in humans. Circ Res 65:483–493PubMedCrossRefGoogle Scholar
  21. 21.
    Nichols WW, O’Rourke M (2005) Vascular impedance. In: Nichols WW, O’Rourke M (eds) McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. Oxford University Press, London, pp 233–267Google Scholar
  22. 22.
    Cholley BP, Lang RM, Berger DS, Korcarz C, Payen D, Shroff SG (1995) Alterations in systemic arterial mechanical properties during septic shock: role of fluid resuscitation. Am J Physiol 269:H375–H384PubMedGoogle Scholar
  23. 23.
    Ricard-Hibon A, Losser MR, Kong R, Beloucif S, Teisseire B, Payen D (1998) Systemic pressure-flow reactivity to norepinephrine in rabbits: impact of endotoxin and fluid loading. Intensive Care Med 24:959–966PubMedCrossRefGoogle Scholar
  24. 24.
    Dellinger RP (2006) Fluid therapy of tissue hypoperfusion. In: Pinsky MR, Payen D (eds) Functional hemodynamic monitoring. Springer, Berlin, pp 285–298Google Scholar
  25. 25.
    Nichols WW, O’Rourke M (2005) McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. Oxford University Press, LondonGoogle Scholar
  26. 26.
    Pohl U, De Wit C, Gloe T (2000) Large arterioles in the control of blood flow: role of endothelium-dependent dilation. Acta Physiol Scand 168:505–510PubMedCrossRefGoogle Scholar
  27. 27.
    Losser MR, Forget AP, Payen D (2006) Nitric oxide involvement in the hemodynamic response to fluid resuscitation in endotoxic shock in rats. Crit Care Med 34:2426–2431PubMedCrossRefGoogle Scholar
  28. 28.
    Milnor WR (1989) Hemodynamics. Williams & Wilkins, BaltimoreGoogle Scholar
  29. 29.
    Pinsky MR (2003) Hemodynamic monitoring in the intensive care unit. Clin Chest Med 24:549–560PubMedCrossRefGoogle Scholar
  30. 30.
    Urzua J, Meneses G, Fajardo C, Lema G, Canessa R, Sacco CM, Medel J, Vergara ME, Irarrazaval M, Moran S (1997) Arterial pressure-flow relationship in patients undergoing cardiopulmonary bypass. Anesth Analg 84:958–963PubMedGoogle Scholar
  31. 31.
    Pierrakos C, Velissaris D, Scolletta S, Heenen S, De Backer D, Vincent JL (2012) Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock? Intensive Care Med 38:422–428PubMedCrossRefGoogle Scholar
  32. 32.
    Monnet X, Letierce A, Hamzaoui O, Chemla D, Anguel N, Osman D, Richard C, Teboul JL (2011) Arterial pressure allows monitoring the changes in cardiac output induced by volume expansion but not by norepinephrine. Crit Care Med 39:1394–1399PubMedCrossRefGoogle Scholar
  33. 33.
    Lakhal K, Ehrmann S, Perrotin D, Wolff M, Boulain T (2013) Fluid challenge: tracking changes in cardiac output with blood pressure monitoring (invasive or non-invasive). Intensive Care Med 39:1953–1962PubMedCrossRefGoogle Scholar
  34. 34.
    Monge Garcia M, Gracia Romero M, Gil Cano A, Aya HD, Rhodes A, Grounds R, Cecconi M (2014) Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study. Crit Care 18:626CrossRefGoogle Scholar
  35. 35.
    Monge Garcia MI, Gil Cano A, Gracia Romero M (2011) Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients. Crit Care 15:R15PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Cecconi M, Monge Garcia MI, Gracia Romero M, Mellinghoff J, Caliandro F, Grounds RM, Rhodes A (2014) The use of pulse pressure variation and stroke volume variation in spontaneously breathing patients to assess dynamic arterial elastance and to predict arterial pressure response to fluid administration. Anesth Analg 120:76–84CrossRefGoogle Scholar
  37. 37.
    Colquhoun DA, Roche AM (2014) Oesophageal Doppler cardiac output monitoring: a longstanding tool with evolving indications and applications. Best Pract Res Clin Anaesthesiol 28:353–362PubMedCrossRefGoogle Scholar
  38. 38.
    Buda AJ, Pinsky MR, Ingels NB Jr, Daughters GT 2nd, Stinson EB, Alderman EL (1979) Effect of intrathoracic pressure on left ventricular performance. N Engl J Med 301:453–459PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Manuel Ignacio Monge García
    • 1
    • 2
    Email author
  • Pedro Guijo González
    • 1
  • Manuel Gracia Romero
    • 1
  • Anselmo Gil Cano
    • 1
  • Chris Oscier
    • 2
  • Andrew Rhodes
    • 2
  • Robert Michael Grounds
    • 2
  • Maurizio Cecconi
    • 2
  1. 1.Unidad de Cuidados IntensivosHospital SAS de JerezJerez de la FronteraSpain
  2. 2.Department of General Intensive CareSt. George’s Healthcare NHS Trust and St George’s University of LondonLondonUK

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