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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effects of norepinephrine on static and dynamic preload indicators in experimental hemorrhagic shock
Critical Care Medicine, Volume 33, No. 10, Year 2005
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Description
Objective: To investigate the effect of norepinephrine on static (right atrial pressure, pulmonary artery occlusion pressure) and dynamic (pulse pressure variation and arterial systolic pressure variation) preload indicators in experimental hemorrhagic shock. Design: Prospective controlled experimental study. Setting: Animal research laboratory. Subjects: Six anesthetized and mechanically ventilated dogs. Interventions: Dogs were instrumented for measurement of arterial blood pressure, pulmonary artery catheter derived variables including right atrial pressure, pulmonary artery occlusion pressure, and cardiac output. Simultaneously, pulse pressure variation and systolic pressure variation were calculated. Pulse pressure variation is the difference between the maximal and the minimal value of pulse pressure divided by the mean of the two values and is expressed as a percentage. Systolic pressure variation is the difference between the maximal and the minimal systolic pressure and is expressed as an absolute value. After baseline measurements, hemorrhagic shock was induced by a stepwise cumulative blood withdrawal of 35 mL·kg -1 of body weight. A second set of hemodynamic measurement was made 30 mins after bleeding. The third set was made 30 mins later under norepinephrine. Measurements and Main Results: Mean arterial pressure and cardiac output decreased after hemorrhage (p < .05), whereas right atrial pressure and pulmonary artery occlusion pressure remained unchanged. Baseline pulse pressure variation and systolic pressure variation increased significantly with hemorrhage, from 12% (9%) to 28% (11.5%) (p < .001) and from 12.5 (6.5) to 21 (8.2) mm Hg (p < .05), respectively. Norepinepiirine induced a significant increase of cardiac output and a significant decrease of pulse pressure variation and systolic pressure variation but did not significantly change right atrial pressure or pulmonary artery occlusion pressure values. Stroke volume was correlated to pulse pressure variation and systolic pressure variation but was not correlated to right atrial pressure or pulmonary artery occlusion pressure. Conclusion: Our study confirms the superiority of dynamic variables (pulse pressure variation and systolic pressure variation) over static ones (right atrial pressure and pulmonary artery occlusion pressure) in assessing cardiac preload changes in hemorrhagic shock. However, norepinephrine could significantly reduce the value of these dynamic variables and mask a true intravascular volume deficit possibly by shifting blood from unstressed to stressed volume. Copyright © 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Authors & Co-Authors
Nouira, Semir
Tunisia, Monastir
Chu Fattouma-bourguiba
Tunisia
Experimental Research Unit 99/ur/088-59
ElAtrous, Souheil
Tunisia, Mahdia
Hôpital Tahar Sfar
Dimassi, Saoussen
Tunisia, Monastir
Chu Fattouma-bourguiba
Besbes-Ouanes, Lamia
Tunisia, Monastir
Chu Fattouma-bourguiba
Tunisia
Experimental Research Unit 99/ur/088-59
Boukef, Riadh
Tunisia, Monastir
Chu Fattouma-bourguiba
Tunisia
Experimental Research Unit 99/ur/088-59
Boussarsar, Mohamed
Tunisia, Monastir
Chu Fattouma-bourguiba
Abrouk, Fekri
Tunisia, Monastir
Chu Fattouma-bourguiba
Statistics
Citations: 111
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1097/01.CCM.0000182801.48137.13
ISSN:
00903493
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study