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The stop-flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography

Abstract : Background The distending intravascular pressure at no flow conditions reflects the stressed volume. While this haemodynamic variable is recognised as clinically important, there is a paucity of reports of its range and responsiveness to volume expansion in patients without cardiovascular disease and no reports of correlations to echocardiographic assessments of left ventricular filling. Methods Twenty-seven awake (13 male), spontaneously breathing patients without any history of cardiopulmonary, vascular or renal disease were studied prior to induction of anaesthesia. The no-flow equilibrium pressure in the arm following rapid circulatory occlusion (P-arm) was measured via a radial arterial catheter. Transthoracic echocardiography was used to measure left ventricular end diastolic area and volume as well as the diameter of the inferior vena cava. The P-arm and echocardiographic variables were measured before and after administration of 500 mL 0.9% NaCl over 10 minutes. Changes were analysed by paired t test, Pearson's correlation and multiple linear regression. Results P-arm increased overall from 22 +/- 5 mm Hg to 25 +/- 6 mm Hg (mean difference 3.0 +/- 4.5 mm Hg, P = 0.002) following the fluid bolus with corresponding increases in arterial pressure and echocardiographic variables. Variability in the direction of the P-arm response reflected concomitant changes in vascular compliance. Only weak correlations were observed between changes in P-arm and inferior vena cava diameter indexed to body surface area (R-2 = 0.29, P = 0.01). Conclusion Preoperative measurements of P-arm increased following acute expansion of the intravascular volume. Echocardiography demonstrated poor correlation with P-arm.
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Soumis le : mardi 22 février 2022 - 11:13:18
Dernière modification le : vendredi 5 août 2022 - 11:25:25

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Konstantin Yastrebov, Anders Aneman, Michel Slama, Vladimir Kokhno, Vsevolod Luchansky, et al.. The stop-flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography. Acta Anaesthesiologica Scandinavica, Wiley, 2019, 63 (5), pp.594-600. ⟨10.1111/aas.13318⟩. ⟨hal-03584076⟩

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