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Clinical Journal of the American... Nov 2017
Topics: Biofeedback, Psychology; Blood Volume; Cross-Over Studies; Humans; Hypotension; Renal Dialysis; Ultrafiltration
PubMed: 29018099
DOI: 10.2215/CJN.09770917 -
Journal of Cardiac Failure Sep 2022The role of blood volume (BV) expansion vs a change in vascular compliance in worsening heart failure (HF) remains under debate. We aimed to assess the relationship...
BACKGROUND
The role of blood volume (BV) expansion vs a change in vascular compliance in worsening heart failure (HF) remains under debate. We aimed to assess the relationship between BV and resting and stress hemodynamics in worsening HF and to further elucidate the significance of BV in cardiac decompensation.
METHODS AND RESULTS
Patients with worsening HF underwent radiolabeled indicator-dilution BV analysis and cardiac catheterization. Intravascular volumes and resting/stress hemodynamics were recorded. Provocative stress maneuvers included change in systolic blood pressure (ΔSBP) from lying to standing and Valsalva and intracardiac pressure changes with leg raise. Correlation between BV and invasive hemodynamics were assessed by linear regression. Of 27 patients with worsening HF, patients' characteristics included mean age 61 ± 12 years, 70% male, 19% Black, and mean ejection fraction 29% ± 15%. Of the patients, 13 (48%) had hypervolemia as measured by total BV, which weakly correlated with ΔSBP by position (R = 0.009) and Valsalva (R = 0.003) and with right atrial (R = 0.049) and pulmonary capillary wedge (R = 0.047) pressure changes during leg raise.
CONCLUSIONS
In patients with worsening HF, BV mildly correlated with intracardiac pressures at rest. Provocative maneuvers intended to test vascular compliance did not correlate with BV, indicating that compliance may serve as a stand-alone metric in HF.
Topics: Aged; Blood Volume; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Pulmonary Wedge Pressure; Stroke Volume
PubMed: 35483537
DOI: 10.1016/j.cardfail.2022.04.004 -
The American Journal of Nursing Nov 2023Infection in an immunocompromised person can be a life-threatening emergency. Collection of blood culture specimens is an important method for detecting organisms when...
Infection in an immunocompromised person can be a life-threatening emergency. Collection of blood culture specimens is an important method for detecting organisms when infection is suspected. One aspect of proper blood culture collection is obtaining an accurate blood volume in the sample in accordance with the blood culture bottle manufacturer's recommendation. Underfilling the culture bottle can lead to false-negative results, while overfilling it can lead to false-positive results. At our institution, the Department of Laboratory Medicine (DLM) routinely monitors blood culture bottle volumes and notifies the nursing department of underfill/overfill events, which the department then reviews. Over several years, the DLM and the nursing department noted an increase in these events. A clinical nurse specialist and three staff nurses in the oncology/critical care services area partnered with the DLM to determine why. Upon investigation, two key issues-imprecise weighing of bottles and staff misunderstanding of the proper blood culture collection technique-were discovered. In response, the nursing standard of practice and guidance on the DLM webpage were updated and nursing education was performed. As a result, underfill/overfill events decreased by 71% in a little over a year.
Topics: Humans; Blood Culture; Critical Care; Health Facilities; Blood Volume
PubMed: 37882404
DOI: 10.1097/01.NAJ.0000995368.45516.ec -
Investigative Radiology Sep 2022We propose a method of quantitatively measuring drug-induced microvascular volume changes, as well as drug-induced changes in blood oxygenation using calibrated blood... (Observational Study)
Observational Study
OBJECTIVES
We propose a method of quantitatively measuring drug-induced microvascular volume changes, as well as drug-induced changes in blood oxygenation using calibrated blood oxygen level-dependent magnetic resonance imaging (MRI). We postulate that for MRI signals there is a contribution to R2* relaxation rates from static susceptibility effects of the intravascular blood that scales with the blood volume/magnetic field and depends on the oxygenation state of the blood. These may be compared with the effects of an intravascular contrast agent. With 4 R2* measurements, microvascular blood volume (MBV) and tissue oxygenation changes can be quantified with the administration of a vasoactive drug.
MATERIALS AND METHODS
The protocol examined 12 healthy rats in a prospective observational study. R2* maps were acquired with and without infusion of adenosine, which increases microvascular blood flow, or dobutamine, which increases myocardial oxygen consumption. In addition, R2* maps were acquired after the intravenous administration of a monocrystalline iron oxide nanoparticle, with and without adenosine or dobutamine.
RESULTS
Total microvascular volume was shown to increase by 10.8% with adenosine and by 25.6% with dobutamine ( P < 0.05). When comparing endocardium versus epicardium, both adenosine and dobutamine demonstrated significant differences between endocardial and epicardial MBV changes ( P < 0.05). Total myocardial oxygenation saturation increased by 6.59% with adenosine and by 1.64% with dobutamine ( P = 0.27). The difference between epicardial and endocardial oxygenation changes were significant with each drug (adenosine P < 0.05, dobutamine P < 0.05).
CONCLUSIONS
Our results demonstrate the ability to quantify microvascular volume and oxygenation changes using calibrated blood oxygen level-dependent MRI, and we demonstrate different responses of adenosine and dobutamine. This method has clinical potential in examining microvascular disease in various disease states without the administration of radiopharmaceuticals or gadolinium-based contrast agents.
Topics: Adenosine; Animals; Blood Volume; Coronary Circulation; Dobutamine; Rats; Vasodilator Agents
PubMed: 35438656
DOI: 10.1097/RLI.0000000000000871 -
Scientific Reports Aug 2017Intrathoracic pressure (ITP) swings challenge many physiological systems. The responses of cerebral hemodynamics to different ITP swings are still less well-known due to...
Intrathoracic pressure (ITP) swings challenge many physiological systems. The responses of cerebral hemodynamics to different ITP swings are still less well-known due to the complexity of cerebral circulation and methodological limitation. Using frequency-domain near-infrared spectroscopy and echocardiography, we measured changes in cerebral, muscular and cardiac hemodynamics in five graded respiratory maneuvers (RM), breath holding, moderate and strong Valsalva maneuvers (mVM/sVM) with 20 and 40 cmHO increments in ITP, moderate and strong Mueller maneuvers (mMM/sMM) with 20 and 40 cmHO decrements in ITP controlled by esophageal manometry. We found cerebral blood volume (CBV) maintains relative constant during the strains while it increases during the recoveries together with increased oxygen supply. By contrast changes in muscular blood volume (MBV) are mainly controlled by systemic changes. The graded changes of ITP during the maneuvers predict the changes of MBV but not CBV. Changes in left ventricular stroke volume and heart rate correlate to MBV but not to CBV. These results suggest the increased CBV after the ITP strains is brain specific, suggesting cerebral vasodilatation. Within the strains, cerebral oxygen saturation only decreases in sVM, indicating strong increment rather than decrement in ITP may be more challenging for the brain.
Topics: Adult; Breath Holding; Cerebral Blood Volume; Cerebrovascular Circulation; Female; Healthy Volunteers; Hemodynamics; Humans; Male; Muscles; Oxygen; Pressure; Respiration; Stroke Volume; Ventricular Function, Left
PubMed: 28827669
DOI: 10.1038/s41598-017-08698-0 -
Psychiatry Research Jun 2015Neuroimaging studies have provided compelling evidence for abnormal hippocampal activity in schizophrenia. Most studies made inferences about baseline hippocampal...
Neuroimaging studies have provided compelling evidence for abnormal hippocampal activity in schizophrenia. Most studies made inferences about baseline hippocampal activity using a single hemodynamic parameter (e.g., blood volume or blood flow). Here we studied several hemodynamic measures in the same cohort to test the hypothesis of increased hippocampal activity in schizophrenia. We used dynamic susceptibility contrast- (DSC-) magnetic resonance imaging (MRI) to assess blood volume, blood flow, and mean transit time in the hippocampus of 15 patients with chronic schizophrenia and 15 healthy controls. Left and right hippocampal measurements were combined for absolute measures of cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT). We found significantly increased hippocampal CBV, but normal CBF and MTT, in schizophrenia. The uncoupling of CBV and CBF could be due to several factors, including antipsychotic medication, loss of cerebral perfusion pressure, or angiogenesis. Further studies need to incorporate several complementary imaging modalities to better characterize hippocampal dysfunction in schizophrenia.
Topics: Adult; Blood Volume; Cerebrovascular Circulation; Female; Hemodynamics; Hippocampus; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Schizophrenia; Young Adult
PubMed: 25896442
DOI: 10.1016/j.pscychresns.2015.03.007 -
PloS One 2020In this study, the physiological values of volumes of plasma, cells, total blood and the F blood factors were identified in 24 adult tree shrews (Tupaia belangeri; 12...
In this study, the physiological values of volumes of plasma, cells, total blood and the F blood factors were identified in 24 adult tree shrews (Tupaia belangeri; 12 male and 12 female; average BW of 123.9±19.19 g). The two-compartment model method of Evans Blue dye was used to obtain the plasma volume and the venous hematocrit was measured by microhematocrit method. To establish the relationship between body weight (BW) and blood volume of tree shrews, We performed linear fitting for these two datasets. Results were analyzed according to gender and weight (<120g vs.>120g). Statistical significance was assessed using the unpaired student t test and one-way ANOVA. The average volumes per 100g body weight of plasma, red blood cell (RBC) and total blood were 5.42±0.543, 3.24±0.445, and 8.66±0.680ml respectively. The mean body hematocrit, cardiac hematocrit, jugular vein hematocrit, femoral vein hematocrit, and tail vein hematocrit was 37.43±4.096, 39.72±3.219, 43.04±4.717, 40.84±3.041, and 38.71±3.442% respectively. The F cardiac was 0.94±0.072, F jugular vein 0.88±0.118, F femoral vein 0.92±0.111, and the F tail vein 0.97±0.117. Blood volume (ml) was 85.89103×BW (kg). This is the first study to provide the parameters of plasma volume, cell volume, total blood volume and F factor and a baseline for future research on blood physiology of tree shrews.
Topics: Animals; Blood Volume; Body Weight; Cell Size; Female; Hematocrit; Male; Plasma Volume; Tupaiidae
PubMed: 32881864
DOI: 10.1371/journal.pone.0234835 -
PloS One 2022Current methods for identification of oxygenator clotting during prolonged extracorporeal life support include visual inspection, evaluation of oxygenator resistance and...
Current methods for identification of oxygenator clotting during prolonged extracorporeal life support include visual inspection, evaluation of oxygenator resistance and oxygen exchange performance, and assessment of clotting-related laboratory parameters. However, these observations do not provide a quantitative assessment of oxygenator clot formation. By measuring changes in the dynamic oxygenator blood volume this study aimed to evaluate the relation to oxygenator resistance and oxygen transfer performance. Sixty-seven oxygenators were studied during adult extracorporeal life support. Oxygenator blood volume, oxygenator resistance, and oxygen transfer efficiency were monitored. Oxygenator blood volume decreased with increasing runtime (r = -0.462; p <0.001). There was a statistically significant, fair negative correlation between oxygenator blood volume and oxygenator resistance (r = -0.476; p<0.001) in all oxygenators, which became stronger analyzing only exchanged oxygenators (r = -0.680; p<0.001) and oxygenators with an oxygenator blood volume <187 mL (r = 0.831; p<0.001). No relevant correlation between oxygenator blood volume and O2 transfer was found. Oxygenator blood volume declined over time and was clearly associated with an increasing oxygenator resistance during prolonged extracorporeal life support, though O2 transfer was less affected.
Topics: Adult; Blood Volume; Carbon Dioxide; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Oxygen; Oxygenators; Regional Blood Flow
PubMed: 35108345
DOI: 10.1371/journal.pone.0263360 -
Journal of Applied Physiology... Sep 2017In this Cores of Reproducibility in Physiology (CORP) article, we present the theory and practical aspects of the carbon monoxide (CO) rebreathing method for the... (Review)
Review
In this Cores of Reproducibility in Physiology (CORP) article, we present the theory and practical aspects of the carbon monoxide (CO) rebreathing method for the determination of total hemoglobin mass in humans. With CO rebreathing, a small quantity of CO is diluted in O and rebreathed for a specified time period, during which most of the CO is absorbed and bound to circulating hemoglobin. The dilution principle then allows calculation of the total number of circulating hemoglobin molecules based on the number of absorbed CO molecules and the resulting changes in the fraction of carboxyhemoglobin in blood. Total hemoglobin mass is derived by multiplication with the molar weight of hemoglobin. CO rebreathing has been used for >100 yr and has undergone steady improvement so that today excellent values in terms of accuracy and precision can be achieved if the methodological precautions are carefully followed.
Topics: Blood Volume; Blood Volume Determination; Carbon Monoxide; Carboxyhemoglobin; Hemoglobins; Humans; Reproducibility of Results
PubMed: 28663373
DOI: 10.1152/japplphysiol.00185.2017 -
BMC Anesthesiology Aug 2020Perioperative fluid management - including the type, dose, and timing of administration -directly affects patient outcome after major surgery. The objective of fluid... (Review)
Review
BACKGROUND
Perioperative fluid management - including the type, dose, and timing of administration -directly affects patient outcome after major surgery. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate.
MAIN TEXT
The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. Goal-directed fluid therapy (GDFT), aimed at optimizing flow-related variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. However, this approach has failed to achieve widespread adoption. A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. Such an approach may change the crystalloid versus colloid debate. Because colloid solutions have a more profound effect on intravascular volume and longer plasma persistence, their use in this more "controlled" context could be associated with a lower fluid balance, and potentially improved patient outcome. Additionally, most studies that have assessed the impact of a GDFT strategy on the outcome of high-risk surgical patients have used hydroxyethyl starch (HES) solutions in their protocols. Some of these studies have demonstrated beneficial effects, while none of them has reported severe complications.
CONCLUSIONS
The type and volume of fluid used for perioperative management need to be individualized according to the patient's hemodynamic status and clinical condition. The amount of fluid given should be guided by well-defined physiologic targets. Compliance with a predefined hemodynamic protocol may be optimized by using a computerized system. The type of fluid should also be individualized, as should any drug therapy, with careful consideration of timing and dose. It is our perspective that HES solutions remain a valid option for fluid therapy in the perioperative context because of their effects on blood volume and their reasonable benefit/risk profile.
Topics: Blood Volume; Fluid Therapy; Hemodynamics; Humans; Hydroxyethyl Starch Derivatives; Patient Care Planning; Perioperative Care; Plasma Substitutes
PubMed: 32819296
DOI: 10.1186/s12871-020-01128-1