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Pediatrics and Neonatology Feb 2021Hemodynamic compromise of the neonate can occur in various clinical situations, including but not limited to maladaptation during the early transitional period, sepsis,... (Review)
Review
Hemodynamic compromise of the neonate can occur in various clinical situations, including but not limited to maladaptation during the early transitional period, sepsis, congenital heart anomalies, hemodynamically significant patent ductus arteriosus, persistent pulmonary hypertension of the newborn, systemic inflammatory diseases such as necrotizing enterocolitis, and dehydration. Despite the handful of advances in neonatal care through ground-breaking clinical trials, the management of neonatal shock is often dependent on the bedside clinician's experience and training without the aid of high-level evidence. However, the recognition for the importance of comprehensive and serial hemodynamic assessment is growing. There is now a wealth of literature investigating the use of functional echocardiography, near-infrared spectroscopy, and noninvasive impedance-based cardiometry to complement common bedside hemodynamic measures such as blood pressure and heart rate measurement. In this review article, the pathophysiology of neonatal hemodynamic compromise is outlined, and concomitant best-evidence management for hemodynamic compromise in the neonate is proposed.
Topics: Ductus Arteriosus, Patent; Echocardiography; Hemodynamics; Humans; Hypotension; Infant, Newborn; Infant, Premature; Shock
PubMed: 33485823
DOI: 10.1016/j.pedneo.2020.12.007 -
British Journal of Anaesthesia Mar 2022During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes. (Meta-Analysis)
Meta-Analysis
BACKGROUND
During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes.
METHODS
Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).
RESULTS
The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=-0.72 days; 95% CI, -1.10 to -0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence.
CONCLUSIONS
Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.
Topics: Anesthesia, General; General Surgery; Hemodynamics; Humans; Postoperative Complications
PubMed: 34916049
DOI: 10.1016/j.bja.2021.10.046 -
Anaesthesiology Intensive Therapy 2019Haemodynamic monitoring is the cornerstone in the optimization of tissue perfusion and the prevention of deteriorating metabolism. Haemodynamic alterations could be... (Review)
Review
Haemodynamic monitoring is the cornerstone in the optimization of tissue perfusion and the prevention of deteriorating metabolism. Haemodynamic alterations could be summarized in terms of cardiac dysfunction, changes of loading conditions (preload or/and afterload), and patient related issues. This review aims to present the clinical applications of different haemodynamic monitoring techniques, discuss advantages and disadvantages, and provide guidance to help the clinician select those techniques suitable to optimize haemodynamics in individual patients during the perioperative period.
Topics: Hemodynamic Monitoring; Hemodynamics; Humans; Perioperative Care
PubMed: 31268276
DOI: 10.5114/ait.2019.86279 -
Medical Ultrasonography Dec 2011Carotid duplex ultrasonography is a noninvasive technique for hemodynamically significant stenosis detection and cardiovascular risk estimation. Anatomic information of... (Review)
Review
Carotid duplex ultrasonography is a noninvasive technique for hemodynamically significant stenosis detection and cardiovascular risk estimation. Anatomic information of carotid arteries is provided by B-mode scanning. Hemodynamic features are displayed color-flow and pulsed Doppler imaging. Examination technique, normal carotid anatomy and flow pattern, and potential limitations are presented.
Topics: Carotid Artery Diseases; Hemodynamics; Humans; Patient Positioning; Ultrasonography, Doppler, Duplex
PubMed: 22132407
DOI: No ID Found -
European Heart Journal Nov 2018Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with... (Review)
Review
Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with the most convenient measurement, brachial pulse pressure, which is widely available, related to development and treatment of heart failure (HF), but often confounded in patients with established HF. The next level of analysis consists of central (rather than brachial) pressures and, more importantly, of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodelling, diastolic dysfunction, exercise capacity, and, in the long-term, the risk of new-onset HF. Wave reflection may also represent a suitable therapeutic target. Treatments for HF with preserved and reduced ejection fraction, based on a reduction of wave reflection, are emerging. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals, which can be readily accomplished with contemporary non-invasive imaging and modelling techniques. This review provides a summary of our current understanding of pulsatile haemodynamics in HF.
Topics: Aged; Blood Pressure; Female; Heart Failure; Hemodynamics; Humans; Male; Models, Cardiovascular; Pulsatile Flow
PubMed: 29947746
DOI: 10.1093/eurheartj/ehy346 -
British Journal of Anaesthesia Aug 2014Trauma is the leading cause of death during the first four decades of life in the developed countries. Its haemodynamic response underpins the patient's initial ability... (Review)
Review
Trauma is the leading cause of death during the first four decades of life in the developed countries. Its haemodynamic response underpins the patient's initial ability to survive, and the response to treatment and subsequent morbidity and resolution. Trauma causes a number of insults including haemorrhage, tissue injury (nociception) and, predominantly, in military casualties, blast from explosions. This article discusses aspects of the haemodynamic responses to these insults and subsequent treatment. 'Simple' haemorrhage (blood loss without significant volume of tissue damage) causes a biphasic response: mean arterial blood pressure (MBP) is initially maintained by the baroreflex (tachycardia and increased vascular resistance, Phase 1), followed by a sudden decrease in MAP initiated by a second reflex (decrease in vascular resistance and bradycardia, Phase 2). Phase 2 may be protective. The response to tissue injury attenuates Phase 2 and may cause a deleterious haemodynamic redistribution that compromises blood flow to some vital organs. In contrast, thoracic blast exposure augments Phase 2 of the response to haemorrhage. However, hypoxaemia from lung injury limits the effectiveness of hypotensive resuscitation by augmenting the attendant shock state. An alternative strategy ('hybrid resuscitation') whereby tissue perfusion is increased after the first hour of hypotensive resuscitation by adopting a revised normotensive target may ameliorate these problems. Finally, morphine also attenuates Phase 2 of the response to haemorrhage in some, but not all, species and this is associated with poor outcome. The impact on human patients is currently unknown and is the subject of a current physiological investigation.
Topics: Analgesics, Opioid; Blast Injuries; Healthy Volunteers; Hemodynamics; Hemorrhage; Humans; Musculoskeletal System; Oxygen Consumption; Resuscitation; Wounds and Injuries
PubMed: 25038158
DOI: 10.1093/bja/aeu232 -
Current Hypertension Reports Aug 2020To review the haemodynamic characteristics of paediatric hypertension. (Review)
Review
PURPOSE OF REVIEW
To review the haemodynamic characteristics of paediatric hypertension.
RECENT FINDINGS
Pulsatile components of blood pressure are determined by left ventricular dynamics, aortic stiffness, systemic vascular resistance and wave propagation phenomena. Recent studies delineating these factors have identified haemodynamic mechanisms contributing to primary hypertension in children. Studies to date suggest a role of cardiac over activity, characterized by increased heart rate and left ventricular ejection, and increased aortic stiffness as the main haemodynamic determinants of primary hypertension in children.
Topics: Blood Pressure; Child; Hemodynamics; Humans; Hypertension; Vascular Resistance; Vascular Stiffness
PubMed: 32840715
DOI: 10.1007/s11906-020-01044-2 -
British Journal of Anaesthesia Aug 2019
Topics: Anesthesia; Hemodynamics; Humans; Perioperative Care; Regional Blood Flow; Vasoconstriction; Vasoconstrictor Agents
PubMed: 31153629
DOI: 10.1016/j.bja.2019.04.052 -
The Korean Journal of Gastroenterology... Nov 2023Chronic liver disease causes hemodynamic changes in the body depending on the degree of progression. These hemodynamic changes begin with splanchnic vasodilation, with... (Review)
Review
Chronic liver disease causes hemodynamic changes in the body depending on the degree of progression. These hemodynamic changes begin with splanchnic vasodilation, with complications beginning to appear as the hyperdynamic changes occur. As chronic liver disease progresses, increased splanchnic vasodilation and hyperdynamic changes worsen portal hypertension and help cause or worsen chronic liver disease complications, such as ascites. Ultimately, the effective plasma volume and blood pressure decrease in the terminal stage.
Topics: Humans; Hemodynamics; Hypertension, Portal; Vasodilation; Ascites
PubMed: 37997216
DOI: 10.4166/kjg.2023.124 -
The European Respiratory Journal Oct 2022The cardiopulmonary haemodynamic profile observed during exercise may identify patients with early-stage pulmonary vascular and primary cardiac diseases, and is used... (Review)
Review
BACKGROUND
The cardiopulmonary haemodynamic profile observed during exercise may identify patients with early-stage pulmonary vascular and primary cardiac diseases, and is used clinically to inform prognosis. However, a standardised approach to interpreting haemodynamic parameters is lacking.
METHODS
We performed a systematic literature search according to PRISMA guidelines to identify parameters that may be diagnostic for an abnormal haemodynamic response to exercise and offer optimal prognostic and differential-diagnostic value. We performed random-effects meta-analyses of the normal values and report effect sizes as weighted mean±sd. Results of diagnostic and prognostic studies are reported descriptively.
RESULTS
We identified 45 eligible studies with a total of 5598 subjects. The mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope, pulmonary arterial wedge pressure (PAWP)/CO slope and peak cardiac index (or CO) provided the most consistent prognostic haemodynamic parameters during exercise. The best cut-offs for survival and cardiovascular events were a mPAP/CO slope >3 Wood units (WU) and PAWP/CO slope >2 WU. A PAWP/CO slope cut-off >2 WU best differentiated pre- from post-capillary causes of PAP elevation during exercise. Upper limits of normal (defined as mean+2sd) for the mPAP/CO and PAWP/CO slopes were strongly age-dependent and ranged in 30-70-year-old healthy subjects from 1.6 to 3.3 WU and 0.6 to 1.8 WU, respectively.
CONCLUSION
An increased mPAP/CO slope during exercise is associated with impaired survival and an independent, prognostically relevant cut-off >3 WU has been validated. A PAWP/CO slope >2 WU may be suitable for the differentiation between pre- and post-capillary causes of PAP increase during exercise.
Topics: Adult; Aged; Hemodynamics; Humans; Lung; Middle Aged; Prognosis; Pulmonary Wedge Pressure; Vascular Resistance
PubMed: 35332069
DOI: 10.1183/13993003.03181-2021