Endovascular Perfusion Augmentation for Critical Care Decreases Vasopressor Requirements while Maintaining Renal Perfusion.
Shock
; 57(5): 740-748, 2022 05 01.
Article
en En
| MEDLINE
| ID: mdl-35583914
ABSTRACT
BACKGROUND:
Ischemia reperfusion injury causes a profound hyperdynamic distributive shock. Endovascular perfusion augmentation for critical care (EPACC) has emerged as a hemodynamic adjunct to vasopressors and crystalloid. The objective of this study was to examine varying levels of mechanical support for the treatment of ischemiareperfusion injury in swine.METHODS:
Fifteen swine underwent anesthesia and then a controlled 30% blood volume hemorrhage followed by 30âmin of supra-celiac aortic occlusion to create an ischemia-reperfusion injury Animals were randomized to standardized critical care (SCC), EPACC with low threshold (EPACC-Low), and EPACC with high threshold (EPACC-High). The intervention phase lasted 270âmin after injury Hemodynamic markers and laboratory values of ischemia were recorded.RESULTS:
During the intervention phase, SCC spent 82.4% of the time avoiding proximal hypotension (>60âmm Hg), while EPACC-Low spent 97.6% and EPACC-High spent 99.5% of the time avoiding proximal hypotension, Pâ <â0.001. Renal artery flow was statistically increased in EPACC-Low compared with SCC (2.29âmL/min/kg vs. 1.77âmL/âmin/kg, Pâ <â0.001), while renal flow for EPACC-High was statistically decreased compared with SCC (1.25âmL/min/kg vs. 1.77âmL/min/kg, Pâ <â0.001). EPACC animals required less intravenous norepinephrine, (EPACC-Low 16.23mcg/kg and EPACC-High 13.72âmcg/kg), compared with SCC (59.45âmcg/kg), Pâ=â0.049 and Pâ=â0.013 respectively.CONCLUSIONS:
Compared with SCC, EPACC-High and EPACC-Low had decreased norepinephrine requirements with decreased frequency of proximal hypotension. EPACC-Low paradoxically had increased renal perfusion despite having a mechanical resistor in the aorta proximal to the renal arteries. This is the first description of low volume mechanical hemodynamic support in the setting of profound shock from ischemia-reperfusion injury in swine demonstrating stabilized proximal hemodynamics and augmented distal perfusion.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Choque Hemorrágico
/
Daño por Reperfusión
/
Oclusión con Balón
/
Hipotensión
Tipo de estudio:
Clinical_trials
Límite:
Animals
/
Humans
Idioma:
En
Revista:
Shock
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2022
Tipo del documento:
Article