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2.
Transplant Proc ; 51(9): 2943-2947, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31607621

RESUMO

INTRODUCTION: The aim of the present investigation was to retrospectively evaluate the utilization of Swan-Ganz catheter during orthotopic liver transplantation as opposed to FloTrac/Vigileo in selected cases, comparing a number of clinical outcomes across postoperative hospitalization. MATERIALS AND METHODS: Before 2015 all recipients received pulmonary artery catheter (Swan-Ganz group, n = 109). After 2015 Swan-Ganz was used only if coronary artery disease or high-grade portal hypertension or Child-Pugh C were present; the remaining recipients were assigned to FloTrac/Vigileo monitoring (Mini group, n =100). A number of clinical outcomes were considered. RESULTS: Donor's Risk Index was similar between groups (median value 1.7, P = .27). Anthropometric characteristics of the recipients were similar in the 2 groups. There were no significant differences in the proportion of patients with Child-Pugh C (P = .873), coronary artery disease (P = .18), and grade of portal hypertension (P = .733). The Model for End-Stage Liver Disease score was slightly higher in the Mini group: (9 [7-11] vs 9 [8-12], Swan-Ganz vs Mini, respectively, P < .035). Swan-Ganz utilization decreased over time (92% vs 26%, Swan-Ganz vs Mini, P < .001). Upon admission to the intensive care unit, patients of the Mini group presented a higher SAPS II score with similar values of Sequential Organ Failure Assessment score. Days on mechanical ventilation were similar between groups. The incidence of graft failure was similar between groups (2% vs 5%, Swan-Ganz and Mini group respectively, P = .376). Recipients' hospital length of stay was similar (13 days [11-19] vs 14 [11-20], P < .083). CONCLUSIONS: Our data suggest that the intraoperative utilization of FloTrac/Vigileo for oncologic patients with low grade end stage liver disease is reasonably safe.


Assuntos
Monitorização Hemodinâmica/métodos , Transplante de Fígado/métodos , Monitorização Intraoperatória/métodos , Cateterismo de Swan-Ganz , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/instrumentação , Estudos Retrospectivos
3.
J Vet Med Sci ; 81(10): 1485-1491, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31484835

RESUMO

Basic information related to the association between right heart echocardiographic parameters and invasive pulmonary artery pressure (PAP) in dogs with pulmonary hypetension (PH) is scarce. The aim of this study was to examine the association between conventional right heart echocardiographic parameters and invasive PAP by right heart catheterization (RHC) before and after PH. Five female beagle dogs regarded as clinically healthy were used. Echocardiography and RHC were conducted before and after creating chronic embolic pulmonary hypertension (CEPH) models. The acceleration time to ejection time ratio in pulmonary artery flow profile (AT/ET), the ratio of the pulmonary artery and aortic diameter in diastole (PA/Ao), the right pulmonary artery distensibility index by M-mode method (RPAD M-mode), the normalized right ventricular internal diameter in diastole (RVIDdn), and the normalized tricuspid annular plane systolic excursion (TAPSEn) were correlated with the invasive systolic PAP (sPAP), mean PAP (mPAP) and diastolic PAP (dPAP). Multiple linear regression analysis identified AT/ET and RVIDdn as independent predictors of sPAP, PA/Ao and RVIDdn as independent predictors of mPAP, and PA/Ao and RPAD M-mode as independent predictors of dPAP. AT/ET and PA/Ao had high sensitivity and specificity for predicting CEPH. In conclusion, AT/ET, PA/Ao, RPAD M-mode, RVIDdn and TAPSEn were significantly correlated with invasive PAP and alterations in PA/Ao or AT/ET might enable clinicians to predict PH, even if tricuspid regurgitation is not observed.


Assuntos
Cateterismo de Swan-Ganz/veterinária , Doenças do Cão/fisiopatologia , Ecocardiografia Doppler/veterinária , Hipertensão Pulmonar/veterinária , Animais , Doença Crônica , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Coração/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia
4.
Scand Cardiovasc J ; 53(5): 235-246, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327253

RESUMO

Objective. To examine how liver function (LF) relates to invasive hemodynamics cross-sectionally and longitudinally, in advanced heart failure (AHF) patients treated with maximally tolerated medical HF therapy. Design. A retrospective study of 309 consecutive AHF patients with a left ventricular ejection fraction < 45% treated with maximally tolerated medical HF therapy who were referred for AHF therapies. All patients underwent right heart catheterization (RHC) using Swan-Ganz catheters. Cardiac output was measured using thermodilution. Measurements of pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP) were obtained. RHC and evaluation of LF were repeated (median (IQR) = 186.5 (150-208) days) in 33 patients. Results. Mean (SD) age was 50 (±13) years, and 239 (77%) were men. Only 22 (7%) were treated with inotropes, and none were receiving mechanical circulatory support. Median (IQR) plasma alanine transaminase (ALT) was 32 (22-53) U/l, alkaline phosphatase (ALP) 82 (63-122) U/l, bilirubin 14 (9-22) µmol/l, albumin 39 (35-43) g/l, lactate dehydrogenase 212 (175-275) U/l, and the prothrombin time/International Normalized Ratio (PT/INR) 1.1 (1.0-1.3). In multivariate analyses significant associations between LF tests and hemodynamics were seen for CVP: ALP (ß = 0.031, p = .0002), bilirubin (ß = 0.027, p = .004), and INR (ß = 0.013, p = .002). PCWP (ß = 0.020, p = .002) and CI (ß = -0.17, p = .005) were also associated with bilirubin. Over time, changes in bilirubin correlated positively with changes in CVP (ß = 1.496, p = .005). Conclusion. In optimally treated AHF patients, CVP was associated with both markers of biliary excretion and liver synthesis function, whereas changes in CVP were associated with changes in markers of biliary excretion. Decongestion may improve measures of LF in AHF.


Assuntos
Bilirrubina/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Fígado/metabolismo , Albumina Sérica Humana/metabolismo , Adulto , Pressão Arterial , Biomarcadores/sangue , Débito Cardíaco , Cateterismo de Swan-Ganz , Pressão Venosa Central , Estudos Transversais , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Coeficiente Internacional Normatizado , Testes de Função Hepática , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Pressão Propulsora Pulmonar , Estudos Retrospectivos , Fatores de Tempo
5.
Crit Care Nurs Clin North Am ; 31(3): 329-348, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351554

RESUMO

The hemodynamic monitoring landscape is rapidly evolving from pressure-based and static parameters to more blood flow-based and dynamic parameters. Consensus guidelines for cardiac surgery state that the pulmonary artery catheter is neither required nor helpful in most patients. In the meantime, critical care has been searching for the alternatives to the pulmonary artery catheter and protocols for use. Best available evidence for any protocol developed suggests the inclusion of stroke volume optimization to determine fluid responsiveness. Additional strategies to using stroke volume to optimize hemodynamics, including case studies, are discussed.


Assuntos
Algoritmos , Procedimentos Cirúrgicos Cardíacos/reabilitação , Volume Sistólico/fisiologia , Cateterismo de Swan-Ganz/efeitos adversos , Enfermagem de Cuidados Críticos , Humanos
6.
J Trauma Acute Care Surg ; 87(2): 379-385, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31349350

RESUMO

BACKGROUND: Compared with a pulmonary artery catheter (PAC), transthoracic echocardiography (TTE) has been shown to have good agreement in cardiac output (CO) measurement in nonsurgical populations. Our hypothesis is that the feasibility and accuracy of CO measured by TTE (CO-TTE), relative to CO measured by PAC thermodilution (CO-PAC), is different in surgical intensive care unit patients (SP) and nonsurgical patients (NSP). METHODS: Surgical patients with PAC for hemodynamic monitoring and NSP undergoing right heart catheterization were prospectively enrolled. Cardiac output was measured by CO-PAC and CO-TTE. Pearson coefficients were used to assess correlation. Bland-Altman analysis was used to determine agreement. RESULTS: Over 18 months, 84 patients were enrolled (51 SP, 33 NSP). Cardiac output TTE could be measured in 65% (33/51) of SP versus 79% (26/33) of NSP; p = 0.17. Inability to measure the left ventricular outflow tract diameter was the primary reason for failure in both groups; 94% (17/18) in SP versus 86% (6/7) NSP; p = 0.47. Velocity time integral could be measured in all patients. In both groups, correlation between PAC and TTE measurement was strong; SP (r = 0.76; p < 0.0001), NSP (r = 0.86; p < 0.0001). Bland-Altman analysis demonstrated bias of -0.1 L/min, limits of agreement of -2.5 and +2.3 L/min, percentage error (PE) of 40% for SP, and bias of +0.4 L/min, limits of agreement of -1.8 and +2.5 L/min, and PE of 40% for NSP. CONCLUSION: There was strong correlation and moderate agreement between TTE and PAC in both SP and NSP. In both patient populations, inability to measure the left ventricular outflow tract diameter was a limiting factor. LEVEL OF EVIDENCE: Diagnostic tests or criteria, level III.


Assuntos
Débito Cardíaco , Ecocardiografia , Cateterismo de Swan-Ganz , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios , Termodiluição
8.
A A Pract ; 13(5): 181-184, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31162226

RESUMO

Placement of a pulmonary artery catheter (PAC) is associated with complications such as entrapment or knotting. PAC entrapment in the heart, vena cava, or pulmonary artery is serious, potentially life-threatening, particularly if they are unrecognized. We present a patient with a PAC knot after aortic valve replacement. Interventional radiology (IR) determined that the catheter may have lodged in the tricuspid valve. Surgical exploration requiring cardiopulmonary bypass revealed that the PAC had passed through the tricuspid valve orifice and knotted itself around the anterior leaflet chordal structure. The catheter was unknotted, with the patient subsequently recovering without long-term sequelae.


Assuntos
Estenose da Valva Aórtica/cirurgia , Ponte Cardiopulmonar/métodos , Cateterismo de Swan-Ganz/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Procedimentos Cirúrgicos Eletivos , Próteses Valvulares Cardíacas , Humanos , Masculino , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia
9.
Crit Care Nurs Q ; 42(3): 304-314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135481

RESUMO

Pulmonary artery catheters (PACs) are invasive devices placed in critically ill patients to monitor hemodynamic data. They are a high-risk, and in some settings a low-volume, medical device due to the complex insertion procedure and potentially lethal complications. Smaller intensive care units (ICUs) have large variances in exposure to PACs, therefore strengthening ICU nurses' belief in their ability to manage these hemodynamic monitoring devices is of utmost importance. The design is a single-group, pre/posttest study conducted on a 15-bed ICU to survey nurses' self-efficacy, knowledge, and satisfaction of an e-learning educational module. Both PAC and noninvasive cardiac output monitor patient application data were collected prior to and following the intervention. Fifteen ICU nurses completed all components of the module. Confidence in ability to accurately interpret hemodynamic data increased from pre- to postintervention (P < .001), and knowledge also increased from pre- to postintervention, albeit not statistically significantly (P = .088). Overall, nurses reported satisfaction with the educational module. With increased self-efficacy, nurses can feel empowered and motivated to further improve patient care management. Thus, workplaces should continue to advocate for additional educational tools for high-risk, low-volume devices.


Assuntos
Cateterismo de Swan-Ganz/métodos , Enfermagem de Cuidados Críticos/educação , Educação a Distância , Hemodinâmica , Artéria Pulmonar , Adulto , Avaliação Educacional , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Autoeficácia
10.
Int J Cardiovasc Imaging ; 35(9): 1661-1670, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31049752

RESUMO

Assessment of right ventricular (RV) function is crucial since RV failure with a reduced cardiac output (CO) is associated with compromised outcome in cardiac surgery. Echocardiographic evaluation of RV function is commonly used, but a reduction in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus tissue Doppler imaging (S') have been observed independently of clinical signs of RV failure. This has led to uncertainty of these variables' validity in cardiac surgery. To describe transesophageal echocardiographic (TEE) measures of RV function during coronary artery bypass graft surgery with detailed haemodynamic assessment using pulmonary artery catheter (PAC) measurements to describe "natural" changes in the absence of RV failure. We prospectively studied 30 patients with concomitant PAC and TEE measurements at four time-points, namely after: anaesthesia induction, sternotomy, cardiopulmonary bypass (CPB) and upon arrival in the intensive care unit. TAPSE and S' were significantly reduced by 43% (p < 0.0001) and 22% (p = 0.006), respectively after CPB without any change in stroke volume (SV). RV ejection fraction (RVEF), RV fractional area change (RVFAC) and global longitudinal strain (RV-GLS) remained unchanged. SV measured with 3D echocardiography correlated with PAC measured SV (r = 0.66[95% CI 0.50; 0.78], p < 0.0001), but 3D showed a minor, but statistically significant underestimation of SV (8.5 ml (95% CI 2.7 ml; 14 ml, p = 0.004). TAPSE and S' were both reduced after CPB despite maintained CO. RVFAC, RVEF and RV-GLS remained stable, however, these measures were unable to detect minor changes in SV. 3D-echocardiographyshowed a strong correlation with SV measured by thermodilution, but with a consistent underestimation of approximately 10%.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Idoso , Cateterismo de Swan-Ganz , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Termodiluição , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia
11.
Br J Hosp Med (Lond) ; 80(4): 204-210, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951425

RESUMO

Cardiogenic shock remains a major problem affecting a large proportion of patients with acute coronary syndromes, with a persistent high mortality rate. Although mechanical reperfusion with percutaneous coronary intervention has improved outcomes following acute coronary syndromes, there is limited evidence supporting the other current treatments used to manage patients with cardiogenic shock (intra-aortic balloon pumps, percutaneous left ventricular assist devices and extracorporeal membrane oxygenation). This article looks at these options, assessing current evidence and recent advances. It also discusses areas that still require research to ensure there is improvement in these high-risk patients, such as coordinated regionalised approaches to cardiogenic shock management with multidisciplinary care provided in designated tertiary shock centres.


Assuntos
Síndrome Coronariana Aguda/terapia , Cardiotônicos/uso terapêutico , Oxigenação por Membrana Extracorpórea/métodos , Coração Auxiliar , Balão Intra-Aórtico/métodos , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/terapia , Vasoconstritores/uso terapêutico , Síndrome Coronariana Aguda/complicações , Cateterismo de Swan-Ganz , Gerenciamento Clínico , Hidratação , Humanos , Choque Cardiogênico/etiologia
12.
J Invasive Cardiol ; 31(5): E95, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034443
13.
Int J Cardiovasc Imaging ; 35(8): 1443-1452, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30877411

RESUMO

Acute pulmonary embolism (PE) is a major public health problem and accounts for 100,000-180,000 deaths per year in the United States. Current prognostic stratification separates acute PE into massive, submassive, and low-risk by the presence or absence of sustained hypotension, RV dysfunction, and myocardial necrosis. Massive, submassive and low-risk PE have mortality rates of 25-65%, 3%, and < 1%, respectively. In this review we will focus on therapies currently available to manage acute massive and submassive PE.


Assuntos
Embolectomia , Procedimentos Endovasculares/métodos , Artéria Pulmonar/cirurgia , Embolia Pulmonar/terapia , Terapia Trombolítica , Doença Aguda , Cateterismo de Swan-Ganz , Angiografia por Tomografia Computadorizada , Embolectomia/efeitos adversos , Embolectomia/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Hemodinâmica , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Circulação Pulmonar , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/fisiopatologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Resultado do Tratamento
14.
J Invasive Cardiol ; 31(4): E56-E57, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30927533

RESUMO

Our experience suggests that ultrasound-assisted thrombolysis with the EkoSonic system could be a valid bail-out strategy in cases of massive pulmonary embolism unresponsive to systemic thrombolysis and provides insight into the role of prolonged administration time in non-high bleeding risk patients with elevated thrombotic burden and initial suboptimal results. In this setting, multimodality imaging could guide patient selection and monitor treatment efficacy to individualize its duration in cases of slow hemodynamic improvement.


Assuntos
Cateterismo de Swan-Ganz/métodos , Artéria Pulmonar , Embolia Pulmonar , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Ultrassonografia de Intervenção/métodos , Angiografia por Tomografia Computadorizada/métodos , Ecocardiografia/métodos , Fibrinolíticos/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Terapia Trombolítica/instrumentação , Terapia Trombolítica/métodos , Resultado do Tratamento
15.
Ultrasound Obstet Gynecol ; 54(1): 35-50, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30737852

RESUMO

Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non-invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical-care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Débito Cardíaco/fisiologia , Ecocardiografia/métodos , Hemodinâmica/fisiologia , Resistência Vascular/fisiologia , Adulto , Pressão Sanguínea/fisiologia , Cateterismo de Swan-Ganz/métodos , Feminino , Coração/diagnóstico por imagem , Coração/fisiologia , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Gravidez , Gestantes , Análise de Onda de Pulso/métodos , Ultrassonografia Doppler/métodos
16.
J Vis Exp ; (143)2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30735186

RESUMO

A variety of pathologies lead to pulmonary hypertension (PH), which is defined as a mean pulmonary artery pressure exceeding 25 mmHg at rest. To further diagnose and manage PH, patients undergo repeated right heart catheterizations (RHC) wherein a Swan-Ganz catheter is advanced into a branch of the pulmonary artery and a balloon is inflated to wedge the catheter tip. This article illustrates a protocol whereby pulmonary artery endothelial cells (PAECs) may be harvested from the balloon tips of Swan-Ganz catheters after RHC, and purified with an anti- CD146 affinity column technique to purify putative PAECs. These cells might be used to provide an in situ snapshot of the biological state of the pulmonary vasculature endothelium to complement hemodynamic measurements obtained during RHC. Harvested and purified PAECs may be used for either cell culture or for subsequent analytical assays such as flow cytometery.


Assuntos
Cateterismo Cardíaco/métodos , Separação Celular/métodos , Células Endoteliais , Artéria Pulmonar/citologia , Cateterismo de Swan-Ganz , Humanos , Hipertensão Pulmonar
17.
Int J Cardiovasc Imaging ; 35(8): 1435-1442, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30715668

RESUMO

BACKGROUND: Periodic echo-based screening to detect early stages of a rare complication of dasatinib, pulmonary arterial hypertension (PAH), is inefficient and weakens the potential benefit of dasatinib as a potent drug for chronic myelogenous leukemia (CML). This study aimed to identify the predisposing factors of DASA-PAH to stratify high-risk patients for dasatinib-induced PAH (DASA-PAH). METHODS: Sixty consecutive adult patients who received dasatinib were enrolled in this case-control study. We defined DASA-PAH when at least one of the following four criteria was met: (1) recent electrocardiographic changes indicating right ventricular pressure overload, (2) estimated systolic pulmonary arterial pressure > 40 mmHg measured by Doppler echocardiography; (3) computed tomography (CT)-measured pulmonary artery to aorta diameter (PaD/AoD) ratio > 1; and (4) mean pulmonary arterial pressure > 25 mmHg and pulmonary artery wedge pressure < 15 mmHg measured by right heart catheterization. RESULTS: We identified 13 patients with DASA-PAH among 59 patients analyzed. Baseline PaD/AoD ratios of patients who developed DASA-PAH (PH group) were significantly larger than those who did not (NPH group). A dramatic rise in PaD/AoD ratio after dasatinib treatment was observed. Interestingly, the EUTOS score and spleen size were significantly smaller in the PH than in the NPH group. CONCLUSION: High baseline PaD/AoD ratio and low EUTOS score were associated with DASA-PAH development. The spleen might play a protective role against DASA-PAH.


Assuntos
Antineoplásicos/efeitos adversos , Aorta/diagnóstico por imagem , Pressão Arterial , Angiografia por Tomografia Computadorizada , Dasatinibe/efeitos adversos , Hipertensão Pulmonar/diagnóstico por imagem , Inibidores de Proteínas Quinases/efeitos adversos , Artéria Pulmonar/diagnóstico por imagem , Idoso , Aorta/fisiopatologia , Pressão Arterial/efeitos dos fármacos , Estudos de Casos e Controles , Cateterismo de Swan-Ganz , Ecocardiografia Doppler , Feminino , Humanos , Hipertensão Pulmonar/induzido quimicamente , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/fisiopatologia , Pressão Propulsora Pulmonar , Medição de Risco , Fatores de Risco , Baço/diagnóstico por imagem , Fatores de Tempo
18.
Circ Heart Fail ; 12(1): e005512, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30616360

RESUMO

BACKGROUND: Right ventricular (RV) maladaptation and failure determine outcome in pulmonary hypertension. The adaptation of RV function to loading (RV-pulmonary arterial coupling) is defined by a ratio of end-systolic to arterial elastances (Ees/Ea). How RV-pulmonary arterial coupling relates to pulmonary hypertension severity and onset of RV failure (defined by excessive volume increase and ejection fraction [EF] decrease) is not exactly known. METHODS AND RESULTS: We performed cardiac magnetic resonance (CMR) imaging within 24 hours of a diagnostic right heart catheterization and invasive measurement of RV pressure-volume loops in 42 patients with pulmonary hypertension. Median (interquartile range) Ees and Ea were 0.49 (0.35-0.74) and 0.74 (0.45-1.04) mm Hg/mL, respectively; Ees/Ea was 0.73 (0.47-1.07). End-diastolic elastance (Eed) was 0.14 (0.06-0.24) mm Hg/mL. RV EF was 39±13%. End-systolic volume and end-diastolic volume/body surface area (BSA) were 62 (45-101) and 104 (83-143) mL/m2, respectively. Ees/Ea decreased with increasing RV end-diastolic volume/BSA, mass/BSA, and pulmonary arterial stiffness, and with decreasing EF, from 0.89 to 1.09 in the least impaired tertiles to 0.55 to 0.61 in the most impaired tertiles. Eed increased with increasing RV mass/BSA, end-diastolic volume/BSA, and T1 mapping and with decreasing EF. Receiver operating characteristic analysis identified an Ees/Ea cutoff of 0.805 associated with onset of RV failure defined by increased RV volumes with EF <35%. CONCLUSIONS: RV-pulmonary arterial coupling (Ees/Ea) has considerable reserve, from normal values of 1.5-2 to <0.8, and has the ability to detect pending RV failure in patients with pulmonary hypertension. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT03403868.


Assuntos
Pressão Arterial , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/complicações , Artéria Pulmonar/fisiopatologia , Volume Sistólico , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita , Adaptação Fisiológica , Idoso , Cateterismo de Swan-Ganz , Doença Crônica , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/fisiopatologia , Remodelação Ventricular
19.
Int J Cardiovasc Imaging ; 35(5): 861-868, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30666551

RESUMO

Echocardiographic assessment of diastolic dysfunction depends on surrogate parameters. In recent years, guideline committees attempted to combine these parameters to diagnostic flowcharts allowing for correct classification of left ventricular filling pressures (LVFP). The value of these diagnostic tools is limited if the applied surrogate parameters are elevated due to other reasons as is the case with maximal tricuspid regurgitation velocity. We aimed to compare the accuracy of the 2009 and the 2016 guideline recommendations in patients with pulmonary hypertension (PH). We included 101 consecutive patients who underwent right heart catheterization and transthoracic echocardiography for suspicion of PH. For the final analysis, only patients with PH were considered. The 2009 and 2016 recommendations for the assessment of diastolic function by echocardiography were applied on each patient. A total of 63 PH patients were included in the final analysis, 43% had elevated LVFP. By using the 2009 recommendations, sensitivity for correct classification of diastolic dysfunction was 67%, specificity was 82%, area under the curve (AUC) was 0.74. By using the 2016 recommendations, sensitivity for correct classification of diastolic dysfunction was 84%, specificity was 80%, AUC was 0.82. In ROC comparison, the AUC for the 2016 recommendations with 0.82 was significantly better compared to the AUC of 0.74 for the 2009 recommendations (p = 0.04). Our study demonstrates that the 2016 recommendations for echocardiographic evaluation of diastolic function are superior to the 2009 recommendations in estimating left ventricular filling pressures in patients with PH.


Assuntos
Ecocardiografia Doppler , Hipertensão Pulmonar/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Pressão Ventricular , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo de Swan-Ganz , Diástole , Ecocardiografia Doppler/normas , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
20.
REME rev. min. enferm ; 23: e-1267, jan.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1048093

RESUMO

OBJETIVOS: identificar fatores que alteram a confiabilidade da temperatura axilar em relação à temperatura de cateter artéria pulmonar. MÉTODOS: estudo de medidas repetidas utilizando 67 aferições de temperatura axilar coletadas de 24 pacientes internados em centros de terapia intensiva de dois hospitais da região metropolitana de Belo Horizonte entre 2017 e 2018. Realizada análise descritiva e regressão linear dos dados. RESULTADOS: foram encontradas acurácia de 0,48 e precisão de 0,47 referentes à temperatura axilar aferida com termômetro digital comparada com a temperatura de cateter de artéria pulmonar. Os fatores que alteram a confiabilidade da temperatura axilar foram o índice de massa corporal e a dose de dobutamina. CONCLUSÃO: os fatores encontrados foram inéditos em relação à alteração da confiabilidade da temperatura axilar e poderão auxiliar enfermeiros na tomada de decisão ao escolherem um método mais preciso para estimativa da temperatura real do corpo. Ainda é necessária a realização de estudos com amostragem maior para avaliação dos fatores intervenientes da confiabilidade de técnicas de temperatura não invasivas, como a temperatura axilar.(AU)


Objectives: to identify factors that alter the reliability of axillary temperature in relation to pulmonary artery catheter temperature. Methods: studying repeated measures using 67 axillary temperature measurements collected from 24 patients admitted to intensive care centers of two hospitals in the metropolitan region of Belo Horizonte between 2017 and 2018. Descriptive analysis and linear regression of the data were performed. Results: accuracy of 0.48 and precision of 0.47 were found for axillary temperature measured with a digital thermometer compared with pulmonary artery catheter temperature. Factors that change the reliability of axillary temperature were body mass index and dobutamine dose. Conclusion: the found factors were unprecedented in relation to the change in axillary temperature reliability and may help nurses in their decision making by choosing a more accurate method to estimate the actual body temperature. Studies with larger sampling are still necessary to evaluate the intervening factors of the reliability of noninvasive temperature techniques, such as axillary temperature.(AU)


Objetivos: identificar los factores que alteran la fiabilidad de la temperatura axilar en relación con la temperatura del catéter de la arteria pulmonar. Métodos: estudio de mediciones repetidas utilizando 67 mediciones de temperatura axilar de 24 pacientes ingresados en centros de cuidados intensivos de dos hospitales de la región metropolitana de Belo Horizonte entre 2017 y 2018. Análisis descriptivo y regresión lineal de los datos. Resultados: se encontró precisión de 0,48 y precisión de 0,47 para la temperatura axilar medida con termómetro digital en comparación a la temperatura del catéter de la arteria pulmonar. Los factores que alteran la fiabilidad de la temperatura axilar fueron el índice de masa corporal y la dosis de dobutamina. Conclusión: los factores encontrados no tienen precedentes en relación con la alteración en la confiabilidad de la temperatura axilar y pueden ayudar a los enfermeros en la toma de decisiones al elegir un método más preciso para estimar la temperatura corporal real. Son necesarios estudios con muestras más amplias para evaluar los factores que intervienen en la fiabilidad de las técnicas de temperatura no invasivas, como la temperatura axilar.(AU)


Assuntos
Artéria Pulmonar , Axila , Termômetros , Temperatura Corporal , Cateterismo de Swan-Ganz , Fatores de Risco
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