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Jean-Yves Lefrant,
Jean-Marie Juan,
Pascal Bruelle,
Roland Demaria,
Robert Cohendy,
Guy Aya,
Marie-Claire Oliva-Lauraire, Pascale Peray,
Emmanuelle Robert,
Jean-Emmanuel de La Coussaye,
Jean-Jacques Eledjam,
Michel Dauzat
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ABSTRACT: The study of induced circulatory changes requires simultaneous assessment of multiple regional circulations because of interactions and compensatory mechanisms. Positive end expiratory pressure mechanical ventilation (PEEP) is known to cause marked, and potentially deleterious, cardiovascular changes. Our aim was to use a comprehensive approach to assess PEEP-induced circulatory changes in open vs closed abdomen animals.
In the anesthetized rabbit, we used implantable Doppler micro-probes to measure blood flow simultaneously in the ascending aorta, inferior vena cava, portal vein, hepatic artery, common carotid artery, and renal artery. We studied spontaneously breathing animals (Group A), and open (Group B) and closed abdomen (Group C) animals mechanically ventilated at 0 (ZEEP) and 12 cm H(2)O PEEP.
In Group A, all biological and hemodynamic variables remained unchanged for three hours at the end of the surgical procedure. In Groups B and C, ZEEP produced no significant hemodynamic change. PEEP induced a decrease in carotid, hepatic, and renal artery blood flow in Groups B and C, a decrease in heart rate and mean arterial blood pressure in Group B, and a decrease in aorta blood flow in Group C.
These experimental results demonstrate the usefulness of the comprehensive approach of circulatory changes, and confirm that PEEP may have deleterious effects on regional blood flow, even without significant change in cardiac output, especially when the abdomen is open.
Canadian Journal of Anaesthesia 04/2002; 49(3):302-8. · 2.35 Impact Factor
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ABSTRACT: Background:: The aims of the study were to verify the effects of ketamine on ventricular conduction velocity and on the ventricular effective refractory period, to determine its effects on anisotropy and on homogeneity of refractoriness, and to use wavelength to determine whether ketamine has antiarrhythmic or arrhythmogenic properties.
Anesthesiology 11/1997; 87(6):1417–1427. · 5.36 Impact Factor
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ABSTRACT: The purpose of the study was to compare cardiac output (CO) measurement by continuous (CTD) with that by conventional thermodilution
(TD) in critically ill patients. In 19 of 20 critically ill patients requiring a pulmonary artery catheterism, 105 paired
CO measurements were performed by both CTD and TD. Regression analysis showed that: CTD CO = 1.18 TD CO − 0.47. Correlation
coefficient was 0.96. Bias and limit of agreement were — 0.8 and 2.4 L · min−1, respectively. When a Bland and Altman diagram was constructed according to cardiac index ranges, biases were −0.2 and −0.3
and −0.8 L · min−1 · m−2 and limits of agreement were 0.3, 0.7 and 1.6 L · min−1 · m−2 for low (<2.5 L · min−1 · m−2), normal (between 2.5 and 4.5 L · min−1 · m−2) and high (> 4.5 L · min−1 · m−2) cardiac indexes, respectively. It is concluded that CTD, compared with TD, is a reliable method of measuring CO, especially
when cardiac index is ≤4.5 L · min−1 · m−2.
Cette étude avait pour but de comparer les mesures du débit cardiaque réalisées par thermodilution continue (CTD) par rapport
à la thermodilution classique (TD) chez des patients de réanimation. Cent cinq paires de mesures du débit cardiaque ont été
comparées chez 19 des 20 patients de réanimation inclus dans l’étude. L’équation de la droite de régression est CTD CO = 1,18
TD CO − 0,47. Le coefficient de corrélation s’élève à 0,96. L’erreur moyenne et l’intervalle de confiance sont respectivement
de −0,8 et 2,4 L · min−1. En réalisant un diagramme de Bland and Altman selon le niveau d’index cardiaque, les erreurs moyennes s’élèvent à −0,2,
−0,3 et −0,8 L · min−1 · m−2 et les intervalles de confiance à 0,3, 0,7 et 1,6 L · min−1 · m−2, respectivement pour les index cardiaques bas (<2,5 L · min−1 · m−2), normaux (entre 2,5 et 4,5 L · min−1 · m−2) et hauts (> 4,5 L · min−1 · m−2). La thermodilution continue, comparée à la thermodilution classique, est une méthode fiable pour le monitorage du débit
cardiaque surtout pour les index cardiaque ≤4,5 L · min−1 · m−2.
Canadian Journal of Anaesthesia 04/1995; 42(11):972-976. · 2.35 Impact Factor
