Abstract
Introduction: It has been suggested that dynamic arterial elastance (Eadyn) can predict decreases in arterial pressure in response to changing norepinephrine levels. The objective of this study was to determine whether Eadyn is correlated with determinants of the vascular waterfall [critical closing pressure (CCP) and systemic arterial resistance (SARi)] in patients treated with norepinephrine.Materials and Methods: Patients treated with norepinephrine for vasoplegia following cardiac surgery were studied. Vascular and flow parameters were recorded immediately before the norepinephrine infusion and then again once hemodynamic parameters had been stable for 15 min. The primary outcomes were Eadyn and its associations with CCP and SARi. The secondary outcomes were the associations between Eadyn and vascular/flow parameters.Results: At baseline, all patients were hypotensive with Eadyn of 0.93 [0.47;1.27]. Norepinephrine increased the arterial blood pressure, cardiac index, CCP, total peripheral resistance (TPRi), arterial elastance, and ventricular elastance and decreased Eadyn [0.40 (0.30;0.60)] and SARi. Eadyn was significantly associated with arterial compliance (CA), CCP, and TPRi (p < 0.05).Conclusion: In patients with vasoplegic syndrome, Eadyn was correlated with determinants of the vascular waterfall. Eadyn is an easy-to-read functional index of arterial load that can be used to assess the patient’s macro/microcirculatory status.Clinical Trial Registration: ClinicalTrials.gov #NCT03478709.
Highlights
It has been suggested that dynamic arterial elastance (Eadyn) can predict decreases in arterial pressure in response to changing norepinephrine levels
The objective of this study was to determine whether Eadyn is correlated with determinants of the vascular waterfall [critical closing pressure (CCP) and systemic arterial resistance (SARi)] in patients treated with norepinephrine
Eadyn was significantly associated with arterial compliance (CA), CCP, and total peripheral resistance (TPRi) (p < 0.05)
Summary
It has been suggested that dynamic arterial elastance (Eadyn) can predict decreases in arterial pressure in response to changing norepinephrine levels. It has been shown that Eadyn can predict (i) the increase in mean arterial pressure (MAP) following a fluid challenge (Monge Garcia et al, 2011) and (ii) the decrease in blood pressure following a decrease in the norepinephrine dose (Guinot et al, 2015, 2017; Nguyen et al, 2021). It is a simple marker, is easy to read, and does not require additional monitoring than that carried out routinely in intensive care (Nguyen et al, 2021). Some studies have evidenced an association between Eadyn and several components of blood pressure: MAP, effective arterial elastance (EA), and arterial compliance (CA; Guinot et al, 2017; Monge García et al, 2017; Bar et al, 2018a)
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