Shock. 2023 Jan 23. doi: 10.1097/SHK.0000000000002085. Online ahead of print.
ABSTRACT
BACKGROUND: The assessment of cardiac output (CO) is a major challenge during shock. The gold standard for CO evaluation is transpulmonary thermodilution, which is an invasive technique. Speckle tracking is an automatized method of analyzing tissue motion using echography. This tool can be used to monitor pulsed arterial diameter variations with low interobserver variability. An experimental model of controlled hemorrhagic shock allows for multiple CO variations. The main aim of this study was to show the correlation between the femoral arterial diameter variations (fADV) and the stroke volume (SV) measured by thermodilution during hemorrhagic shock management and the resuscitation of anesthetized piglets. The secondary objective was to explore the respective correlations between SV and sub-aortic time-velocity index (aoVTI), abdominal aorta ADV (aoADV), carotid ADV (cADV), and subclavian ADV (sclADV).
METHODS: Piglets were bled until mean arterial pressure reached 40 mmHg. Controlled hemorrhage was maintained for thirty minutes before randomizing the piglets to three resuscitation groups-the fluid-filling group (reanimated with saline solution only), NEph group (norepinephrine + saline solution), and Eph group (epinephrin + saline solution). Speckle tracking, echocardiographic, and hemodynamic measures were performed at different stages of the protocol.
RESULTS: Thirteen piglets were recruited and included for statistical analysis. Of all the piglets, 164 fADV measures were attempted, and 160 were successful (98%). The correlation coefficient between fADV and SV was 0.71 (CI95% [0.62; 0.78]; p < 0.01). The correlation coefficient between SV and aoADV, sclADV, and cADV was 0.30 (CI95 % [0.13; 0.46]; p < 0.01), 0.56 (CI95 % [0.45; 0.66], p < 0.01), and 0.15 (CI95 % [-0.01; 0.30], p = 0.06), respectively.
CONCLUSION: In this hemorrhagic shock model using piglets, fADV was strongly correlated with SV.
PMID:36669228 | DOI:10.1097/SHK.0000000000002085
