Impact of epinephrine and norepinephrine on two dynamic indices in a porcine hemorrhagic shock model

Giraud, Raphael; Siegenthaler, Nils; Arroyo, Diego Andoni; Bendjelid, Karim (2014). Impact of epinephrine and norepinephrine on two dynamic indices in a porcine hemorrhagic shock model. Journal of Trauma and Acute Care Surgery, 77(4), pp. 564-569. Lippincott Williams & Wilkins 10.1097/TA.0000000000000409

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Abstract BACKGROUND: Pulse pressure variations (PPVs) and stroke volume variations (SVVs) are dynamic indices for predicting fluid responsiveness in intensive care unit patients. These hemodynamic markers underscore Frank-Starling law by which volume expansion increases cardiac output (CO). The aim of the present study was to evaluate the impact of the administration of catecholamines on PPV, SVV, and inferior vena cava flow (IVCF). METHODS: In this prospective, physiologic, animal study, hemodynamic parameters were measured in deeply sedated and mechanically ventilated pigs. Systemic hemodynamic and pressure-volume loops obtained by inferior vena cava occlusion were recorded. Measurements were collected during two conditions, that is, normovolemia and hypovolemia, generated by blood removal to obtain a mean arterial pressure value lower than 60 mm Hg. At each condition, CO, IVCF, SVV, and PPV were assessed by catheters and flow meters. Data were compared between the conditions normovolemia and hypovolemia before and after intravenous administrations of norepinephrine and epinephrine using a nonparametric Wilcoxon test. RESULTS: Eight pigs were anesthetized, mechanically ventilated, and equipped. Both norepinephrine and epinephrine significantly increased IVCF and decreased PPV and SVV, regardless of volemic conditions (p < 0.05). However, epinephrine was also able to significantly increase CO regardless of volemic conditions. CONCLUSION: The present study demonstrates that intravenous administrations of norepinephrine and epinephrine increase IVCF, whatever the volemic conditions are. The concomitant decreases in PPV and SVV corroborate the fact that catecholamine administration recruits unstressed blood volume. In this regard, understanding a decrease in PPV and SVV values, after catecholamine administration, as an obvious indication of a restored volemia could be an outright misinterpretation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Arroyo, Diego Andoni

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2163-0755

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Diego Andoni Arroyo

Date Deposited:

13 Oct 2014 12:27

Last Modified:

31 Oct 2015 02:30

Publisher DOI:

10.1097/TA.0000000000000409

BORIS DOI:

10.7892/boris.59144

URI:

https://boris.unibe.ch/id/eprint/59144

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