Application of Cardiovascular Physiology to the Critically Ill Patient.


Journal

Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501

Informations de publication

Date de publication:
21 Dec 2023
Historique:
medline: 21 12 2023
pubmed: 21 12 2023
entrez: 21 12 2023
Statut: aheadofprint

Résumé

To use the ventricular pressure-volume relationship and time-varying elastance model to provide a foundation for understanding cardiovascular physiology and pathophysiology, interpreting advanced hemodynamic monitoring, and for illustrating the physiologic basis and hemodynamic effects of therapeutic interventions. We will build on this foundation by using a cardiovascular simulator to illustrate the application of these principles in the care of patients with severe sepsis, cardiogenic shock, and acute mechanical circulatory support. Publications relevant to the discussion of the time-varying elastance model, cardiogenic shock, and sepsis were retrieved from MEDLINE. Supporting evidence was also retrieved from MEDLINE when indicated. Data from relevant publications were reviewed and applied as indicated. The ventricular pressure-volume relationship and time-varying elastance model provide a foundation for understanding cardiovascular physiology and pathophysiology. We have built on this foundation by using a cardiovascular simulator to illustrate the application of these important principles and have demonstrated how complex pathophysiologic abnormalities alter clinical parameters used by the clinician at the bedside.

Identifiants

pubmed: 38126845
doi: 10.1097/CCM.0000000000006136
pii: 00003246-990000000-00253
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Déclaration de conflit d'intérêts

Dr. Gomez’s institution received funding from the National Institute of Diabetes and Digestive and Kidney Diseases, Baxter, and bioMérieux; he received funding from Trilinear Bioventures, AclRx, Novartis, and the National Kidney Foundation. Dr. Burkhoff received funding from PVLoops. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Références

Meert KL, Banks R, Holubkov R, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Morbidity and mortality in critically ill children II A qualitative patient-level analysis of pathophysiologies and potential therapeutic solutions. Crit Care Med 2020; 48:799–807
Morrow DA, Fang JC, Fintel DJ, et al.; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Council on Quality of Care and Outcomes Research: Evolution of critical care cardiology: Transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation 2012; 126:1408–1428
De Backer D, Vieillard-Baron A: Clinical examination: A trigger but not a substitute for hemodynamic evaluation. Intensive Care Med 2019; 45:269–271
Tibby SM, Hatherill M, Marsh MJ, et al.: Clinicians’ abilities to estimate cardiac index in ventilated children and infants. Arch Dis Child 1997; 77:516–518
Connors AF Jr, McCaffree DR, Gray BA: Evaluation of right-heart catheterization in the critically ill patient without acute myocardial infarction. N Engl J Med 1983; 308:263–267
Stevenson LW, Perloff JK: The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA 1989; 261:884–888
Eagle KA, Quertermous T, Singer DE, et al.: Left ventricular ejection fraction physician estimates compared with gated blood pool scan measurements. Arch Intern Med 1988; 148:882–885
Marantz PR, Tobin JN, Wassertheil-Smoller S, et al.: The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation 1988; 77:607–612
Mimoz O, Rauss A, Rekik N, et al.: Pulmonary artery catheterization in critically ill patients: A prospective analysis of outcome changes associated with catheter-prompted changes in therapy. Crit Care Med 1994; 22:573–579
Eisenberg PR, Jaffe AS, Schuster DP: Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12:549–553
Narang N, Chung B, Nguyen A, et al.: Discordance between clinical assessment and invasive hemodynamics in patients with advanced heart failure. J Card Fail 2020; 26:128–135
Cecconi M, De Backer D, Antonelli M, et al.: Consensus on circulatory shock and hemodynamic monitoring task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40:1795–1815
Weiss SL, Peters MJ, Alhazzani W, et al.: Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020; 21:e52–e106
Tonelli MR, Curtis JR, Guntupalli KK, et al.; ACCP/ATS/SCCM Working Group: An official multi-society statement: The role of clinical research results in the practice of critical care medicine. Am J Respir Crit Care Med 2012; 185:1117–1124
Binanay C, Califf RM, Hasselblad V, et al.; ESCAPE Investigators and ESCAPE Study Coordinators: Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: The ESCAPE trial. JAMA 2005; 294:1625–1633
Chatterjee K: The Swan-Ganz catheters: Past, present, and future. A viewpoint. Circulation 2009; 119:147–152
Harvey S, Harrison DA, Singer M, et al.; PAC-Man study collaboration: Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): A randomised controlled trial. Lancet 2005; 366:472–477
Croskerry P: From mindless to mindful practice—cognitive bias and clinical decision making. N Engl J Med 2013; 368:2445–2448
Norman GR, Monteiro SD, Sherbino J, et al.: The causes of errors in clinical reasoning: Cognitive biases, knowledge deficits, and dual process thinking. Acad Med 2017; 92:23–30
Simpkin AL, Schwartzstein RM: Tolerating uncertainty—the next medical revolution? N Engl J Med 2016; 375:1713–1715
Morris AH: Human cognitive limitations broad, consistent, clinical application of physiological principles will require decision support. Ann Am Thorac Soc 2018; 15(Suppl 1):S53–S56
Royce CS, Hayes MM, Schwartzstein RM: Teaching critical thinking: A case for instruction in cognitive biases to reduce diagnostic errors and improve patient safety. Acad Med 2019; 94:187–194
Gnaegi A, Feihl F, Perret C: Intensive care physicians’ insufficient knowledge of right-heart catheterization at the bedside: Time to act? Crit Care Med 1997; 25:213–220
Iberti TJ, Fischer EP, Leibowitz AB, et al.: A multicenter study of physicians’ knowledge of the pulmonary artery catheter Pulmonary Artery Catheter Study Group. JAMA 1990; 264:2928–2932
Boerma EC, Bootsma IT: Physician factors in utilizing haemodynamic data in patient care. Curr Opin Crit Care 2019; 25:292–297
Perel A, Saugel B, Teboul JL, et al.: The effects of advanced monitoring on hemodynamic management in critically ill patients: A pre and post questionnaire study. J Clin Monit Comput 2016; 30:511–518
Saugel B, Malbrain ML, Perel A: Hemodynamic monitoring in the era of evidence-based medicine. Crit Care 2016; 20:401
Squara P, Bennett D, Perret C: Pulmonary artery catheter: Does the problem lie in the users? Chest 2002; 121:2009–2015
Suga H, Sagawa K: Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res 1974; 35:117–126
Sunagawa K, Maughan WL, Burkhoff D, et al.: Left ventricular interaction with arterial load studied in isolated canine ventricle. Am J Physiol 1983; 245(5 Pt 1):H773–H780
Guyton AC: Determination of cardiac output by equating venous return curves with cardiac response curves. Physiol Rev 1955; 35:123–129
Burkhoff D, Mirsky I, Suga H: Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: A guide for clinical, translational, and basic researchers. Am J Physiol Heart Circ Physiol 2005; 289:H501–H512
Burkhoff D, Tyberg JV: Why does pulmonary venous pressure rise after onset of LV dysfunction: A theoretical analysis. Am J Physiol 1993; 265(5 Pt 2):H1819–H1828
Doshi D, Burkhoff D: Cardiovascular simulation of heart failure pathophysiology and therapeutics. J Card Fail 2016; 22:303–311
Bastos MB, Burkhoff D, Maly J, et al.: Invasive left ventricle pressure-volume analysis: Overview and practical clinical implications. Eur Heart J 2020; 41:1286–1297
Burkhoff D: Pressure-volume loops in clinical research: A contemporary view. J Am Coll Cardiol 2013; 62:1173–1176
Chantler PD, Lakatta EG, Najjar SS: Arterial-ventricular coupling: Mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol (1985) 2008; 105:1342–1351
Guarracino F, Bertini P, Pinsky MR: Cardiovascular determinants of resuscitation from sepsis and septic shock. Crit Care 2019; 23:118
Guarracino F, Ferro B, Morelli A, et al.: Ventriculoarterial decoupling in human septic shock. Crit Care 2014; 18:R80
Ky B, French B, May Khan A, et al.: Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. J Am Coll Cardiol 2013; 62:1165–1172
Nishio R, Sasayama S, Matsumori A: Left ventricular pressure-volume relationship in a murine model of congestive heart failure due to acute viral myocarditis. J Am Coll Cardiol 2002; 40:1506–1514
Pinsky MR, Guarracino F: How to assess ventriculoarterial coupling in sepsis. Curr Opin Crit Care 2020; 26:313–318
Tanaka K, Oshita S, Kitahata H, et al.: Effects of nicardipine on ventriculo-arterial coupling in humans. Br J Anaesth 1998; 81:180–185
Yamamoto K, Kodama K, Masuyama T, et al.: Adverse effects of epinephrine in patients with advanced left ventricular dysfunction: Analysis of ventriculo-arterial coupling. Int J Cardiol 1992; 34:143–155
Suga H: Total mechanical energy of a ventricle model and cardiac oxygen consumption. Am J Physiol Heart Circ Physiol 1979; 236:H498–H505
Zile MR, Brutsaert DL: New concepts in diastolic dysfunction and diastolic heart failure: Part I: Diagnosis, prognosis, and measurements of diastolic function. Circulation 2002; 105:1387–1393
Glantz SA, Parmley WW: Factors which affect the diastolic pressure-volume curve. Circ Res 1978; 42:171–180
Mirsky I, Pasipoularides A: Clinical assessment of diastolic function. Prog Cardiovasc Dis 1990; 32:291–318
Gaasch WH: Left ventricular radius to wall thickness ratio. Am J Cardiol 1979; 43:1189–1194
Gaasch WH, Levine HJ, Quinones MA, et al.: Left ventricular compliance: Mechanisms and clinical implications. Am J Cardiol 1976; 38:645–653
Bronicki RA, Anas NG: Cardiopulmonary interaction. Pediatr Crit Care Med 2009; 10:313–322
Gattinoni L, Chiumello D, Carlesso E, et al.: Bench-to-bedside review: Chest wall elastance in acute lung injury/acute respiratory distress syndrome patients. Crit Care 2004; 8:350–355
Leite-Moreira AF: Current perspectives in diastolic dysfunction and diastolic heart failure. Heart 2006; 92:712–718
Sunagawa K, Sagawa K, Maughan WL: Ventricular interaction with the loading system. Ann Biomed Eng 1984; 12:163–189
Kelly RP, Ting CT, Yang TM, et al.: Effective arterial elastance as index of arterial vascular load in humans. Circulation 1992; 86:513–521
Burkhoff D, Sagawa K: Ventricular efficiency predicted by an analytical model. Am J Physiol 1986; 250(6 Pt 2):R1021–R1027
Little WC, Pu M: Left ventricular-arterial coupling. J Am Soc Echocardiogr 2009; 22:1246–1248
Nevo E: Constrained optimization of ventricular efficiency in normal and failing hearts. Am J Physiol 1993; 264(4 Pt 2):H1292–H1299
Sasayama S, Asanoi H: Coupling between the heart and arterial system in heart failure. Am J Med 1991; 90:14S–18S
Suga H, Hisano R, Hirata S, et al.: Mechanism of higher oxygen consumption rate: Pressure-loaded vs volume-loaded heart. Am J Physiol 1982; 242:H942–H948
Hollenberg SM: Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med 2011; 183:847–855
Fudim M, Kaye DM, Borlaug BA, et al.: Venous tone and stressed blood volume in heart failure: JACC review topic of the week. J Am Coll Cardiol 2022; 79:1858–1869
Magder S, Veerassamy S, Bates JH: A further analysis of why pulmonary venous pressure rises after the onset of LV dysfunction. J Appl Physiol (1985) 2009; 106:81–90
Pang CC: Autonomic control of the venous system in health and disease: Effects of drugs. Pharmacol Ther 2001; 90:179–230
Greenway CV: Mechanisms and quantitative assessment of drug effects on cardiac output with a new model of the circulation. Pharmacol Rev 1981; 33:213–251
Greenway CV, Lautt WW: Effects of infusions of catecholamines, angiotensin, vasopressin and histamine on hepatic blood volume in the anaesthetized cat. Br J Pharmacol 1972; 44:177–184
Arimura H, Bosnjak ZJ, Hoka S, et al.: Catecholamine-induced changes in vascular capacitance and sympathetic nerve activity in dogs. Can J Physiol Pharmacol 1992; 70:1021–1031
Chang PI, Rutlen DL: Effects of beta-adrenergic agonists on splanchnic vascular volume and cardiac output. Am J Physiol 1991; 261(5 Pt 2):H1499–H1507
Caravita S, Baratto C, Di Marco F, et al.: Haemodynamic characteristics of COVID-19 patients with acute respiratory distress syndrome requiring mechanical ventilation: An invasive assessment using right heart catheterization. Eur J Heart Fail 2020; 22:2228–2237
Ceneviva G, Paschall JA, Maffei F, et al.: Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 1998; 102:e19
Mercier JC, Beaufils F, Hartmann JF, et al.: Hemodynamic patterns of meningococcal shock in children. Crit Care Med 1988; 16:27–33
Parker MM, Shelhamer JH, Natanson C, et al.: Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: Heart rate as an early predictor of prognosis. Crit Care Med 1987; 15:923–929
Pollack MM, Fields AI, Ruttimann UE: Sequential cardiopulmonary variables of infants and children in septic shock. Crit Care Med 1984; 12:554–559
Vieillard-Baron A, Prin S, Chergui K, et al.: Hemodynamic instability in sepsis: Bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med 2003; 168:1270–1276
Guarracino F, Baldassarri R, Pinsky MR: Ventriculo-arterial decoupling in acutely altered hemodynamic states. Crit Care 2013; 17:213
Perel A: Bench-to-bedside review: The initial hemodynamic resuscitation of the septic patient according to surviving sepsis campaign guidelines—does one size fit all? Crit Care 2008; 12:223
Davis AL, Carcillo JA, Aneja RK, et al.: American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med 2017; 45:1061–1093
Evans L, Rhodes A, Alhazzani W, et al.: Executive summary: Surviving sepsis campaign: International guidelines for the management of sepsis and septic shock 2021. Crit Care Med 2021; 49:1974–1982
Levy MM, Evans LE, Rhodes A: The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018; 44:925–928
Diepen S, Katz JN, Albert NM, et al.: Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation 2017; 136:e232–e268
Jentzer JC, Pöss J, Schaubroeck H, et al.: Advances in the management of cardiogenic shock. Crit Care Med 2023; 51:1222–1233
Kociol RD, Cooper LT, Fang JC, et al.; American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology: Recognition and initial management of fulminant myocarditis: A scientific statement from the American Heart Association. Circulation 2020; 141:e69–e92
Law YM, Lal AK, Chen S, et al.; American Heart Association Pediatric Heart Failure and Transplantation Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young and Stroke Council: Diagnosis and management of myocarditis in children: A scientific statement from the American Heart Association. Circulation 2021; 144:e123–e135
Maconochie IK, Aickin R, Hazinski MF, et al.; Pediatric Life Support Collaborators: Pediatric life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2020; 142(16_suppl_1):S140–S184
Ezad SM, Ryan M, Donker DW, et al.: Unloading the left ventricle in venoarterial ECMO: In whom, when, and how? Circulation 2023; 147:1237–1250
Kloner RA: Can myocardial infarct size be reduced by mechanically unloading the left ventricle? Circulation 2013; 128:318–321
Rao P, Khalpey Z, Smith R, et al.: Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail 2018; 11:e004905
Tamareille S, Achour H, Amirian J, et al.: Left ventricular unloading before reperfusion reduces endothelin-1 release and calcium overload in porcine myocardial infarction. J Thorac Cardiovasc Surg 2008; 136:343–351
Todaka K, Ogino K, Gu A, et al.: Effect of ventricular stretch on contractile strength, calcium transient, and cAMP in intact canine hearts. Am J Physiol 1998; 274:H990–1000
Uchida K, Scarborough EA, Prosser BL: Cardiomyocyte microtubules: Control of mechanics, transport, and remodeling. Annu Rev Physiol 2022; 84:257–283
Uriel N, Sayer G, Annamalai S, et al.: Mechanical unloading in heart failure. J Am Coll Cardiol 2018; 72:569–580
Zhang J, Narula J: Molecular biology of myocardial recovery. Surg Clin North Am 2004; 84:223–242
Nicolosi AC, Kwok CS, Contney SJ, et al.: Gadolinium prevents stretch-mediated contractile dysfunction in isolated papillary muscles. Am J Physiol Heart Circ Physiol 2001; 280:H1122–H1128
Burkhoff D, Sayer G, Doshi D, et al.: Hemodynamics of mechanical circulatory support. J Am Coll Cardiol 2015; 66:2663–2674
Bachofen H, Schürch S, Weibel ER: Experimental hydrostatic pulmonary edema in rabbit lungs barrier lesions. Am Rev Respir Dis 1993; 147:997–1004
West JB: Invited review: Pulmonary capillary stress failure. J Appl Physiol (1985) 2000; 89:2483–9;discussion 2497
Bachofen H, Schürch S, Michel RP, et al.: Experimental hydrostatic pulmonary edema in rabbit lungs morphology. Am Rev Respir Dis 1993; 147:989–996
Donker DW, Burkhoff D, Mack MJ: ECMO: We need to vent about the need to vent! J Am Coll Cardiol 2022; 79:1251–1253
Stewart GC: Finding the right time and place to vent. JACC Heart Fail 2018; 6:1044–1046

Auteurs

Ronald A Bronicki (RA)

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

Sebastian Tume (S)

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

Hernando Gomez (H)

Critical Care Medicine Department, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Cameron Dezfulian (C)

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

Daniel J Penny (DJ)

Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

Michael R Pinsky (MR)

Critical Care Medicine Department, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Daniel Burkhoff (D)

Cardiovascular Research Foundation, New York, NY.

Classifications MeSH