Cargando…

Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study

BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) allows a high blood volume into systemic circulation abruptly. The primary aim of the study was to investigate the effect of TIPS on systemic, portal hemodynamics, and electric cardiometry (EC) parameters in sedated and sponta...

Descripción completa

Detalles Bibliográficos
Autores principales: Kamel, Yasmin A., Elmoniar, Mahmoud M., Fathi, Yasser I., Lotfi, Mamdouh E., Alwarraky, Mohamed S., Yassen, Khaled A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10220200/
https://www.ncbi.nlm.nih.gov/pubmed/37250237
http://dx.doi.org/10.4103/joacp.joacp_198_21
_version_ 1785049167906734080
author Kamel, Yasmin A.
Elmoniar, Mahmoud M.
Fathi, Yasser I.
Lotfi, Mamdouh E.
Alwarraky, Mohamed S.
Yassen, Khaled A.
author_facet Kamel, Yasmin A.
Elmoniar, Mahmoud M.
Fathi, Yasser I.
Lotfi, Mamdouh E.
Alwarraky, Mohamed S.
Yassen, Khaled A.
author_sort Kamel, Yasmin A.
collection PubMed
description BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) allows a high blood volume into systemic circulation abruptly. The primary aim of the study was to investigate the effect of TIPS on systemic, portal hemodynamics, and electric cardiometry (EC) parameters in sedated and spontaneous breathing patients. Secondary aims?? MATERIAL AND METHODS: Adult consecutive hepatic patients scheduled for elective TIPS were included. Patients were sedated with bispectral index-guided propofol infusion + fentanyl boluses. EC parameters, i.e., cardiac output (CO) and systemic vascular resistance (SVR) were noted. Noninvasive blood pressure, heart rate, central venous pressure (CVP, cmH(2)O), and portal venous pressure (PVP, cmH(2)O) were measured pre- and post-TIPS. RESULTS: Thirty-six people were enrolled (n = 25 included) from Aug 2018 to Dec 2019. Data (expressed in median (IQ)) were: age 33 (27–40) years, body mass index 24 (22.0–27) kg/m(2), child A 60%, B 36%, and C 4%. Post-TIPS, PVP decreased (from 40 [37–45] to 34 [27–37] mmHg, P < 0.001), whereas CVP increased (from 7 [4–10] to 16 [10.0–19.0] mmHg, P < 0.001). The CO increased (P = 0.03) and SVR reduced (P = 0.012). CONCLUSION: The reduction in PVP following successful TIPS insertion elevated the CVP abruptly. EC was able to monitor an immediate increase in the CO and a reduction in SVR in association with the above PVP and CVP changes. The results of this unique study indicate that EC monitoring is promising; however, further evaluation in a larger population and in correlation with other gold-standard CO monitors is still indicated.
format Online
Article
Text
id pubmed-10220200
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-102202002023-05-28 Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study Kamel, Yasmin A. Elmoniar, Mahmoud M. Fathi, Yasser I. Lotfi, Mamdouh E. Alwarraky, Mohamed S. Yassen, Khaled A. J Anaesthesiol Clin Pharmacol Original Article BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) allows a high blood volume into systemic circulation abruptly. The primary aim of the study was to investigate the effect of TIPS on systemic, portal hemodynamics, and electric cardiometry (EC) parameters in sedated and spontaneous breathing patients. Secondary aims?? MATERIAL AND METHODS: Adult consecutive hepatic patients scheduled for elective TIPS were included. Patients were sedated with bispectral index-guided propofol infusion + fentanyl boluses. EC parameters, i.e., cardiac output (CO) and systemic vascular resistance (SVR) were noted. Noninvasive blood pressure, heart rate, central venous pressure (CVP, cmH(2)O), and portal venous pressure (PVP, cmH(2)O) were measured pre- and post-TIPS. RESULTS: Thirty-six people were enrolled (n = 25 included) from Aug 2018 to Dec 2019. Data (expressed in median (IQ)) were: age 33 (27–40) years, body mass index 24 (22.0–27) kg/m(2), child A 60%, B 36%, and C 4%. Post-TIPS, PVP decreased (from 40 [37–45] to 34 [27–37] mmHg, P < 0.001), whereas CVP increased (from 7 [4–10] to 16 [10.0–19.0] mmHg, P < 0.001). The CO increased (P = 0.03) and SVR reduced (P = 0.012). CONCLUSION: The reduction in PVP following successful TIPS insertion elevated the CVP abruptly. EC was able to monitor an immediate increase in the CO and a reduction in SVR in association with the above PVP and CVP changes. The results of this unique study indicate that EC monitoring is promising; however, further evaluation in a larger population and in correlation with other gold-standard CO monitors is still indicated. Wolters Kluwer - Medknow 2023 2022-03-07 /pmc/articles/PMC10220200/ /pubmed/37250237 http://dx.doi.org/10.4103/joacp.joacp_198_21 Text en Copyright: © 2022 Journal of Anaesthesiology Clinical Pharmacology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Kamel, Yasmin A.
Elmoniar, Mahmoud M.
Fathi, Yasser I.
Lotfi, Mamdouh E.
Alwarraky, Mohamed S.
Yassen, Khaled A.
Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study
title Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study
title_full Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study
title_fullStr Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study
title_full_unstemmed Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study
title_short Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study
title_sort monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. a diagnostic test accuracy study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10220200/
https://www.ncbi.nlm.nih.gov/pubmed/37250237
http://dx.doi.org/10.4103/joacp.joacp_198_21
work_keys_str_mv AT kamelyasmina monitoringhaemodynamicchangesduringtransjugularportosystemicshuntinsertionwithelectriccardiometryinsedatedandspontaneousbreathingpatientsadiagnostictestaccuracystudy
AT elmoniarmahmoudm monitoringhaemodynamicchangesduringtransjugularportosystemicshuntinsertionwithelectriccardiometryinsedatedandspontaneousbreathingpatientsadiagnostictestaccuracystudy
AT fathiyasseri monitoringhaemodynamicchangesduringtransjugularportosystemicshuntinsertionwithelectriccardiometryinsedatedandspontaneousbreathingpatientsadiagnostictestaccuracystudy
AT lotfimamdouhe monitoringhaemodynamicchangesduringtransjugularportosystemicshuntinsertionwithelectriccardiometryinsedatedandspontaneousbreathingpatientsadiagnostictestaccuracystudy
AT alwarrakymohameds monitoringhaemodynamicchangesduringtransjugularportosystemicshuntinsertionwithelectriccardiometryinsedatedandspontaneousbreathingpatientsadiagnostictestaccuracystudy
AT yassenkhaleda monitoringhaemodynamicchangesduringtransjugularportosystemicshuntinsertionwithelectriccardiometryinsedatedandspontaneousbreathingpatientsadiagnostictestaccuracystudy