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 spont...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
| Subjects: | |
| Online Access: | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=1;spage=127;epage=133;aulast=Kamel |
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| author | Yasmin A Kamel Mahmoud M Elmoniar Yasser I Fathi Mamdouh E Lotfi Mohamed S Alwarraky Khaled A Yassen |
| author_facet | Yasmin A Kamel Mahmoud M Elmoniar Yasser I Fathi Mamdouh E Lotfi Mohamed S Alwarraky Khaled A Yassen |
| author_sort | Yasmin A Kamel |
| collection | DOAJ |
| 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, cmH2O), and portal venous pressure (PVP, cmH2O) 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/m2, 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. |
| first_indexed | 2024-03-12T22:15:30Z |
| format | Article |
| id | doaj.art-04eba8a2a0d84d548b6204fd833d1235 |
| institution | Directory Open Access Journal |
| issn | 0970-9185 |
| language | English |
| last_indexed | 2024-03-12T22:15:30Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj.art-04eba8a2a0d84d548b6204fd833d12352023-07-23T11:17:37ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852023-01-0139112713310.4103/joacp.joacp_198_21Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy studyYasmin A KamelMahmoud M ElmoniarYasser I FathiMamdouh E LotfiMohamed S AlwarrakyKhaled A YassenBackground 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, cmH2O), and portal venous pressure (PVP, cmH2O) 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/m2, 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.http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=1;spage=127;epage=133;aulast=Kamelcardiac outputelectric cardiometryhemodynamicsnoninvasivetips |
| spellingShingle | Yasmin A Kamel Mahmoud M Elmoniar Yasser I Fathi Mamdouh E Lotfi Mohamed S Alwarraky Khaled A Yassen Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study Journal of Anaesthesiology Clinical Pharmacology cardiac output electric cardiometry hemodynamics noninvasive tips |
| 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 | cardiac output electric cardiometry hemodynamics noninvasive tips |
| url | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=1;spage=127;epage=133;aulast=Kamel |
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