Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis
Abstract Background The same principle behind pulse wave analysis can be applied on the pulmonary artery (PA) pressure waveform to estimate right ventricle stroke volume (RVSV). However, the PA pressure waveform might be influenced by the direct transmission of the intrathoracic pressure changes thr...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-04-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40635-024-00618-7 |
| _version_ | 1797209592553275392 |
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| author | Arnoldo Santos M. Ignacio Monge-García João Batista Borges Jaime Retamal Gerardo Tusman Anders Larsson Fernando Suarez-Sipmann |
| author_facet | Arnoldo Santos M. Ignacio Monge-García João Batista Borges Jaime Retamal Gerardo Tusman Anders Larsson Fernando Suarez-Sipmann |
| author_sort | Arnoldo Santos |
| collection | DOAJ |
| description | Abstract Background The same principle behind pulse wave analysis can be applied on the pulmonary artery (PA) pressure waveform to estimate right ventricle stroke volume (RVSV). However, the PA pressure waveform might be influenced by the direct transmission of the intrathoracic pressure changes throughout the respiratory cycle caused by mechanical ventilation (MV), potentially impacting the reliability of PA pulse wave analysis (PAPWA). We assessed a new method that minimizes the direct effect of the MV on continuous PA pressure measurements and enhances the reliability of PAPWA in tracking beat-to-beat RVSV. Methods Continuous PA pressure and flow were simultaneously measured for 2–3 min in 5 pigs using a high-fidelity micro-tip catheter and a transonic flow sensor around the PA trunk, both pre and post an experimental ARDS model. RVSV was estimated by PAPWA indexes such as pulse pressure (SVPP), systolic area (SVSystAUC) and standard deviation (SVSD) beat-to-beat from both corrected and non-corrected PA signals. The reference RVSV was derived from the PA flow signal (SVref). Results The reliability of PAPWA in tracking RVSV on a beat-to-beat basis was enhanced after accounting for the direct impact of intrathoracic pressure changes induced by MV throughout the respiratory cycle. This was evidenced by an increase in the correlation between SVref and RVSV estimated by PAPWA under healthy conditions: rho between SVref and non-corrected SVSD – 0.111 (0.342), corrected SVSD 0.876 (0.130), non-corrected SVSystAUC 0.543 (0.141) and corrected SVSystAUC 0.923 (0.050). Following ARDS, correlations were SVref and non-corrected SVSD – 0.033 (0.262), corrected SVSD 0.839 (0.077), non-corrected SVSystAUC 0.483 (0.114) and corrected SVSystAUC 0.928 (0.026). Correction also led to reduced limits of agreement between SVref and SVSD and SVSystAUC in the two evaluated conditions. Conclusions In our experimental model, we confirmed that correcting for mechanical ventilation induced changes during the respiratory cycle improves the performance of PAPWA for beat-to-beat estimation of RVSV compared to uncorrected measurements. This was demonstrated by a better correlation and agreement between the actual SV and the obtained from PAPWA. |
| first_indexed | 2024-04-24T09:57:09Z |
| format | Article |
| id | doaj.art-f1002fa432344e55bd45dc8394bb0021 |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-04-24T09:57:09Z |
| publishDate | 2024-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-f1002fa432344e55bd45dc8394bb00212024-04-14T11:05:51ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2024-04-0112111210.1186/s40635-024-00618-7Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysisArnoldo Santos0M. Ignacio Monge-García1João Batista Borges2Jaime Retamal3Gerardo Tusman4Anders Larsson5Fernando Suarez-Sipmann6Intensive Care Medicine Department. Hospital, Universitario Fundación Jiménez Díaz. IIS-FJDUnidad de Cuidados Críticos, Hospital Universitario SAS de JerezFirst Faculty of Medicine, Institute of Physiology, Charles UniversityDepartamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de ChileDepartment of Anesthesia, Hospital Privado de ComunidadDepartment of Surgical Sciences, Uppsala UniversityCIBER de Enfermedades Respiratorias CIBERES ISCIIIAbstract Background The same principle behind pulse wave analysis can be applied on the pulmonary artery (PA) pressure waveform to estimate right ventricle stroke volume (RVSV). However, the PA pressure waveform might be influenced by the direct transmission of the intrathoracic pressure changes throughout the respiratory cycle caused by mechanical ventilation (MV), potentially impacting the reliability of PA pulse wave analysis (PAPWA). We assessed a new method that minimizes the direct effect of the MV on continuous PA pressure measurements and enhances the reliability of PAPWA in tracking beat-to-beat RVSV. Methods Continuous PA pressure and flow were simultaneously measured for 2–3 min in 5 pigs using a high-fidelity micro-tip catheter and a transonic flow sensor around the PA trunk, both pre and post an experimental ARDS model. RVSV was estimated by PAPWA indexes such as pulse pressure (SVPP), systolic area (SVSystAUC) and standard deviation (SVSD) beat-to-beat from both corrected and non-corrected PA signals. The reference RVSV was derived from the PA flow signal (SVref). Results The reliability of PAPWA in tracking RVSV on a beat-to-beat basis was enhanced after accounting for the direct impact of intrathoracic pressure changes induced by MV throughout the respiratory cycle. This was evidenced by an increase in the correlation between SVref and RVSV estimated by PAPWA under healthy conditions: rho between SVref and non-corrected SVSD – 0.111 (0.342), corrected SVSD 0.876 (0.130), non-corrected SVSystAUC 0.543 (0.141) and corrected SVSystAUC 0.923 (0.050). Following ARDS, correlations were SVref and non-corrected SVSD – 0.033 (0.262), corrected SVSD 0.839 (0.077), non-corrected SVSystAUC 0.483 (0.114) and corrected SVSystAUC 0.928 (0.026). Correction also led to reduced limits of agreement between SVref and SVSD and SVSystAUC in the two evaluated conditions. Conclusions In our experimental model, we confirmed that correcting for mechanical ventilation induced changes during the respiratory cycle improves the performance of PAPWA for beat-to-beat estimation of RVSV compared to uncorrected measurements. This was demonstrated by a better correlation and agreement between the actual SV and the obtained from PAPWA.https://doi.org/10.1186/s40635-024-00618-7Stroke volumeRight ventricleMechanical ventilationPulse wave analysisHeart lung interactionsFluid responsiveness |
| spellingShingle | Arnoldo Santos M. Ignacio Monge-García João Batista Borges Jaime Retamal Gerardo Tusman Anders Larsson Fernando Suarez-Sipmann Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis Intensive Care Medicine Experimental Stroke volume Right ventricle Mechanical ventilation Pulse wave analysis Heart lung interactions Fluid responsiveness |
| title | Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis |
| title_full | Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis |
| title_fullStr | Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis |
| title_full_unstemmed | Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis |
| title_short | Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis |
| title_sort | impact of respiratory cycle during mechanical ventilation on beat to beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis |
| topic | Stroke volume Right ventricle Mechanical ventilation Pulse wave analysis Heart lung interactions Fluid responsiveness |
| url | https://doi.org/10.1186/s40635-024-00618-7 |
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