Mechanisms maintaining right ventricular contractility-to-pulmonary arterial elastance ratio in VA ECMO: a retrospective animal data analysis of RV-PA coupling.

IF 3.8 2区医学 Q1 CRITICAL CARE MEDICINE Journal of Intensive Care Pub Date : 2024-05-11 DOI:10.1186/s40560-024-00730-6

Kaspar F Bachmann, Per Werner Moller, Lukas Hunziker, Marco Maggiorini, David Berger

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Abstract

Background: To optimize right ventricular-pulmonary coupling during veno-arterial (VA) ECMO weaning, inotropes, vasopressors and/or vasodilators are used to change right ventricular (RV) function (contractility) and pulmonary artery (PA) elastance (afterload). RV-PA coupling is the ratio between right ventricular contractility and pulmonary vascular elastance and as such, is a measure of optimized crosstalk between ventricle and vasculature. Little is known about the physiology of RV-PA coupling during VA ECMO. This study describes adaptive mechanisms for maintaining RV-PA coupling resulting from changing pre- and afterload conditions in VA ECMO.

Methods: In 13 pigs, extracorporeal flow was reduced from 4 to 1 L/min at baseline and increased afterload (pulmonary embolism and hypoxic vasoconstriction). Pressure and flow signals estimated right ventricular end-systolic elastance and pulmonary arterial elastance. Linear mixed-effect models estimated the association between conditions and elastance.

Results: At no extracorporeal flow, end-systolic elastance increased from 0.83 [0.66 to 1.00] mmHg/mL at baseline by 0.44 [0.29 to 0.59] mmHg/mL with pulmonary embolism and by 1.36 [1.21 to 1.51] mmHg/mL with hypoxic pulmonary vasoconstriction (p < 0.001). Pulmonary arterial elastance increased from 0.39 [0.30 to 0.49] mmHg/mL at baseline by 0.36 [0.27 to 0.44] mmHg/mL with pulmonary embolism and by 0.75 [0.67 to 0.84] mmHg/mL with hypoxic pulmonary vasoconstriction (p < 0.001). Coupling remained unchanged (2.1 [1.8 to 2.3] mmHg/mL at baseline; - 0.1 [- 0.3 to 0.1] mmHg/mL increase with pulmonary embolism; - 0.2 [- 0.4 to 0.0] mmHg/mL with hypoxic pulmonary vasoconstriction, p > 0.05). Extracorporeal flow did not change coupling (0.0 [- 0.0 to 0.1] per change of 1 L/min, p > 0.05). End-diastolic volume increased with decreasing extracorporeal flow (7.2 [6.6 to 7.8] ml change per 1 L/min, p < 0.001).

Conclusions: The right ventricle dilates with increased preload and increases its contractility in response to afterload changes to maintain ventricular-arterial coupling during VA extracorporeal membrane oxygenation.

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维持 VA ECMO 中右心室收缩力与肺动脉弹性比值的机制：RV-PA 耦合的回顾性动物数据分析。

背景：为了在静脉-动脉（VA）ECMO 断流期间优化右心室-肺耦合，使用了肌力剂、血管加压剂和/或血管扩张剂来改变右心室（RV）功能（收缩力）和肺动脉（PA）弹性（后负荷）。RV-PA 耦合是右心室收缩力和肺血管弹性之间的比率，因此是衡量心室和血管之间优化串扰的指标。人们对 VA ECMO 期间 RV-PA 耦合的生理学知之甚少。本研究描述了在 VA ECMO 中因前负荷和后负荷条件变化而导致的维持 RV-PA 耦合的适应性机制：方法：在 13 头猪中，将体外流量从基线时的 4 升/分钟降至 1 升/分钟，并增加后负荷（肺栓塞和缺氧性血管收缩）。压力和流量信号估算了右心室收缩末期弹性和肺动脉弹性。线性混合效应模型估计了条件与弹性之间的关联：结果：在没有体外血流的情况下，收缩末期弹性从基线时的 0.83 [0.66 至 1.00] mmHg/mL增加了 0.44 [0.29 至 0.59] mmHg/mL，肺栓塞时增加了 0.44 [0.29 至 0.59] mmHg/mL，缺氧性肺血管收缩时增加了 1.36 [1.21 至 1.51] mmHg/mL（P 0.05）。体外流量没有耦合变化（每变化 1 升/分钟，耦合变化为 0.0 [- 0.0 至 0.1]，P > 0.05）。舒张末期容积随体外流量的减少而增加（每 1 升/分钟变化 7.2 [6.6 至 7.8] 毫升，p 结论：体外流量减少时，舒张末期容积增加（每 1 升/分钟变化 7.2 [6.6 至 7.8] 毫升，p）：右心室随着前负荷的增加而扩张，并随着后负荷的变化而增加收缩力，以维持体外膜肺氧合过程中的心室-动脉耦合。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine

CiteScore

11.90

自引率

1.40%

发文量

审稿时长

15 weeks

期刊介绍： "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.