tailieunhanh - Báo cáo y học: "Withdrawing intra-aortic balloon pump support paradoxically improves microvascular flow"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Withdrawing intra-aortic balloon pump support paradoxically improves microvascular flow. | Munsterman et al. Critical Care 2010 14 R161 http content 14 4 R161 c CRITICAL CARE RESEARCH Open Access Withdrawing intra-aortic balloon pump support paradoxically improves microvascular flow 2 2 2 Luuk DH Munsterman Paul WG Elbers Alaattin Ozdemir Eric PA van Dongen Mat van Iterson Can Ince1 Abstract Introduction The Intra-Aortic Balloon Pump IABP is frequently used to mechanically support the heart. There is evidence that IABP improves microvascular flow during cardiogenic shock but its influence on the human microcirculation in patients deemed ready for discontinuing IABP support has not yet been studied. Therefore we used sidestream dark field imaging SDF to test our hypothesis that human microcirculation remains unaltered with or without IABP support in patients clinically ready for discontinuation of mechanical support. Methods We studied 15 ICU patients on IABP therapy. Measurements were performed after the clinical decision was made to remove the balloon catheter. We recorded global hemodynamic parameters and performed venous oximetry during maximal IABP support 1 1 and 10 minutes after temporarily stopping the IABP therapy. At both time points we also recorded video clips of the sublingual microcirculation. From these we determined indices of microvascular perfusion including perfused vessel density PVD and microvascular flow index MFI . Results Ceasing IABP support lowered mean arterial pressure 74 8 to 71 10 mmHg P and increased diastolic pressure 43 10 to 53 9 mmHg P . However at the level of the microcirculation we found an increase of PVD of small vessels 20 gm to P . PVD for vessels 20 gm and MFI for both small and large vessels were unaltered. During the procedure global oxygenation parameters ScvO2 SvO2 remained unchanged. Conclusions In patients deemed ready for discontinuing IABP support according to current practice SDF imaging showed an increase of microcirculatory flow of small .