tailieunhanh - Báo cáo y học: "Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale. | Simons et al. Journal of Cardiothoracic Surgery 2010 5 30 http content 5 1 30 JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Quantitative assessment of cardiac load-responsiveness during extracorporeal life support case and rationale Antoine P Simons 1 Marcus D Lancé2 Koen D Reesink3 Frederik H van der Veen1 Patrick WWeerwind1 and Jos G Maessen1 Abstract We describe a case of a patient assisted by extracorporeal life support in which we obtained the dynamic filling index a measure for venous volume during extracorporeal life support and used this index to assess cardiac loadresponsiveness during acute reloading. While reloading the obtained findings on cardiac pump function by the dynamic filling index were supported by trans-esophageal echocardiography and standard pressure measurement. This suggests that the dynamic filling index can be used to assess cardiac load-responsiveness during extracorporeal life support. Background The successful use of extracorporeal life support ELS for cardiopulmonary assist and as bridge to myocardial recovery has been shown in many cases 1-3 . Unfortunately weaning from extracorporeal life support often relies on preconceived protocols if any and is largely based on trial-and-error and limited data on actual cardiac function. The common procedure to assess cardiac recovery during ELS is the use of stress tests. These tests induce an increased volume load on the myocardium and address the Frank-Starling response. This response can be visualized using trans-esophageal echocardiography TEE and further quantified by measurement of blood pressure and cardiac output 4 5 . Volume loading is achieved by reducing ELS flow upon which depending on the degree of recovery the heart will increase its output and maintain arterial and venous blood pressure Figure 1 . In patients whose heart has not yet recovered the response is blunted which causes low output decreased arterial blood pressure and increased