Efectos de reto de líquidos sobre el acople ventrículo arterial en un biomodelo porcino de choque endotóxico Efectos de reto de líquidos sobre el acople ventrículo arterial en un biomodelo porcino de choque endotóxico

Abstract

Introduction: The fluid challenge is a test that consists of administering fluids and measuring the hemodynamic response by changing cardiac output (CO), however, measuring only CO is insufficient. The Ventriculo-Arterial Coupling (AVA) (Effective Arterial Elastance / Telesystolic Elastance, Eae/Ets) appears as a variable that evaluates the cardiocirculatory status more comprehensively.

Objectives: Evaluate AVA in an endotoxic shock biomodel and during fluid challenges.

Materials and methods: Endotoxic shock biomodel (9 pigs). Hemodynamic variables were measured every hour from time 0 (T0) to T6. 5 liquid challenges were performed between T0 - T4. The time of hypotension was called TH0. Variable median differences between T0 - T4 were calculated. The challenges were classified into two groups according to the AVA delta (AVA post-challenge – AVA pre-challenge), in ΔAVA≤0 or >0, variables were measured before and after each challenge. The lactate/pyruvate (L/P) ratio was measured at T0, T3 and T6, and correlations were established between the LP T6-T0 difference and hemodynamic variables.

Results: AVA increased (1.58 to 2.02, p=0.042) due to an increase in Eae (1.74 to 2.55, p=0.017). The ΔAVA≤0 group increased CO (4.32 to 5.46, p=0.032) and cardiac power (PC) (0.61 to 0.77, p=0.028). The ΔLP was correlated with the Systolic and Diastolic Shock Index (r=0.73), but not with the AVA.

Conclusion: During endotoxic shock, AVA increased significantly. During the liquid challenge, the ΔAVA≤0 group increased their CO and PC. The ΔLP did not correlate with AVA variables.