Utility of a bedside Doppler in tracking left ventricular dysfunction related to hemorrhagic shock.
Treatment of hemorrhagic shock with fluid resuscitation alone results in diastolic dysfunction as measured by peak systolic pressure/end systolic volume ratio (PSP/ESV). The purpose of this study was to test the ability of a simple Doppler device to track diastolic dysfunction in hemorrhagic shock. In this prospective, controlled crossover study, five adult swine were resuscitated from hemorrhagic shock using fluids. Diastolic dysfunction was confirmed using PSP/ESV ratio. The effect of nitroprusside and dobutamine on this diastolic dysfunction was evaluated. Data (PSP/ESV, Doppler-derived acceleration, and oxygen transport parameters) were collected at each stage of the model. Arterial pressure and oxygen transport parameters corrected to baseline values; however, the PSP/ESV and Doppler-derived acceleration failed to correct with fluid resuscitation alone. Treatment with nitroprusside and dobutamine increased oxygen transport parameters, PSP/ESV ratio, and Doppler-derived acceleration significantly. Doppler-derived acceleration tracks left ventricular dysfunction seen in hemorrhagic shock.
Chendrasekhar
A
A
Department of Surgery, West Virginia University School of Medicine, Morgantown, USA.
Prabhakar
G
G
Pillai
S
S
Fagerli
J C
JC
Barringer
L S
LS
Dulaney
J
J
Timberlake
G A
GA
D000818:Animals; D002302:Cardiac Output / Q000187:drug effects; D002306:Cardiac Volume / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D018592:Cross-Over Studies; D003971:Diastole; D004195:Disease Models, Animal; D004280:Dobutamine / Q000627:therapeutic use; D005440:Fluid Therapy; D018670:Monitoring, Ambulatory / Q000295:instrumentation; D009599:Nitroprusside / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D013552:Swine; D013599:Systole; D018608:Ultrasonography, Doppler / Q000295:instrumentation; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D017725:Ventricular Pressure / Q000187:drug effects
D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D004280:Dobutamine; D010100:Oxygen