Effects of norepinephrine on dynamic variables of fluid responsiveness during hemorrhage and after resuscitation in a pediatric porcine model.
BACKGROUND
The effect of vasopressors on pulse pressure variation (PPV), stroke volume variation (SVV) and on the volumetric variable global end-diastolic volume (GEDV) during changing loading conditions is currently under debate. The aim of our study was to investigate the effect of norepinephrine (NE) on PPV, SVV and GEDV in a pediatric animal model of hemorrhage and resuscitation.


METHODS
Eight anesthetized piglets were studied at normovolemia, after stepwise blood withdrawal (25 ml x kg(-1)), after infusion of NE to restore mean arterial pressure (MAP), after NE titration was stopped and shed blood was retransfused and finally again after NE titration. Stroke volume (SV) was measured using a thermodilution pulmonary artery catheter. GEDV was measured by transpulmonary thermodilution. PPV and SVV were monitored continuously by pulse contour analysis. In response to NE administration during hemorrhage, MAP significantly increased (P < 0.01), PPV significantly decreased (P = 0.02), whereas SVV, SV and GEDV remained unchanged. After retransfusion, SVV and GEDV significantly correlated with volume induced percentage change in SV. This significant correlation was reversed after NE administration for SVV and persisted for GEDV. In conclusion, NE administration significantly affected PPV and SVV, whereas the volumetric variable GEDV remained unchanged.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. renner@anaesthesie.uni-kiel.de
Jochen
J
Renner
Patrick
P
Meybohm
Robert
R
Hanss
Matthias
M
Gruenewald
Jens
J
Scholz
Berthold
B
Bein
D000758:Anesthesia; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D001826:Body Fluids / Q000187:drug effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000503:physiopathology*; D008297:Male; D009638:Norepinephrine / Q000494:pharmacology*; D012151:Resuscitation; D013318:Stroke Volume / Q000187:drug effects; D013552:Swine; D013815:Thermodilution; D014882:Water-Electrolyte Balance / Q000187:drug effects
D009638:Norepinephrine