title: Pig model of pulmonary embolism: where is the hemodynamic break point?
abstract: Early recognition of collapsing hemodynamics in pulmonary embolism is necessary to avoid cardiac arrest using aggressive medical therapy or mechanical cardiac support. The aim of the study was to identify the maximal acute hemodynamic compensatory steady state. Overall, 40 dynamic obstructions of pulmonary artery were performed and hemodynamic data were collected. Occlusion of only left or right pulmonary artery did not lead to the hemodynamic collapse. When gradually obstructing the bifurcation, the right ventricle end-diastolic area expanded proportionally to pulmonary artery mean pressure from 11.6 (10.1, 14.1) to 17.8 (16.1, 18.8) cm(2) (p<0.0001) and pulmonary artery mean pressure increased from 22 (20, 24) to 44 (41, 47) mmHg (p<0.0001) at the point of maximal hemodynamic compensatory steady state. Similarly, mean arterial pressure decreased from 96 (87, 101) to 60 (53, 78) mmHg (p<0.0001), central venous pressure increased from 4 (4, 5) to 7 (6, 8) mmHg (p<0.0001), heart rate increased from 92 (88, 97) to 147 (122, 165) /min (p<0.0001), continuous cardiac output dropped from 5.2 (4.7, 5.8) to 4.3 (3.7, 5.0) l/min (p=0.0023), modified shock index increased from 0.99 (0.81, 1.10) to 2.31 (1.99, 2.72), p<0.0001. In conclusion, instead of continuous cardiac output all of the analyzed parameters can sensitively determine the individual maximal compensatory response to obstructive shock. We assume their monitoring can be used to predict the critical phase of the hemodynamic status in routine practice.
authors: Third Department of Medicine, General University Hospital, Prague, Czech Republic. jaroslav.kudlicka@vfn.cz.
authors: J
authors: J
authors: Kudlička
authors: M
authors: M
authors: Mlček
authors: P
authors: P
authors: Hála
authors: S
authors: S
authors: Lacko
authors: D
authors: D
authors: Janák
authors: M
authors: M
authors: Hrachovina
authors: J
authors: J
authors: Malík
authors: J
authors: J
authors: Bělohlávek
authors: P
authors: P
authors: Neužil
authors: O
authors: O
authors: Kittnar
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002302:Cardiac Output; D004195:Disease Models, Animal; D005260:Female; D006339:Heart Rate; D006801:Humans; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000150:complications* / Q000503:physiopathology*; D012769:Shock / Q000209:etiology* / Q000503:physiopathology*; D013552:Swine