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Article

Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock

1
Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
2
Outcomes Research Consortium, Cleveland, OH 44195, USA
3
Hellenic Society of Cardiopulmonary Resuscitation, 11528 Athens, Greece
4
First Department of Neurology, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
5
Medical Supervision S.A., 10680 Athens, Greece
6
Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
7
Department of Anesthesiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
8
School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Bruno Mégarbané
J. Pers. Med. 2022, 12(5), 724; https://doi.org/10.3390/jpm12050724
Received: 1 April 2022 / Revised: 19 April 2022 / Accepted: 28 April 2022 / Published: 29 April 2022
(This article belongs to the Special Issue Respiratory and Critical Care)
The present work investigated the dynamic changes in stressed volume (Vs) and other determinants of venous return using a porcine model of hyperdynamic septic shock. Septicemia was induced in 10 anesthetized swine, and fluid challenges were started after the diagnosis of sepsis-induced arterial hypotension and/or tissue hypoperfusion. Norepinephrine infusion targeting a mean arterial pressure (MAP) of 65 mmHg was started after three consecutive fluid challenges. After septic shock was confirmed, norepinephrine infusion was discontinued, and the animals were left untreated until cardiac arrest occurred. Baseline Vs decreased by 7% for each mmHg decrease in MAP during progression of septic shock. Mean circulatory filling pressure (Pmcf) analogue (Pmca), right atrial pressure, resistance to venous return, and efficiency of the heart decreased with time (p < 0.001 for all). Fluid challenges did not improve hemodynamics, but noradrenaline increased Vs from 107 mL to 257 mL (140%) and MAP from 45 mmHg to 66 mmHg (47%). Baseline Pmca and post-cardiac arrest Pmcf did not differ significantly (14.3 ± 1.23 mmHg vs. 14.75 ± 1.5 mmHg, p = 0.24), but the difference between pre-arrest Pmca and post-cardiac arrest Pmcf was statistically significant (9.5 ± 0.57 mmHg vs. 14.75 ± 1.5 mmHg, p < 0.001). In conclusion, the baseline Vs decreased by 7% for each mmHg decrease in MAP during progression of hyperdynamic septic shock. Significant changes were also observed in other determinants of venous return. A new physiological intravascular volume existing at zero transmural distending pressure was identified, termed as the rest volume (Vr). View Full-Text
Keywords: septic shock; venous return; mean circulatory filling pressure; stressed volume; unstressed volume; rest volume; cardiovascular dynamics; hemodynamics; anesthesiology; intensive care medicine septic shock; venous return; mean circulatory filling pressure; stressed volume; unstressed volume; rest volume; cardiovascular dynamics; hemodynamics; anesthesiology; intensive care medicine
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MDPI and ACS Style

Chalkias, A.; Laou, E.; Papagiannakis, N.; Spyropoulos, V.; Kouskouni, E.; Theodoraki, K.; Xanthos, T. Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock. J. Pers. Med. 2022, 12, 724. https://doi.org/10.3390/jpm12050724

AMA Style

Chalkias A, Laou E, Papagiannakis N, Spyropoulos V, Kouskouni E, Theodoraki K, Xanthos T. Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock. Journal of Personalized Medicine. 2022; 12(5):724. https://doi.org/10.3390/jpm12050724

Chicago/Turabian Style

Chalkias, Athanasios, Eleni Laou, Nikolaos Papagiannakis, Vaios Spyropoulos, Evaggelia Kouskouni, Kassiani Theodoraki, and Theodoros Xanthos. 2022. "Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock" Journal of Personalized Medicine 12, no. 5: 724. https://doi.org/10.3390/jpm12050724

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