Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 1;236(2):294-304.
doi: 10.1097/XCS.0000000000000474. Epub 2022 Nov 4.

Central Venous Waveform Analysis and Cardiac Output in a Porcine Model of Endotoxemic Hypotension and Resuscitation

Zachary R Bergman  1 , Roy K Kiberenge  2 , Azmath Mohammed  1 , Richard W Bianco  1 , Greg J Beilman  1 , Colleen M Brophy  3 , Kyle M Hocking  3   4 , Bret D Alvis  5   4 , Eric S Wise  1
Affiliations

Central Venous Waveform Analysis and Cardiac Output in a Porcine Model of Endotoxemic Hypotension and Resuscitation

Zachary R Bergman et al. J Am Coll Surg. .

Abstract

Background: Cardiac output (CO) is a valuable proxy for perfusion, and governs volume responsiveness during resuscitation from distributive shock. The underappreciated venous system has nuanced physiology that confers valuable hemodynamic information. In this investigation, deconvolution of the central venous waveform by the fast Fourier transformation (FFT) algorithm is performed to assess its ability to constitute a CO surrogate in a porcine model of endotoxemia-induced distributive hypotension and resuscitation.

Study design: Ten pigs were anesthetized, catheterized, and intubated. A lipopolysaccharides infusion protocol was used to precipitate low systemic vascular resistance hypotension. Four crystalloid boluses (10 cc/kg) were then given in succession, after which heart rate, mean arterial pressure, thermodilution-derived CO, central venous pressure (CVP), and the central venous waveform were collected, the last undergoing fast Fourier transformation analysis. The amplitude of the fundamental frequency of the central venous waveform's cardiac wave (f0-CVP) was obtained. Heart rate, mean arterial pressure, CVP, f0-CVP, and CO were plotted over the course of the boluses to determine whether f0-CVP tracked with CO better than the vital signs, or than CVP itself.

Results: Distributive hypotension to a 25% mean arterial pressure decrement was achieved, with decreased systemic vascular resistance (mean 918 ± 227 [SD] dyne/s/cm-5 vs 685 ± 180 dyne/s/cm-5; p = 0.038). Full hemodynamic parameters characterizing this model were reported. Slopes of linear regression lines of heart rate, mean arterial pressure, CVP, f0-CVP, and CO were -2.8, 1.7, 1.8, 0.40, and 0.35, respectively, demonstrating that f0-CVP values closely track with CO over the 4-bolus range.

Conclusions: Fast Fourier transformation analysis of the central venous waveform may allow real-time assessment of CO during resuscitation from distributive hypotension, possibly offering a venous-based approach to clinical estimation of volume responsiveness.

PubMed Disclaimer

References

    1. Narayan S, Petersen TL. Uncommon etiologies of shock. Crit Care Clin. 2022;38:429–441.
    1. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49:e1063–e1143.
    1. Alvarado Sanchez JI, Caicedo Ruiz JD, Diaztagle Fernández JJ, et al. Use of pulse pressure variation as predictor of fluid responsiveness in patients ventilated with low tidal volume: a systematic review and meta-analysis. Clin Med Insights Circ Respir Pulm Med. 2020;14:117954842090151.
    1. Weigl W, Adamski J, Onichimowski D, et al. Methods of assessing fluid responsiveness in septic shock patients: a narrative review. Anaesthesiol Intensive Ther. 2022;54:175–183.
    1. Chaudhuri D, Herritt B, Lewis K, et al. Dosing fluids in early septic shock. Chest. 2021;159:1493–1502.

LinkOut - more resources