Background

Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variations and stroke volume variations, has been proposed to assess functional arterial load. We evaluated the evolution of Eadyn during volume expansion and the effects of neosynephrine infusion in hypotensive and preload-responsive patients.

Methods

In this prospective bicentre study, we included 56 mechanically ventilated patients in the operating room. Each patient had volume expansion and neosynephrine infusion. Stroke volume and stroke volume variations were obtained using esophageal Doppler, and pulse pressure variations were measured through the arterial line. Pressure response to volume expansion was defined as an increase in mean arterial pressure (MAP) ≥ 10%.

Results

Twenty-one patients were pressure responders to volume expansion. Volume expansion induced a decrease in Eadyn (from 0.69 [0.58–0.85] to 0.59 [0.42–0.77]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after volume expansion were related to age, history of arterial hypertension, net arterial compliance and effective arterial elastance. Eadyn value before volume expansion > 0.65 predicted a MAP increase ≥ 10% with a sensitivity of 76% (95% CI 53–92%) and a specificity of 60% (95% CI 42–76%). Neosynephrine infusion induced a decrease in Eadyn (from 0.67 [0.48–0.80] to 0.54 [0.37–0.68]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after neosynephrine infusion were only related to heart rate.

Conclusion

Eadyn is a potential sensitive marker of arterial tone changes following vasopressor infusion.

中文翻译：

---

手术室中容积扩张和血管加压药诱导的动态动脉弹性变化：一项前瞻性bicentre研究

背景

已经提出动态动脉弹性（Eadyn），其定义为脉搏压力变化与每搏量变化之间的比率，以评估功能性动脉负荷。我们评估了降压和预负荷反应患者中Eadyn在容量扩展过程中的演变以及新新肾上腺素输注的影响。

方法

在这项前瞻性双中心研究中，我们纳入了手术室中的56名机械通气患者。每位患者均进行了容量扩张和新肾上腺素输注。使用食道多普勒获得搏动量和搏动量变化，并通过动脉管路测量搏动压力变化。对体积膨胀的压力反应定义为平均动脉压（MAP）≥10％的增加。

结果

21名患者是容量扩张的压力反应者。容积膨胀导致Eadyn下降（从0.69 [0.58–0.85]下降到0.59 [0.42-0.77]），与脉搏压力变化的减小相比，搏动量变化的减小更为明显。容量增加后，Eadyn的基线和变化与年龄，高血压病史，净动脉顺应性和有效动脉弹性有关。体积膨胀> 0.65之前的Eadyn值预测MAP≥10％，灵敏度为76％（95％CI 53–92％），特异性为60％（95％CI 42–76％）。新肾上腺素输注引起的Eadyn减少（从0.67 [0.48–0.80]降低至0.54 [0.37–0.68]）与脉搏压力变化的减少相比，其搏动量变化的减少更为明显。

结论

Eadyn是输注血管加压药后动脉张力变化的潜在敏感标志物。