Tesi etd-06172017-124248 |
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Tipo di tesi
Tesi di specializzazione (5 anni)
Autore
GONNELLA, SIMONA
URN
etd-06172017-124248
Titolo
L'ACCOPPIAMENTO VENTRICOLO ARTERIOSO PER LA GESTIONE DELL'INSTABILITA' EMODINAMICA IN SALA OPERATORIA: UN METODO ECOCARDIOGRAFICO BASATO SULL'ELASTANZA
Dipartimento
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
ANESTESIA, RIANIMAZIONE, TERAPIA INTENSIVA E DEL DOLORE
Relatori
relatore Prof. Forfori, Francesco
relatore Dott. Guarracino, Fabio
relatore Dott. Guarracino, Fabio
Parole chiave
- Stroke work
- Pressure-volume area
- Elastanza arteriosa
- Elastanza ventricolare
- Accoppiamento ventricolo arterioso
- CABG
- CPB
- CEC
- myocardial Work efficiency
- cardiochirurgia
Data inizio appello
05/07/2017
Consultabilità
Completa
Riassunto
BACKGROUND
Perioperative echocardiography is an important tool to assess hemodynamic impairment. It can be used both intraoperatively and during the postoperative period in the ICU. TOE is widely used during cardiac surgery and nevertheless it is still the technique that most clinicians use as decision maker regarding the use of inotropes, vasodilators and volume replacement therapy. Recognition and the consequently cure of detrimental conditions leading to hemodynamic alteration by measuring the relationship between ventricular conctractility and arterial load has been described in the critical care setting. Demonstration that ventricular elastance (Ees) can be estimated in a single beat fashion and subsequent validation of a non invasive echocardiographic based approach to measure Ees has made clinical evaluation of ventricular arterial coupling (VAC) feasible at the bedside. As already reported, measuring of VAC as the result of the ratio of arterial elastance (Ea) and Ees offers a better understanding of hemodynamic alteration and more accurate representation of cardiovascular interations.
OBJECTIVE
I investigate the feasibility and the accuracy of the nonivasive echocardiographic based method to measure arterial elastanance (Ea), ventricular elastance (Ees) and ventricular arterial coupling (VAC) in the operating theatre.
METHOD
In patients undergoing CABG we measure elastances using a single-beat noninvasive echocardiographic approach (Chen Method 2001). Conventional invasive and non invasive hemodynamic measurements (HR, SBP, DBP, SV; CO) are also recorded. All measurements were carried out in the operating theatre before and after the cardiopulmonary bypass, and after any hemodynamic treatment change in order to evaluate its response. Hemodynamic derangement was defined as commonly by MAP<65mmHg or CO<2,5l/min.
MEASUREMENTS
Invasive (radial artery catheter): SBP, DBP, MAP
Noninvasive (ECG): HR
Echocardiography (TOE): SV, CO, Ea, Ees, VAC, Stroke work, Potential energy, Pressure-volume area
PRIMARY OUTCOMES
Early recognition of the underlying determinants of hemodynamic impairment using the pathophysiological elastance approach in the operating theatre.
Perioperative echocardiography is an important tool to assess hemodynamic impairment. It can be used both intraoperatively and during the postoperative period in the ICU. TOE is widely used during cardiac surgery and nevertheless it is still the technique that most clinicians use as decision maker regarding the use of inotropes, vasodilators and volume replacement therapy. Recognition and the consequently cure of detrimental conditions leading to hemodynamic alteration by measuring the relationship between ventricular conctractility and arterial load has been described in the critical care setting. Demonstration that ventricular elastance (Ees) can be estimated in a single beat fashion and subsequent validation of a non invasive echocardiographic based approach to measure Ees has made clinical evaluation of ventricular arterial coupling (VAC) feasible at the bedside. As already reported, measuring of VAC as the result of the ratio of arterial elastance (Ea) and Ees offers a better understanding of hemodynamic alteration and more accurate representation of cardiovascular interations.
OBJECTIVE
I investigate the feasibility and the accuracy of the nonivasive echocardiographic based method to measure arterial elastanance (Ea), ventricular elastance (Ees) and ventricular arterial coupling (VAC) in the operating theatre.
METHOD
In patients undergoing CABG we measure elastances using a single-beat noninvasive echocardiographic approach (Chen Method 2001). Conventional invasive and non invasive hemodynamic measurements (HR, SBP, DBP, SV; CO) are also recorded. All measurements were carried out in the operating theatre before and after the cardiopulmonary bypass, and after any hemodynamic treatment change in order to evaluate its response. Hemodynamic derangement was defined as commonly by MAP<65mmHg or CO<2,5l/min.
MEASUREMENTS
Invasive (radial artery catheter): SBP, DBP, MAP
Noninvasive (ECG): HR
Echocardiography (TOE): SV, CO, Ea, Ees, VAC, Stroke work, Potential energy, Pressure-volume area
PRIMARY OUTCOMES
Early recognition of the underlying determinants of hemodynamic impairment using the pathophysiological elastance approach in the operating theatre.
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