Model-based computation of total stressed blood volume from a preload reduction manoeuvre

peer reviewedTotal stressed blood volume is an important parameter for both doctors and engineers. From a medical point of view, it has been associated with the success or failure of fluid therapy, a primary treatment to manage acute circulatory failure. From an engineering point of view, it dictates the cardiovascular system’s behavior in changing physiological situations. Current methods to determine this parameter involve repeated phases of circulatory arrests followed by fluid administration. In this work, a more straightforward method is developed using data from a preload reduction manoeuvre. A simple six-chamber cardiovascular system model is used and its parameters are adjusted to pig experimental data. The parameter adjustment process has three steps: (1) compute nominal values for all model parameters; (2) determine the five most sensitive parameters; and (3) adjust only these five parameters. Stressed blood volume was selected by the algorithm, which emphasizes the importance of this parameter. The model was able to track experimental trends with a maximal root mean squared error of 29.2%. Computed stressed blood volume equals 486 ± 117 ml or 15.7 ± 3.6 ml/kg, which matches previous independent experiments on pigs, dogs and humans. The method proposed in this work thus provides a simple way to compute total stressed blood volume from usual hemodynamic data

Effects of increased afterload on left ventricular performance and mechanical efficiency are not baroreflex-mediated

peer reviewedObjective: To assess baroreflex intervention during increase in left ventricular afterload, we compared the effects of aortic banding on the intact cardiovascular system and under hexamethonium infusion. Methods: Six open-chest pigs, instrumented for measurement of aortic pressure and flow, left ventricular pressure and volume, were studied under pentobarbital-sufentanil anesthesia. Vascular arterial properties were estimated with a four-element windkessel model. Left ventricular contractility was assessed by the slope of end-systolic pressure-volume relationship. Results: The effects of aortic banding on mechanical aortic properties were unaffected by autonomic nervous system inhibition. However, increase in peripheral arterial vascular resistance and in heart rate were prevented by hexamethonium. Aortic banding increased left ventricular contractility and stroke work. Left ventricular-arterial coupling remained unchanged, but mechanical efficiency was impaired. These ventricular changes were independent of baroreflex integrity. Conclusions: Our results demonstrate that an augmentation in afterload has a composite effect on left ventricular function. Left ventricular performance is increased, as demonstrated by increase in contractility and stroke work, but mechanical efficiency is decreased. These changes are observed independently of baroreflex integrity. Such mechanisms of autoregulation, independent of the autonomic nervous system, are of paramount importance in heart transplant patients. (C) 2003 Elsevier B.V. All fights reserved

Comparison between single-beat and multiple-beat methods for estimation of right ventricular contractility.

OBJECTIVE: It was investigated whether pharmacologically induced changes in right ventricular contractility can be detected by a so-called "single-beat" method that does not require preload reduction. DESIGN: Prospective animal research. SETTING: Laboratory at a large university medical center. SUBJECTS: Eight anesthetized pigs. INTERVENTIONS: End-systolic elastance values obtained by a recently proposed single-beat method (Eessb) were compared with those obtained using the reference multiple-beat method (Eesmb). MEASUREMENTS AND MAIN RESULTS: Administration of dobutamine increased Eesmb from 1.6 +/- 0.3 to 3.8 +/- 0.5 mm Hg/mL (p =.001), whereas there was only a trend toward an increase in Eessb from 1.5 +/- 0.2 to 1.7 +/- 0.4 mm Hg/mL. Esmolol decreased Eesmb from 1.7 +/- 0.3 to 1.1 +/- 0.2 mm Hg/mL (p =.006), whereas there was only a trend for a decrease in Eessb from 1.5 +/- 0.2 to 1.3 +/- 0.1. CONCLUSIONS: The present method using single-beat estimation to assess right ventricular contractility does not work as expected, since it failed to detect either increases or decreases in right ventricular contractility induced by pharmacologic interventions.Peer reviewe