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ESICM 2013 oral presentation 9 October 2013
Citation preview
The new inflatable external lower leg compression improves stroke volume and
peripheral perfusion during central hypovolemia in healthy volunteers
M. Helmi, A. Lima, D. Gommers, J. Bakker, J. van Bommel.
Shock
HypotensionTissue hypoperfusionEnd-organ damage
Shock
To reverse hemodynamic alterations
Fluid overloading
Fluid resuscitation
External leg compression
Reverse hypotensionNo risk of fluid overloading
Use in intensive care ??
Hemodynamic effectHemodynamic effectExternal leg compression
Venous
Emptying
Venous return Venous pressure
Soft tissue blood flow Tissue oxygenation
Arterial
Arteriovenous gradient
Stroke volume Cardiac output
Mean arterial pressure Heart rate
What is the potential effect of ELC around the legs during mild hypovolemia on systemic hemodynamic and peripheral perfusion parameters?
Question
?? ?
Prevent central hypovolemia when applied before HUT
The application of a new inflatable ELC around the upper and lower legs is able to:
Hypothesis
Restore central hypovolemia when applied after HUT.
!!
• 20 healthy volunteers:– Free of cardiovascular or neurological disease– Not taking any medication
Subjects
External leg compression
• Around upper and lower legs
• Inflation pressure can be set at levels of 0, 20, 40 and a maximum of 50 cmH2O
The head up tilt
One maneuver
Measurements• Global hemodynamic with Finometer®
• Perfusion index (PI) with Masimo®
• Tissue oxygen saturation (StO2) with InSpectra®
Each intervention was done in three minutes
To find the ideal ELC compression pressure (the inflation pressure related to the best SV and HR values).
SUP
Pre-Study
HUT HUT50 HUT40 HUT20
Supine HUT0 HUT50 HUT40 HUT20
• SV, mL 86±16 62±14 70±19 67±19 65±18• HR, bpm 71±13 85±12 77±10 79±9 82±11
Results pre-study
Each intervention was done in three minutes
Study protocol
Control model
SUP
HUT SUP’
Prevention model
SUP50 HUT50 SUP50’
Prevent hemodynamic alteration.-Mechanical ventilation-Hemodialysis
Restore model
SUP HUT50 HUT’
Restore hemodynamic alteration.(Circulatory shock)
HUT
*: P < .05 against previous time point.
Global HemodynamicsControl model Prevention model
*
*-27%
**-17%
*
*+19%
* *+9%
*: P < .05 against previous time point.
*
**
Restore model
+24%
-9%
*: P < .05 against previous time point.
Control model Prevention model
*
*
*
*
*
**
*
Peripheral perfusion
-79% -65%
-9% -4%
*: P < .05 against previous time point.
*
**
Restore model
+117%*
+30%
It may be used to prevent or to restore hemodynamic alterations in critically ill patients.
ELC was shown to be able to prevent and restore hemodynamic alterations during HUT.
ELC produced an auto transfusion effect in normovolemic subjects in a 60o HUT at 50 cm H2O compression pressure.
Conclusion
Thank you!!!