The Experts below are selected from a list of 186 Experts worldwide ranked by ideXlab platform
Pierre Asfar - One of the best experts on this subject based on the ideXlab platform.
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Mean Arterial Pressure target in patients with septic shock.
Minerva anestesiologica, 2016Co-Authors: François Beloncle, Peter Radermacher, Claude Guérin, Pierre AsfarAbstract:In patients with septic shock, a mean Arterial Pressure higher than 65 mmHg is recommended by the Surviving Sepsis Campaign Guidelines. However, a precise mean Arterial Pressure target has not been delineated. The aim of this paper was to review the physiological rationale and clinical evidence for increasing mean Arterial Pressure in septic shock. A mean Arterial Pressure level lower than renal autoregulatory threshold may lead to renal dysfunction. However, adjusting macrocirculation objectives in particular after the early phase of septic shock may not correct established microcirculation impairments. Moreover, sympathetic over-stimulation due to high doses of vasopressor (needed to achieve high mean Arterial Pressure targets) may be associated with numerous harmful effects. Observational and small short term interventional studies did not provide a definitive answer to this question but suggested that a high mean Arterial Pressure (around 75-85 mmHg) may prevent acute kidney injury in some patients. The SEPSISPAM Trial, a large prospective, randomized, controlled study, compared the targets of High (i.e. 80 to 85 mm Hg) versus Low (i.e. 65 to 70 mm Hg) mean Arterial Pressure in patients with septic shock. The mortality was not different in the two groups. However in patients with chronic hypertension, there were significantly less renal failure in the high mean Arterial Pressure group than the low mean Arterial Pressure group.
Jeanlouis Teboul - One of the best experts on this subject based on the ideXlab platform.
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clinical review interpretation of Arterial Pressure wave in shock states
Critical Care, 2005Co-Authors: Bouchra Lamia, Denis Chemla, Christian Richard, Jeanlouis TeboulAbstract:In critically ill patients monitored with an Arterial catheter, the Arterial Pressure signal provides two types of information that may help the clinician to interpret haemodynamic status better: the mean values of systolic, diastolic, mean and pulse Pressures; and the magnitude of the respiratory variation in Arterial Pressure in patients undergoing mechanical ventilation. In this review we briefly discuss the physiological mechanisms responsible for Arterial Pressure generation, with special focus on resistance, compliance and pulse wave amplification phenomena. We also emphasize the utility of taking into consideration the overall Arterial Pressure set (systolic, diastolic, mean and pulse Pressures) in order to define haemodynamic status better. Finally, we review recent studies showing that quantification of respiratory variation in pulse and systolic Arterial Pressures can allow one to identify the mechanically ventilated patients who may benefit from volume resuscitation.
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Review Clinical review: Interpretation of Arterial Pressure wave in shock
2005Co-Authors: Denis Chemla, Christian Richard, Jeanlouis TeboulAbstract:In critically ill patients monitored with an Arterial catheter, the Arterial Pressure signal provides two types of information that may help the clinician to interpret haemodynamic status better: the mean values of systolic, diastolic, mean and pulse Pressures; and the magnitude of the respiratory variation in Arterial Pressure in patients undergoing mechanical ventilation. In this review we briefly discuss the physiological mechanisms responsible for Arterial Pressure generation, with special focus on resistance, compliance and pulse wave amplification phenomena. We also emphasize the utility of taking into consideration the overall Arterial Pressure set (systolic, diastolic, mean and pulse Pressures) in order to define haemodynamic status better. Finally, we review recent studies showing that quantification of respiratory variation in pulse and systolic Arterial Pressures can allow one to identify the mechanically ventilated patients who may benefit from volume resuscitation.
Thomas Pasch - One of the best experts on this subject based on the ideXlab platform.
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Measurement of systemic Arterial Pressure
Current Opinion in Anaesthesiology, 1997Co-Authors: Branko M. Weiss, Thomas PaschAbstract:Irrespective of the method used, non-invasive measurement of Arterial Pressure may provide misleading information. The accuracy and performance requirements should be of the highest level possible for all instruments designed for Pressure measurements in the perioperative environment. Invasive Pressure measurement is prone to errors and must be considered a relative standard. The proper choice of Arterial site, adequate handling of material and equipment, and prudent clinical interpretation are required to upgrade the invasive measurement to high-quality Arterial Pressure monitoring.
Claude Julien - One of the best experts on this subject based on the ideXlab platform.
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Effect of desipramine on spontaneous Arterial Pressure oscillations in the rat.
European journal of pharmacology, 1999Co-Authors: Delphine Bertram, Christian Barrès, Claude JulienAbstract:Abstract There has been no previous report on the effect of the noradrenaline uptake inhibitor desipramine on short-term variability of Arterial Pressure. Mean Arterial Pressure was recorded in 9 conscious resting rats during 4 consecutive 30-min periods: (1) under baseline conditions, (2) after desipramine administration (2 mg/kg i.v., followed by 1 mg/kg every hour), then after (3) cardiac autonomic blockade with methylatropine and atenolol, and (4) α-adrenoceptor blockade with phentolamine. Fast Fourier transform analysis was applied to beat-to-beat data after resampling at 10 Hz of consecutive 205-s time series. Desipramine did not change the mean level and overall variability of mean Arterial Pressure. However, spectral power in the mid-frequency (0.3–0.5 Hz) band containing the Mayer waves was reduced by more than 80%, and power in the low-frequency (0.05–0.2 Hz) band was enhanced by approximately 50%, especially due to the appearance of a major oscillation centred at 0.095±0.005 Hz. This slow oscillation was further enhanced after cardiac autonomic blockade and was abolished after α-adrenoceptor blockade. In conclusion, desipramine profoundly alters short-term Arterial Pressure variability in resting rats, mainly by shifting vasomotor waves from 0.4 to 0.1 Hz. Desipramine may prove a valuable pharmacological tool to study the dynamic aspects of Arterial Pressure control.
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Hemodynamic analysis of Arterial Pressure oscillations in conscious rats
Journal of the autonomic nervous system, 1995Co-Authors: Claude Julien, Zhi-qi Zhang, Catherine Cerutti, Christian BarrèsAbstract:This study examined the contribution of rhythmic fluctuations of regional blood flow and vascular conductance to the genesis of low- (LF, 0.27-0.74 Hz) and high- (HF, 0.76-5 Hz) frequency oscillations of Arterial Pressure. In conscious 15-week-old male intact (n = 11), guanethidine-sympathectomized (n = 8) and chronically sinoaortic denervated (n = 7) rats, Arterial Pressure and regional blood flow velocities (pulsed Doppler probes) were simultaneously recorded. Indices of subdiaphragmatic aortic, hindquarters and superior mesenteric conductances were calculated on a beat-to-beat basis over a 60-min period. Spectral power was calculated in the LF and HF bands using a fast Fourier transform algorithm. Transfer function analysis was also performed to calculate coherence and phase between Arterial Pressure and regional flows and conductances. In the LF band, spectral power of Arterial Pressure was decreased by approx. 85% in sympathectomized and approx. 54% in sinoaortic denervated rats. In the HF band, spectral power did not differ between the groups. In the three groups of rats, relations between Arterial Pressure and blood flow were characterized by a significant coherence in the HF band with little or no phase delay (synchronous oscillations). Relations between Arterial Pressure and vascular conductance were characterized in intact rats by a significant coherence in the LF band and a phase delay tending to pi radians (opposite oscillations), whereas in both sympathectomized and sinoaortic denervated rats, coherence did not reach significance. It is concluded that LF oscillations of Arterial Pressure are mostly secondary to rhythmic fluctuations in the vasomotor sympathetic tone in several regional circulations. Part of these oscillations originate from the synchronizing influence of the baroreceptor reflex. The study also suggests that the respiratory (HF) oscillations of Arterial Pressure involve fluctuations in cardiac output of purely mechanical origin.
François Beloncle - One of the best experts on this subject based on the ideXlab platform.
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Mean Arterial Pressure target in patients with septic shock.
Minerva anestesiologica, 2016Co-Authors: François Beloncle, Peter Radermacher, Claude Guérin, Pierre AsfarAbstract:In patients with septic shock, a mean Arterial Pressure higher than 65 mmHg is recommended by the Surviving Sepsis Campaign Guidelines. However, a precise mean Arterial Pressure target has not been delineated. The aim of this paper was to review the physiological rationale and clinical evidence for increasing mean Arterial Pressure in septic shock. A mean Arterial Pressure level lower than renal autoregulatory threshold may lead to renal dysfunction. However, adjusting macrocirculation objectives in particular after the early phase of septic shock may not correct established microcirculation impairments. Moreover, sympathetic over-stimulation due to high doses of vasopressor (needed to achieve high mean Arterial Pressure targets) may be associated with numerous harmful effects. Observational and small short term interventional studies did not provide a definitive answer to this question but suggested that a high mean Arterial Pressure (around 75-85 mmHg) may prevent acute kidney injury in some patients. The SEPSISPAM Trial, a large prospective, randomized, controlled study, compared the targets of High (i.e. 80 to 85 mm Hg) versus Low (i.e. 65 to 70 mm Hg) mean Arterial Pressure in patients with septic shock. The mortality was not different in the two groups. However in patients with chronic hypertension, there were significantly less renal failure in the high mean Arterial Pressure group than the low mean Arterial Pressure group.