Hemodynamic Reverse Remodeling With Remote Pulmonary Artery Pressure-guided Therapy: A New Paradigm In Heart Failure Care.
HFSA ePoster Library. Castro M. 09/10/21; 343540; 300
Miguel Castro
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Abstract
Discussion Forum (0)
Background: Hemodynamic monitoring of patients on inotrope support presents numerous challenges including duration of invasive pulmonary artery catheter (PAC) placement, limited mobility, and increased intensive care unit stay. Invasive hemodynamic assessment with PAC, including mixed venous oxygen saturation (MVO2), provides objective information regarding efficacy of inotrope support and optimal dose. However, PACs cannot be indefinitely retained. Surrogate measures such as creatinine and bilirubin, may reflect changes in cardiac output only after considerable deterioration has occurred. Prior data has shown poor correlation between venous oxygen saturation (ScvO2) assessments from central venous catheters (CVC) and MVO2 measurements obtained from PACs for assessing Fick cardiac output. However, peripherally inserted central catheters (PICC), with proximity closer to the right atrium compared to standard CVCs, may provide a more reliable correlation. ScvO2 measurements from PICC are often used in the clinical setting, but there is a paucity of literature supporting correlation of PICC ScvO2 with PAC MVO2. In this study, we aim to assess the correlation of these measurements in successive paired samples from heart failure patients on inotrope support with both PICC and PAC present.
Methods: We prospectively studied 55 advanced heart failure patients in a single cardiac intensive care unit who had simultaneous PAC and PICC access. Blood samples were collected from the distal ports of both catheters, and venous oxygen saturations were recorded. Data points collected in these patients included age, PAC MVO2, PICC ScvO2, and time delay between samples. All male and female patients >18 years of age who required intravenous inotrope therapy and had simultaneous PAC and PICC were included. Patients with structural heart disease (VSD, ASD, PFO) and presence of AV fistula were excluded. Paired t-test was used to assess the difference between the mean values of the two variables (PAC MVO2 and PICC ScvO2). Pearson correlation coefficient was used to measure the linear correlation of the two variables.
Results: 55 paired samples were obtained. The mean PAC MVO2 was 57.16% (St Dev 8.3), and the mean ScvO2 was 55.85% (St Dev 8.40). The mean value for the paired difference was 1.309 (95% CI -0.331 - 2.949) with p=0.115. The Pearson correlation coefficient was 0.736. There was no correlation between time delay and difference between PAC MVO2 and PICC ScvO2 in the paired samples.
Conclusions: In this single center study, there was no statistical difference between paired mean venous oxygen samples obtained from PAC and PICC access. A high correlation was identified between these two variables. Our data suggests that PICC ScvO2 may be a reasonable surrogate marker for PAC MVO2. Use of PICC ScvO2 may assist in earlier removal of PAC, earlier transfer out of the intensive care unit, and earlier mobility. Further studies should be performed to validate our data.
Methods: We prospectively studied 55 advanced heart failure patients in a single cardiac intensive care unit who had simultaneous PAC and PICC access. Blood samples were collected from the distal ports of both catheters, and venous oxygen saturations were recorded. Data points collected in these patients included age, PAC MVO2, PICC ScvO2, and time delay between samples. All male and female patients >18 years of age who required intravenous inotrope therapy and had simultaneous PAC and PICC were included. Patients with structural heart disease (VSD, ASD, PFO) and presence of AV fistula were excluded. Paired t-test was used to assess the difference between the mean values of the two variables (PAC MVO2 and PICC ScvO2). Pearson correlation coefficient was used to measure the linear correlation of the two variables.
Results: 55 paired samples were obtained. The mean PAC MVO2 was 57.16% (St Dev 8.3), and the mean ScvO2 was 55.85% (St Dev 8.40). The mean value for the paired difference was 1.309 (95% CI -0.331 - 2.949) with p=0.115. The Pearson correlation coefficient was 0.736. There was no correlation between time delay and difference between PAC MVO2 and PICC ScvO2 in the paired samples.
Conclusions: In this single center study, there was no statistical difference between paired mean venous oxygen samples obtained from PAC and PICC access. A high correlation was identified between these two variables. Our data suggests that PICC ScvO2 may be a reasonable surrogate marker for PAC MVO2. Use of PICC ScvO2 may assist in earlier removal of PAC, earlier transfer out of the intensive care unit, and earlier mobility. Further studies should be performed to validate our data.
Background: Hemodynamic monitoring of patients on inotrope support presents numerous challenges including duration of invasive pulmonary artery catheter (PAC) placement, limited mobility, and increased intensive care unit stay. Invasive hemodynamic assessment with PAC, including mixed venous oxygen saturation (MVO2), provides objective information regarding efficacy of inotrope support and optimal dose. However, PACs cannot be indefinitely retained. Surrogate measures such as creatinine and bilirubin, may reflect changes in cardiac output only after considerable deterioration has occurred. Prior data has shown poor correlation between venous oxygen saturation (ScvO2) assessments from central venous catheters (CVC) and MVO2 measurements obtained from PACs for assessing Fick cardiac output. However, peripherally inserted central catheters (PICC), with proximity closer to the right atrium compared to standard CVCs, may provide a more reliable correlation. ScvO2 measurements from PICC are often used in the clinical setting, but there is a paucity of literature supporting correlation of PICC ScvO2 with PAC MVO2. In this study, we aim to assess the correlation of these measurements in successive paired samples from heart failure patients on inotrope support with both PICC and PAC present.
Methods: We prospectively studied 55 advanced heart failure patients in a single cardiac intensive care unit who had simultaneous PAC and PICC access. Blood samples were collected from the distal ports of both catheters, and venous oxygen saturations were recorded. Data points collected in these patients included age, PAC MVO2, PICC ScvO2, and time delay between samples. All male and female patients >18 years of age who required intravenous inotrope therapy and had simultaneous PAC and PICC were included. Patients with structural heart disease (VSD, ASD, PFO) and presence of AV fistula were excluded. Paired t-test was used to assess the difference between the mean values of the two variables (PAC MVO2 and PICC ScvO2). Pearson correlation coefficient was used to measure the linear correlation of the two variables.
Results: 55 paired samples were obtained. The mean PAC MVO2 was 57.16% (St Dev 8.3), and the mean ScvO2 was 55.85% (St Dev 8.40). The mean value for the paired difference was 1.309 (95% CI -0.331 - 2.949) with p=0.115. The Pearson correlation coefficient was 0.736. There was no correlation between time delay and difference between PAC MVO2 and PICC ScvO2 in the paired samples.
Conclusions: In this single center study, there was no statistical difference between paired mean venous oxygen samples obtained from PAC and PICC access. A high correlation was identified between these two variables. Our data suggests that PICC ScvO2 may be a reasonable surrogate marker for PAC MVO2. Use of PICC ScvO2 may assist in earlier removal of PAC, earlier transfer out of the intensive care unit, and earlier mobility. Further studies should be performed to validate our data.
Methods: We prospectively studied 55 advanced heart failure patients in a single cardiac intensive care unit who had simultaneous PAC and PICC access. Blood samples were collected from the distal ports of both catheters, and venous oxygen saturations were recorded. Data points collected in these patients included age, PAC MVO2, PICC ScvO2, and time delay between samples. All male and female patients >18 years of age who required intravenous inotrope therapy and had simultaneous PAC and PICC were included. Patients with structural heart disease (VSD, ASD, PFO) and presence of AV fistula were excluded. Paired t-test was used to assess the difference between the mean values of the two variables (PAC MVO2 and PICC ScvO2). Pearson correlation coefficient was used to measure the linear correlation of the two variables.
Results: 55 paired samples were obtained. The mean PAC MVO2 was 57.16% (St Dev 8.3), and the mean ScvO2 was 55.85% (St Dev 8.40). The mean value for the paired difference was 1.309 (95% CI -0.331 - 2.949) with p=0.115. The Pearson correlation coefficient was 0.736. There was no correlation between time delay and difference between PAC MVO2 and PICC ScvO2 in the paired samples.
Conclusions: In this single center study, there was no statistical difference between paired mean venous oxygen samples obtained from PAC and PICC access. A high correlation was identified between these two variables. Our data suggests that PICC ScvO2 may be a reasonable surrogate marker for PAC MVO2. Use of PICC ScvO2 may assist in earlier removal of PAC, earlier transfer out of the intensive care unit, and earlier mobility. Further studies should be performed to validate our data.
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