01.08.2010 | Research | Ausgabe 4/2010 Open Access

Withdrawing intra-aortic balloon pump support paradoxically improves microvascular flow
- Zeitschrift:
- Critical Care > Ausgabe 4/2010
Electronic supplementary material
Competing interests
Authors' contributions
Introduction
Materials and methods
Results
Patients
Mean ± SD or n (%)
|
|
---|---|
Number of patients
|
15
|
Age (years)
|
65.7 ± 11.8
|
Male
|
12 (80)
|
Length (cm)
|
175 ± 11
|
Weight (kg)
|
81 ± 14
|
Hemoglobin level (μmol)
|
6.2 ± 0.7
|
Hematocrit (%)
|
30 ± 3.5
|
Arterial blood lactate (mmol/l)*
|
1.2 ± 0.4
|
Temperature (°C)
|
36.9 ± 1.0
|
APACHE II score
|
14.5 ± 5.3
|
History of vascular disease
|
5 (33)
|
Hypertension
|
6 (40)
|
Diabetes Mellitus
|
3 (20)
|
Chronic renal insufficiency
|
1 (7)
|
Dopamine (mg/h), nine patients
|
17.7 ± 8.7
|
Norepinephrine (mg/h), five patients
|
0.26 ± 0.2
|
Dobutamine (mg/h), two patients
|
15.0 ± 7.1
|
Nitroglycerine (mg/h), six patients
|
1.0 ± 0.0
|
Artificial ventilation
|
11 (73)
|
Systemic hemodynamic data
Assist ratio 1:1
|
No assist
|
Difference
|
95% CI lower boundary
|
95% CI upper boundary
|
P- value
|
|
---|---|---|---|---|---|---|
Heart rate (beats/minute)
|
83.4(12.1)
|
85.1(12.8)
|
-1.7
|
-4.45
|
0.98
|
0.193
|
ABP systolic (mmHg)
|
115.3 (16.0)
|
110.3 (15.0)
|
5.0
|
-2.18
|
12.18
|
0.157
|
ABP mean (mmHg)
|
73.7 (8.2)
|
70.7 (10.0)
|
2.9
|
0.03
|
5.83
|
0.048
|
ABP diastolic (mmHg)
|
42.6 (10.0)
|
53.3 (8.8)
|
-10.7
|
-15.20
|
-6.10
|
0.0002
|
CVP (mmHg)
|
12.5 (6.0)
|
13.0 (6.6)
|
-0.5
|
-1.72
|
0.78
|
0.437
|
ScvO
2/SvO
2 (%)
|
70.9 (7.2)
|
71.4 (7.5)
|
-0.5
|
-1.48
|
1.31
|
0.897
|
SpO
2 (%)
|
96.4 (2.3)
|
96.5 (2.1)
|
-0.1
|
-0.91
|
0.65
|
0.719
|
PAP systolic (mmHg)
|
46.0 (8.3)
|
46.3 (6.8)
|
-0.3
|
-2.78
|
2.12
|
0.741
|
PAP mean (mmHg)
|
28.8 (4.2)
|
28.5 (4.3)
|
0.3
|
-0.75
|
1.41
|
0.465
|
PAP diastolic (mmHg)
|
22.7 (8.1)
|
22.5 (7.8)
|
0.2
|
-0.62
|
0.95
|
0.61
|
Microcirculation
Assist ratio 1:1
|
No assist
|
Difference
|
95% CI lower boundary
|
95% CI upper boundary
|
P- value
|
|
---|---|---|---|---|---|---|
PVD vessels <20 μm (mm
-1)
|
5.47 (1.76)
|
6.63 (1.90)
|
-1,16
|
-1.89
|
-0.44
|
0.0039
|
PPV vessels <20 μm (mm
-1)
|
88.4 (14.1)
|
88.8 (16.4)
|
-0,43
|
-6.49
|
5.61
|
0.879
|
MFI vessels <20 μm
|
2.75 [2.0 to 3.0]
|
3.0 [2.58 to 3.0]
|
-0.25
|
NA
|
NA
|
0.422
|
HI-PVD vessels <20 μm
|
0.38 (0.23)
|
0.40 (0.37)
|
-0,02
|
-0.19
|
0.15
|
0.834
|
HI-MFI vessels <20 μm
|
0.68 (0.68)
|
0.57 (0.87)
|
0,11
|
-0.27
|
0.49
|
0.547
|
PVD vessels >20 μm (mm
-1)
|
1.34 (0.88)
|
1.64 (0.63)
|
-0,31
|
-0.83
|
0.21
|
0.222
|
PPV vessels >20 μm (mm
-1)
|
95.5 (9.6)
|
96.9 (7.7)
|
-1,38
|
-4.94
|
2.18
|
0.420
|
MFI vessels >20 μm
|
3.0 [2.5 to 3.0]
|
3.0 [2.78 to 3.0]
|
0
|
NA
|
NA
|
0.109
|
HI-PVD vessels >20 μm
|
0.59 (0.25)
|
0.50 (0.25)
|
0,08
|
-0.08
|
0.25
|
0.299
|
HI-MFI vessels >20 μm
|
0.44 (0.58)
|
0.18 (0.29)
|
0,26
|
-0.05
|
0.57
|
0.096
|
Discussion
Conclusions
Key messages
-
Discontinuing IABP-therapy increases sublingual microvascular perfusion of small vessels in patients deemed clinically ready for ceasing IABP-support.
-
Global hemodynamic parameters and venous oximetry do not correlate with and may therefore be unreliable for predicting adequacy of microvascular perfusion in this clinical setting.