Bergman Zachary R, Kiberenge Roy K, Bianco Richard W, Beilman Gregory J, Brophy Colleen M, Hocking Kyle M, Alvis Bret D, Wise Eric S
Department of Surgery, University of Minnesota Twin Cities Medical School, Minneapolis, MN, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
J Invest Surg. 2025 Dec;38(1):2445603. doi: 10.1080/08941939.2024.2445603. Epub 2025 Jan 6.
Venous waveform analysis is an emerging technique to estimate intravascular fluid status by fast Fourier transform deconvolution. Fluid status has been shown proportional to , the amplitude of the fundamental frequency of the waveform's cardiac wave upon deconvolution. Using a porcine model of distributive shock and fluid resuscitation, we sought to determine the influence of norepinephrine on of the central venous waveform.
Eight pigs were anesthetized, catheterized and treated with norepinephrine after precipitation of endotoxemic hypotension, and subsequent fluid resuscitation to mimic sepsis physiology. Hemodynamic parameters and central venous waveforms were continually transduced throughout the protocol for post-hoc analysis. Central venous waveform before, during and after norepinephrine administration were determined using Fourier analysis.
Heart rate increased, while central venous pressure, pulmonary capillary wedge pressure and stroke volume decreased throughout norepinephrine administration ( < 0.05). Mean at pre-norepinephrine, and doses 0.05, 0.10, 0.15, 0.20 and 0.25 mcg/kg/min, were 2.5, 1.4, 1.7, 1.7, 1.6 and 1.4 mmHg, respectively (repeated measures ANOVA; < 0.001). On post-hoc comparison to pre-norepinephrine, at 0.05 mcg/kg/min was decreased ( = 0.04).
As the performance of f was previously characterized during fluid administration, these data offer novel insight into the performance of f during vasopressor delivery. Central venous waveform is a decreased with norepinephrine, in concordance with pulmonary capillary wedge pressure. This allows contextualization of the novel, venous-derived signal f during vasopressor administration, a finding that must be understood prior to clinical translation.
静脉波形分析是一种通过快速傅里叶变换反褶积来估计血管内液体状态的新兴技术。研究表明，液体状态与反褶积后波形的心搏波基频的振幅成正比。我们使用分布性休克和液体复苏的猪模型，旨在确定去甲肾上腺素对中心静脉波形的影响。
八只猪麻醉后插管，在内毒素血症性低血压诱发后用去甲肾上腺素治疗，随后进行液体复苏以模拟脓毒症生理状态。在整个实验过程中持续记录血流动力学参数和中心静脉波形，用于事后分析。使用傅里叶分析确定去甲肾上腺素给药前、给药期间和给药后的中心静脉波形。
在整个去甲肾上腺素给药过程中，心率增加，而中心静脉压、肺毛细血管楔压和每搏量降低（P<0.05）。去甲肾上腺素给药前以及剂量为0.05、0.10、0.15、0.20和0.25μg/kg/min时的平均f分别为2.5、1.4、1.7、1.7、1.6和1.4mmHg（重复测量方差分析；P<0.001）。事后与去甲肾上腺素给药前比较，0.05μg/kg/min时的f降低（P=0.04）。
由于之前已对补液期间f的表现进行了特征描述，这些数据为血管加压药输注期间f的表现提供了新的见解。中心静脉波形f随去甲肾上腺素降低，与肺毛细血管楔压一致。这使得在血管加压药给药期间对新的静脉衍生信号f有了背景认识，这一发现必须在临床转化之前加以理解。
