Heart-Lung Interactions & Cardiovascular Insufficiency

心肺相互作用

• 批准号: 8078075
• 负责人: MICHAEL R PINSKY
• 金额: $ 16.36万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-05-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8078075
• 关键词: Address; Affect; Blood Circulation; Blood Volume; Breathing; Cardiac; Cardiac Surgery procedures; Cardiopulmonary Physiology; Cardiovascular system; Clinic; Clinical; Complex; Diagnosis; Environment; Environmental air flow; Etiology; General Hospitals; Goals; Heart; Human; Image; Imaging Techniques; Intensive Care Units; Learning; Lung; Mentors; Monitor; Operating Rooms; Outpatients; Pathway interactions; Performance; Play; Positive-Pressure Respiration; Pulse Pressure; Research; Research Personnel; Respiratory Failure; Role; Stroke Volume; Techniques; Testing; Tidal Volume; Time; Tissues; Training; Venous; Ventricular; Ventricular Function; base; career; clinical application; clinically relevant; expiration; hemodynamics; improved; meetings; post-doctoral training; pressure; response; tool; ward

DESCRIPTION (provided by applicant): We shall use the clinical analysis of heart-lung interactions and contraction dyssynchrony as the vehicles for training post-doctoral candidates. This is an excellent and proven productive pathway for mentoring because it is based in clinically relevant cardiopulmonary physiology and requires the trainee to learn to use state-of- the-art monitoring and imaging techniques with broad applications to the operating room, ICU, general hospital ward and out-patient clinic. Although numerous investigators have studied heart-lung interactions, an accurate clinical application has been lacking. Ventilation and ventilatory maneuvers have profound and only recently documented understood hemodynamic effects that can be used to define cardio-respiratory failure. Our goal is to develop and validate clinically relevant and easily applicable bedside tools for the rapid and unambiguous diagnosis of the etiology of hemodynamic insufficiency and the impact of ventilatory and adjunct cardiovascular therapies upon it. We use as our research environment, the ICU, echocardiographic clinic and the cardiac surgery suite. To accomplish these goals we are testing three hypotheses: 1) Positive-pressure induced changes in LV preload and afterload are differentially affected by contractility and effective circulating blood volume. 2) Positive end-expiratory pressure improves LV performance by minimizing ventricular interdependence and LV ejection asynchrony by increasing ITP. 3) LV contractile reserve and preload responsiveness (often opposite ends of the cardiac function spectrum) and arterial tone can be readily identified by analysis of the arterial pulse pressure responses to spontaneous and positive-pressure ventilation. We shall use state-of-the- art echocardiographic imaging techniques (speckle tracking and tissue Doppler imaging) for complex analysis of LV performance and simple aortic Doppler and arterial pressure waveform analysis to assess preload- responsiveness, contractile reserve and arterial tone to derive clinically useful information.

描述（由申请人提供）：我们将使用心脏肺相互作用和收缩异性疾病的临床分析作为训练博士后候选者的工具。这是一种出色而良好的富有生产力指导途径，因为它基于临床相关的心肺生理学，要求学员学习使用最新的ART监测和成像技术，并在手术室，ICU，ICU，总医院病房和门诊临床上使用广泛应用。尽管许多研究人员研究了心肺相互作用，但缺乏准确的临床应用。通风和通风操作具有深刻的，直到最近才记录在可理解的血液动力学作用中，可用于定义心脏呼吸衰竭。我们的目标是开发和验证与临床相关且易于适用的床旁工具，以快速且明确的诊断血液动力学功能不全的病因以及通风和辅助心血管疗法对其的影响。我们用作研究环境，ICU，超声心动图诊所和心脏手术套件。为了实现这些目标，我们正在检验三个假设：1）正压诱导的LV预加载和后负载的变化受收缩性和有效循环血容量的差异影响。 2）正急血压阳性通过增加心室相互依赖性和通过增加ITP来最大程度地提高LV性能。 3）通过分析动脉脉压压力响应对自发和正压通风的动脉压力响应，可以轻松地识别出LV收缩储备和预加载响应性（通常相反的心脏功能谱系的相对端）和动脉音调。我们将使用最先进的超声心动图成像技术（斑点跟踪和组织多普勒成像）进行LV性能和简单主动脉多普勒和动脉压力波形分析的复杂分析，以评估预付响应性，收缩储备，动脉储备和动脉张力，以获取临床有用信息。

项目成果

Practical issues of hemodynamic monitoring at the bedside.

床边血流动力学监测的实际问题。

• DOI: 10.1016/j.suc.2006.09.003
• 发表时间: 2006
• 期刊: The Surgical clinics of North America
• 作者: Polanco,PatricioM;Pinsky,MichaelR
• 通讯作者: Pinsky,MichaelR

Principals of hemodynamic monitoring.

血流动力学监测原理。

• DOI: 10.1159/000102078
• 发表时间: 2007
• 期刊: Contributions to nephrology
• 作者: Polanco,PatricioM;Pinsky,MichaelR
• 通讯作者: Pinsky,MichaelR

Determination of vascular waterfall phenomenon by bedside measurement of mean systemic filling pressure and critical closing pressure in the intensive care unit.

• DOI: 10.1213/ane.0b013e318247fa44
• 发表时间: 2012-04
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Maas JJ;de Wilde RB;Aarts LP;Pinsky MR;Jansen JR
• 通讯作者: Jansen JR

Very low frequency variability in the peripheral circulation: the possibility of plethysmographic quantification.

外周循环的频率变化非常低：体积描记量化的可能性。

• DOI: 10.1097/eja.0b013e3283297539
• 发表时间: 2009
• 期刊: European journal of anaesthesiology
• 影响因子: 3.6
• 作者: Zenker,Sven;Polanco,PatricioM;Torres,Andres;Clermont,Gilles;Kim,HyungKook;Vodovotz,Yoram;Pinsky,MichaelR;Namas,RajaieA;Puyana,JuanCarlos
• 通讯作者: Puyana,JuanCarlos

Heat shock factor 1 inhibits nuclear factor-kappaB nuclear binding activity during endotoxin tolerance and heat shock.

• DOI: 10.1016/j.jcrc.2007.09.007
• 发表时间: 2008-09
• 期刊: Journal of critical care
• 影响因子: 3.7
• 作者: Mingchen Song;M. Pinsky;J. Kellum