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（申请人提供）：我们将以心肺相互作用和收缩不同步的临床分析作为培养博士后的载体。这是一种优秀且行之有效的指导途径，因为它基于临床相关的心肺生理学，要求学员学习使用最先进的监测和成像技术，广泛应用于手术室、ICU、综合医院病房和门诊。尽管许多研究者研究了心肺相互作用，但仍缺乏准确的临床应用。通气和通气操作具有深远的意义，直到最近才被记录为了解可用于定义心肺衰竭的血流动力学效应。我们的目标是开发和验证临床相关且易于应用的床旁工具，以快速、明确地诊断血流动力学不足的病因以及通气和辅助心血管治疗对其的影响。我们使用 ICU、超声心动图诊所和心脏手术室作为我们的研究环境。为了实现这些目标，我们正在测试三个假设：1）正压引起的左室前负荷和后负荷变化受到收缩力和有效循环血量的不同影响。 2) 呼气末正压可通过增加 ITP 最小化心室相互依赖性和左心室射血异步性来改善左心室性能。 3) 通过分析动脉脉压对自发通气和正压通气的反应，可以很容易地识别左心室收缩储备和前负荷反应性（通常是心功能谱的两端）和动脉张力。我们将使用最先进的超声心动图成像技术（散斑追踪和组织多普勒成像）对左心室性能进行复杂分析，并使用简单的主动脉多普勒和动脉压波形分析来评估前负荷反应性、收缩储备和动脉张力，以进行临床推导。有用的信息。

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