TY  - BOOK
AU  - Carney, Bonnie C
AU  - Keyloun, John 
AU  - Moffatt, Lauren T
AU  - Oliver, Mary A
AU  - Shupp, Jeffrey W
TI  - The Potential of Arterial Pulse Wave Analysis in Burn Resuscitation: A Pilot In Vivo Study
SN  - 1559-047X
KW  - *Burns
KW  - Animals
KW  - Arteries
KW  - Blood Pressure
KW  - Burns/th [Therapy]
KW  - Fluid Therapy/mt [Methods]
KW  - Hemodynamics
KW  - Pulse Wave Analysis
KW  - Respiration, Artificial
KW  - Resuscitation/mt [Methods]
KW  - Swine
KW  - Automated
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - MedStar General Surgery Residency
KW  - Journal Article
N1  - Available online through MWHC library: 2006 - present, Available in print through MWHC library: 2006 - present
N2  - While urinary output (UOP) remains the primary endpoint for titration of intravenous fluid resuscitation, it is an insufficient indicator of fluid responsiveness. Although advanced hemodynamic monitoring (including arterial pulse wave analysis (PWA)) is of recent interest, the validity of PWA-derived indices in burn resuscitation extremes has not been established. The goal of this paper is to test the hypothesis that PWA-derived cardiac output (CO) and stroke volume (SV) indices as well as pulse pressure variation (PPV) and systolic pressure variation (SPV) can play a complementary role to UOP in burn resuscitation. Swine were instrumented with a Swan-Ganz catheter for reference CO and underwent a 40% total body surface area burns with varying resuscitation paradigms, and were monitored for 24 hours in an ICU setting under mechanical ventilation. The longitudinal changes in PWA-derived indices were investigated, and resuscitation adequacy was compared as determined by UOP versus PWA indices. The results indicated that PWA-derived indices exhibited trends consistent with reference CO and SV measurements: CO and SV indices were proportional to reference CO and SV, respectively (CO: post-calibration limits of agreement (LoA)=+/-24.7 [ml/min/kg], SV: post-calibration LoA=+/-0.30 [ml/kg]) while PPV and SPV were inversely proportional to reference SV (PPV: post-calibration LoA=+/-0.32 [ml/kg], SPV: post-calibration LoA=+/-0.31 [ml/kg]). The results also indicated that PWA-derived indices exhibited notable discrepancies from UOP in determining adequate burn resuscitation. Hence, it was concluded that the PWA-derived indices may have complementary value to UOP in assessing and guiding burn resuscitation. Copyright Published by Oxford University Press on behalf of the American Burn Association 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US
UR  - https://dx.doi.org/10.1093/jbcr/irac097
ER  -