Effect of norepinephrine on the vascular waterfall and tissue perfusion in vasoplegic hypotensive patients: a prospective, observational, applied physiology study in cardiac surgery

Andrei, Stefan; Bar, Stéphane; Nguyen, Maxime; Bouhemad, Bélaid; Guinot, Pierre-Grégoire

doi:10.1186/s40635-023-00539-x

Intensive Care Medicine Experimental

Table 2 Comparison of hemodynamic parameters before and after intervention for VW-responders and non-responders patients (¹Wilcoxon matched-pair signed rank test, p-value shown)

From: Effect of norepinephrine on the vascular waterfall and tissue perfusion in vasoplegic hypotensive patients: a prospective, observational, applied physiology study in cardiac surgery

Variable	Baseline	After NE	p-value¹
Heart rate (bpm), mean (SD)
All cohort	81 (18)	81 (18)	0.791
- VW responders	82 (20)	82 (20)	0.72
- VW non-responders	79 (13)	79 (15)	0.87
Systolic arterial pressure (mmHg), mean (SD)
All cohort	85 (10)	121 (15)	< 0.001
- VW responders	86 (9)	124 (17)	< 0.001
- VW non-responders	84 (12)	116 (8)	< 0.001
Mean arterial pressure (mmHg), mean (SD)
All cohort	59 (7)	80 (12)	< 0.001
- VW responders	60 (5)	85 (13)	< 0.001
- VW non-responders	58 (9)	77 (8)	< 0.001
Diastolic arterial pressure (mmHg), mean (SD)
All cohort	47 (7)	63 (12)	< 0.001
- VW responders	47 (6)	65 (13)	< 0.001
- VW non-responders	46 (9)	58 (9)	< 0.001
Central venous pressure (mmHg), mean (SD)
All cohort	7 (4)	9 (4)	< 0.001
- VW responders	7 (4)	9 (4)	< 0.001
- VW non-responders	8 (4)	10 (4)	0.01
Mean systemic pressure (mmHg), median [IQR]
All cohort	23 [18; 26]	22 [15; 26]	0.269
- VW responders	22 [17; 26]	20 [16; 25]	0.15
- VW non-responders	23 [17; 26]	24 [22; 28]	0.59
Critical closure pressure (mmHg), median [IQR]
All cohort	25 [14; 34]	45 [27;60]	< 0.001
- VW responders	26 [20; 29]	58 [46;71]*	< 0.001
- VW non-responders	25 [18 ;37]	27 [15;40]*	0.58
Vascular waterfall (mmHg), median [IQR]
All cohort	3.5 [− 10; 10]	23 [− 2; 47]	< 0.001
- VW responders	4 [− 14; 8]	44 [26; 48]*	0.001
- VW non-responders	5 [− 5; 16]	− 2 [− 12; 15]*	0.17
Indexed systemic arterial resistance (mmHg L⁻¹ min⁻¹ m⁻²), mean (SD)
All cohort	20 [14; 28]	16 [7; 29]	0.271
- VW responders	19 [14; 34]	11 [5; 24]*	0.002
- VW non-responders	22 [6; 26]	28 [16; 32]*	0.03
Indexed total peripheral resistances (mmHg L⁻¹ min⁻¹ m⁻²), mean (SD)
All cohort	34 (17)	40 (15)	< 0.001
- VW responders	34 (21)	40 (18)	0.002
- VW non-responders	34 (9)	40 (8)	0.013
Cardiac index (L min⁻¹ m⁻²), mean (SD)
All cohort	1.7 (0.6)	2 (0.5)	< 0.001
- VW responders	1.8 (0.6)	2.2 (0.5)*	0.002
- VW non-responders	1.6 (0.3)	1.8 (0.4)*	0.09
ScvO₂ (%), mean (SD)
All cohort	61 (10)	67 (10)	0.001
- VW responders	64 (10)	69 (8)	0.02
- VW non-responders	57 (8)	63 (12)	0.05
pCO₂ gap (mmHg), median [IQR]
All cohort	9 [7; 11]	7 [4; 10]	0.073
- VW responders	9 [7; 10]	6 [4; 8]*	0.04
- VW non-responders	10 [8.00; 11]	11 [8; 12]*	0.57
pCO₂ gap/arterio-venous oxygen tension, median [IQR]
All cohort	1.8 [1.6; 2.1]	1.9 [0.9; 2.3]	0.289
- VW responders	1.9 [1.6; 2.1]	1.6 [0.8; 2.1]	0.04
- VW non-responders	1.8 [1.6; 2.0]	2.2 [1.8; 2.5]	0.38
Arterial lactates (mmol L⁻¹), mean (SD)
All cohort	1.6 (0.5)	1.7 (0.7)	0.705
- VW responders	1.5 (0.4)	1.6 (0.6)	0.52
- VW non-responders	1.8 (0.6)	1.8 (0.7)	0.71
Capillary refill time (s), mean (SD)
All cohort	4.2 (1.1)	3.3 (1.1)	0.001
- VW responders	4.2 (1.1)	3.1 (1)	0.006
- VW non-responders	4.1 (1)	3.7 (1.4)	0.44

At each timepoint the two groups were also compared (Wilcoxon signed rank test, p-value not shown; * = statistically significant difference between the VW-responders and non-responders patients)
bpm beats per minute, IQR 25%-75% interquartile range, NE norepinephrine, pCO₂ carbon dioxide pressure, ScvO₂ central venous oxygen saturation, SD standard deviation, VW vascular waterfall

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