en
Scientific article
Review
English

The use of the oesophageal Doppler in perioperative medicine: new opportunities in research and clinical practice

Published inJournal of clinical monitoring and computing, vol. 31, no. 5, p. 895-902
Publication date2017
Abstract

The oesophageal Doppler (OD) is a minimally invasive haemodynamic monitor used in the surgical theatre and the ICU. Using the OD, goal-directed therapy (GDT) has been shown to reduce perioperative complications in high-risk surgical patients. However, most GDT protocols currently in use are limited to stroke volume optimisation. In the present manuscript, we examine the conceptual models behind new OD-based measurements. These would provide the clinician with a comprehensive view of haemodynamic pathophysiology; including pre-load, contractility, and afterload. Specifically, volume status could be estimated using mean systemic filling pressure (MSFP), the pressure to which all intravascular pressures equilibrate during asystole. Using the OD, MSFP could be readily estimated by simultaneous measurements of aortic blood flow and arterial pressure with sequential manoeuvres of increasing airway pressure. This would result in subsequent reductions in cardiac output and arterial pressure and would allow for a linear extrapolation of a static MSFP value to a "zero flow" state. In addition, we also demonstrate that EF is proportional to mean blood flow velocity measured in the descending thoracic aorta with the OD. Furthermore, OD-derived indexes of blood flow velocity and acceleration, as well as force and kinetic energy, can be derived and used for continuous assessment of cardiac contractility at the bedside. Using OD-derived parameters, the different components of afterload: inertia, resistance and elastance, could also be individually determined. The integration of these additional haemodynamic parameters could assist the clinician in optimising and individualising haemodynamic performance in unstable patients.

Funding
  • European Commission - MULTISCALE APPROACH TO THE IDENTIFICATION OF MOLECULAR BIOMARKERS IN ACUTE HEART FAILURE INDUCED BY SHOCK [602706]
Citation (ISO format)
BOLEN PINTO, Bernardo et al. The use of the oesophageal Doppler in perioperative medicine: new opportunities in research and clinical practice. In: Journal of clinical monitoring and computing, 2017, vol. 31, n° 5, p. 895–902. doi: 10.1007/s10877-016-9926-5
Main files (1)
Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal1387-1307
467views
1downloads

Technical informations

Creation08/31/2016 2:14:00 PM
First validation08/31/2016 2:14:00 PM
Update time03/15/2023 12:41:54 AM
Status update03/15/2023 12:41:53 AM
Last indexation05/02/2024 5:43:53 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack