• Aarne Feldheiser, Peter Juhl-Olsen, Michael Nordine, Matthias Stetzuhn, Ludwig Wiegank, Fabian Knebel, Sascha Treskatsch, and Christian Berger.
• From the Department of Anaesthesiology and Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (AF, MS, LW), Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Evang. Kliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany (AF), Department of Cardiothoracic- and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus, Denmark (PJ-O), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany (MN, ST, CB), Sana Berlin-Klinkum Lichtenberg, Fanninger Straße 32, 10365 Berlin und Charité Universitätsmedizin, Campus Mitte, Klinik für Kardiologie und Angiologie. 10098 Berlin (FK).
• Eur J Anaesthesiol. 2023 Aug 1; 40 (8): 578586578-586.

BackgroundPeri-operative and critically ill patients often experience mild to moderate hypovolaemic shock with preserved mean arterial pressure (MAP), heart rate (HR) and decreased stroke volume index (SVI).ObjectivesThe aim of this study was to evaluate echocardiographic parameters during simulated mild to moderate central hypovolaemia.DesignThis was a prospective preclinical study.SettingLaboratory trial performed in Charité-Universitätsmedizin Berlin, Germany.Patients And MethodsThirty healthy male volunteers underwent graded central hypovolaemia using a lower body negative pressure (LBNP) chamber with a stepwise decrease to simulate a mild (-15 mmHg), mild-to-moderate (-30 mmHg), and moderate state of hypovolaemic shock (-45 mmHg). During every stage, a transthoracic echocardiography examination (TTE) was performed by a certified examiner.Main Outcome MeasuresSystolic and diastolic myocardial performance markers, as well as cardiac volumes were recorded during simulated hypovolaemia and compared to baseline values.ResultsDuring simulated hypovolaemia via LBNP, SVI decreased progressively at all stages, whereas MAP and HR did not consistently change. Left ventricular (LV) ejection fraction decreased at -30 and -45 mmHg. Simultaneously with SVI decline, LV global longitudinal strain (LV GLS), tricuspid annular plain systolic excursion (TAPSE), and right ventricular RV S' and left-atrial end-systolic volume (LA ESV) decreased compared to baseline at all stages.ConclusionsIn this study, simulated central hypovolaemia using LBNP did not induce consistent changes in MAP and HR. SVI decreased and was associated with deteriorated right- and left-ventricular function, observed with echocardiography. The decreased filling status was characterised by decreased LA ESV.Clinical Trial NumberClinicalTrials.gov Identifier: NCT03481855.Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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