Anestezide Arteriyal Dalga Analizinin Kullanımı
Özet
Kardiyovasküler hastalıklar küresel ölümlerin %31’ini oluştururken, damar sertliği bu hastalıklar için kritik bir risk faktörüdür. Arteriyel dalga, kan damarı boyunca yayılan basınç ve akış hızı değişikliği olarak tanımlanır ve hızı yaşla birlikte artış gösterir. Tarihsel süreci 1733’te Stephen Hales’in ilk ölçümleriyle başlayan bu alan, 1949’da klinik uyumlu kateterlerin geliştirilmesiyle modern boyutuna ulaşmıştır. Sistemik arteriyel basınç dalgası, sol ventrikülün sistol sırasında kanı pompalamasıyla oluşur ve EKG sinyalleriyle doğrudan ilişkilidir. Dalga formundaki dikrotik çentik aort kapağının kapandığını simgeler. Analizlerde dalga eğiminin dikliği kalp kontraktilitesinin gücünü yansıtır; bu da inotrop ilaçların titrasyonunda yol göstericidir. Ayrıca Nabız Basıncı Varyasyonu (PPV) ve Atım Hacmi Varyasyonu (SVV), mekanik ventilasyon altındaki hastalarda sıvı tedavisine yanıtı değerlendirmede altın standart kabul edilen dinamik parametrelerdir. PPV için %12, SVV için %9-14 eşik değerleri sıvı yönetimi için kritiktir. Günümüzde invaziv kateterler ölçümde altın standart olmaya devam ederken, aplanasyon tonometrisi gibi noninvaziv yöntemler de mevcuttur. Sonuç olarak, arteriyel dalga analizi anestezi yönetiminde doku perfüzyonu ve sıvı dengesini optimize eden vazgeçilmez bir araçtır.
While cardiovascular diseases account for 31% of global deaths, arterial stiffness is a critical risk factor for these conditions. An arterial wave is defined as a change in pressure and flow velocity propagating along a blood vessel, and its velocity increases with age. The field, which began with Stephen Hales' first measurements in 1733, reached its modern dimension with the development of clinically compatible catheters in 1949. The systemic arterial pressure wave results from the left ventricle pumping blood during systole and is directly linked to ECG signals. The dicrotic notch in the waveform symbolizes the closure of the aortic valve. In analyses, the steepness of the wave slope reflects the strength of cardiac contractility, which guides the titration of inotropic drugs. Furthermore, Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) are dynamic parameters considered the gold standard for assessing fluid responsiveness in mechanically ventilated patients. Threshold values of 12% for PPV and 9-14% for SVV are critical for fluid management. Today, while invasive catheters remain the gold standard for measurement, non-invasive methods such as applanation tonometry are also available. Consequently, arterial waveform analysis is an indispensable tool in anesthesia management that optimizes tissue perfusion and fluid balance.
Referanslar
Mynard, J. P., Kondiboyina, A., Kowalski, R., et al. Measurement, Analysis and Interpretation of Pressure/Flow Waves in Blood Vessels. Front. Physiol.2020; 11, 1085.
McEniery, CM, Yasmin, Hall IR, et al. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J. Am. Coll. Cardiol. 2005; 46, 1753–1760.
Lewis, O. Stephen Hales and the measurement of blood pressure. J. Hum. Hypertens 1994; 8, 865–871.
Peterson LH, Dripps RD, Risman GC. A method for recording the arterial pressure pulse and blood pressure in man. Am. Heart J.1949; 37, 771–782.
Peirce EC. 2nd. Percutaneous femoral artery catheterization in man with special reference to aortography. Surg. Gynecol. Obstet. 1951; 93, 56–74.
Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol. 1953; 39, 368–376.
Durie M, Beckmann U, Gillies DM. Incidents relating to arterial cannulation as identified in 7,525 reports submitted to the Australian incident monitoring study (AIMS-ICU). Anaesth. Intensive Care. 2002; 30, 60–65.
McCann UG. 2nd et al. Invasive arterial BP monitoring in trauma and critical care: effect of variable transducer level, catheter access, and patient position. Chest 120. 2001; 1322–1326.
Dorman T. Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients. Crit. Care Med. 1998; 26, 1646–1649.
O’Rourke MF, Gallagher DE. Pulse wave analysis. J. Hypertens. Suppl. Off. J. Int. Soc. Hypertens. 1996; 14, S147-57.
Thiele RH, Durieux ME. Arterial waveform analysis for the anesthesiologist: past, present, and future concepts. Anesth. Analg. 2011; 113, 766–776.
Esper SA, Pinsky MR. Arterial waveform analysis. Best Pract. Res. Clin. Anaesthesiol. 2014; 28, 363–380.
Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit. Care Med. 2013; 41, 1774–1781.
Rooke GA, Schwid HA, Shapira Y. The effect of graded hemorrhage and intravascular volume replacement on systolic pressure variation in humans during mechanical and spontaneous ventilation. Anesth. Analg. 1995; 80, 925–932.
Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit. Care Med. 2009; 37, 2642–2647.
Guinot P. Ability of stroke volume variation measured by oesophageal Doppler monitoring to predict fluid responsiveness during surgery. Br. J. Anaesth. 2013; 110, 28–33.
Zhang Z, Lu B, Sheng X, et al. Accuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysis. J. Anesth. 2011; 25, 904–916.
Perel A, Pizov R, Cotev S. Respiratory variations in the arterial pressure during mechanical ventilation reflect volume status and fluid responsiveness. Intensive Care Med. 2014; 40, 798–807.
Perel A. Assessing fluid responsiveness by the systolic pressure variation in mechanically ventilated patients. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology vol. 1998; 89 1309–1310.
Papaioannou TG, Protogerou AD, Stamatelopoulos KS, et al. Non-invasive methods and techniques for central blood pressure estimation: procedures, validation, reproducibility and limitations. Curr. Pharm. Des. 2009; 15, 245–253.
Shabani Varaki E, Gargiulo GD, Penkala S, et al. Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomed. Eng. Online. 2018; 17, 61.
