Assessment of Hemodynamic Changes During Large-Volume Plasmapheresis with a Non-Invasive Cardiac Output Monitor in Patients with Neurological Disease: A Prospective Cohort Study.

IF 0.9 3区医学 Q4 NEUROSCIENCES

Neurology India Pub Date : 2025-05-01 Epub Date: 2025-05-23 DOI:10.4103/neurol-india.Neurol-India-D-24-00199

Shweta Naik, Mathangi Krishnakumar, Amruta Nirale, V Bhadrinarayan, Francis Joseph

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引用次数: 0

Abstract

Introduction: Therapeutic large-volume plasmapheresis (LVP) effectively manages neurological diseases, such as Guillain-Barre syndrome (GBS) and myasthenia gravis (MG), but it induces alterations in intravascular volume, necessitating vigilant monitoring. This study investigated the hemodynamic changes and the utility of non-invasive cardiac output monitoring (NICOM) during LVP.

Methods: This prospective observational study included 50 neurological patients receiving their first LVP cycle. Standard monitoring of heart rate (HR), non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and cardiac output (CO) using NICOM was performed. Changes in HR, NIBP, CO, total peripheral resistance (TPR), stroke volume (SV), and stroke volume variation (SVV) were recorded at baseline and multiple time points during LVP.

Results: The mean age was 36 ± 15.05 years. The mean arterial pressure (MAP) significantly decreased from baseline at 30 and 60 minutes, and LVP completion (P < 0.05). While HR and systolic/diastolic blood pressure (SBP/DBP) remained stable, SV, CO, and cardiac index (CI) significantly decreased (P < 0.05), peaking at 60 minutes. TPR significantly increased (P < 0.05) with a maximum of 30 minutes. The volume of plasma removed directly influenced CO, CI, and SV changes (P < 0.05).

Discussion: LVP induced transient hemodynamic alterations, primarily affecting CO and TPR. Despite fluid replacement, significant changes occurred, highlighting the need for close CO monitoring, especially in GBS patients with potential autonomic dysfunction.

Conclusion: LVP significantly alters hemodynamics, impacting CO and TPR. Standard monitoring might miss these changes, emphasizing the importance of NICOM, particularly in neurological patients. Further research is warranted to solidify NICOM's role in optimizing LVP protocols and improving patient outcomes.

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用无创心输出量监测仪评估神经系统疾病患者大容量血浆置换过程中的血流动力学变化：一项前瞻性队列研究

导语：治疗性大容量血浆置换（LVP）可有效治疗神经系统疾病，如格林-巴利综合征（GBS）和重症肌无力（MG），但它会引起血管内容量的改变，需要警惕监测。本研究探讨了血流动力学的变化和无创心输出量监测（NICOM）的应用。方法：本前瞻性观察研究包括50例接受第一次LVP周期的神经系统患者。采用NICOM标准监测心率（HR）、无创血压（NIBP）、脉搏血氧仪（SpO2）和心输出量（CO）。在基线和LVP期间多个时间点记录HR、NIBP、CO、总外周阻力（TPR）、卒中容积（SV）和卒中容积变化（SVV）的变化。结果：患者平均年龄36±15.05岁。平均动脉压（MAP）在30min和60min较基线显著降低，LVP完成度显著降低（P < 0.05）。HR和收缩压/舒张压（SBP/DBP）保持稳定，SV、CO和心脏指数（CI）显著降低（P < 0.05），并在60分钟达到峰值。TPR显著升高（P < 0.05），最高可达30分钟。血浆切除量直接影响CO、CI和SV的变化（P < 0.05）。讨论：LVP引起短暂性血流动力学改变，主要影响CO和TPR。尽管进行了补液，但仍发生了明显的变化，这突出了密切监测一氧化碳的必要性，特别是在有潜在自主神经功能障碍的GBS患者中。结论：LVP显著改变血流动力学，影响CO和TPR。标准监测可能会忽略这些变化，强调NICOM的重要性，特别是在神经系统患者中。需要进一步的研究来巩固NICOM在优化LVP方案和改善患者预后方面的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology India 医学-神经科学

CiteScore

1.60

自引率

70.40%

发文量

434

审稿时长

2 months

期刊介绍： Neurology India (ISSN 0028-3886) is Bi-monthly publication of Neurological Society of India. Neurology India, the show window of the progress of Neurological Sciences in India, has successfully completed 50 years of publication in the year 2002. ‘Neurology India’, along with the Neurological Society of India, has grown stronger with the passing of every year. The full articles of the journal are now available on internet with more than 20000 visitors in a month and the journal is indexed in MEDLINE and Index Medicus, Current Contents, Neuroscience Citation Index and EMBASE in addition to 10 other indexing avenues. This specialty journal reaches to about 2000 neurologists, neurosurgeons, neuro-psychiatrists, and others working in the fields of neurology.