Name: invasive hemodynamic monitoring of aortic and pulmonary artery hemodynamics in a large animal model of ards
Uploaded: 2018-11-26T12:30:00
Description: Watch this Scientific Journal Video about Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS at JoVE.com

The authors have no acknowledgements.

This prospective experimental trial with 21 anesthetized male and female domestic pigs (German landrace) at the age of 3&#8211;6 months with a body weight between 45-55 kg was approved by the Governmental Commission on the Care and Use of Animals of the City of Hamburg (Reference-No. 18/17). According to the ARRIVE guidelines, all experiments were carried out and all animals received care in compliance with the &#39;Guide for the Care and Use of Laboratory Animals&#39; (NIH publication No. 86-23, revised 1996)<sup class=...

<ol>
	<li>Kapur, N. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+Circulatory+Support+Devices+for+Acute+Right+Ventricular+Failure.">Mechanical Circulatory Support Devices for Acute Right Ventricular Failure.</a> Circulation. 136, 314-326 (2017).</li><li>Zochios, V., Jones, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+right+heart+syndrome+in+the+critically+ill+patient.">Acute right heart syndrome in the critically ill patient.</a> Heart Lung Vessel. 6 (3), 157-170 (2014).</li><li>Ranucci, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluid+responsiveness+and+right+ventricular+function+in+cardiac+surgical+patients.+A+multicenter+study.">Fluid responsiveness and right ventricular function in cardiac surgical patients. A multicenter study.</a> HSR Proceedings in Intensive Care and Cardiovascular Anesthesia. 1 (1), 21-29 (2009).</li><li>Mehta, S. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+right+ventricular+involvement+on+mortality+and+morbidity+in+patients+with+inferior+myocardial+infarction.">Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction.</a> Journal of the American College of Cardiology. 37, 37-43 (2001).</li><li>Vieillard-Baron, A., Charron, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preload+responsiveness+or+right+ventricular+dysfunction.">Preload responsiveness or right ventricular dysfunction.</a> Critical Care Medicine. 37 (9), 2662-2663 (2009).</li><li>Marik, P. E., Baram, M., Vahid, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+central+venous+pressure+predict+fluid+responsiveness?+A+systematic+review+of+the+literature+and+the+tale+of+seven+mares.">Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares.</a> Chest. 134 (1), 172-178 (2008).</li><li>Marik, P. E., Cavallazzi, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+the+central+venous+pressure+predict+fluid+responsiveness?+An+updated+meta-analysis+and+a+plea+for+some+common+sense.">Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense.</a> Critical CareMedicine. 41 (7), 1774-1781 (2013).</li><li>Eskesen, T. G., Wetterslev, M., Perner, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review+including+re-analyses+of+1148+individual+data+sets+of+central+venous+pressure+as+a+predictor+of+fluid+responsiveness.">Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness.</a> Intensive Care Medicine. 42 (3), 324-332 (2016).</li><li>Kilkenny, C., Browne, W. J., Cuthill, I. C., Emerson, M., Altman, D. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+bioscience+research+reporting:+the+ARRIVE+guidelines+for+reporting+animal+research.">Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research.</a> Osteoarthritis and cartilage, Osteoarthritis Research Society. 20 (2), 56-60 (2012).</li><li>Akella, A., Sharma, P., Pandey, R., Deshpande, S. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+oleic+acid-induced+acute+respiratory+distress+syndrome+model+in+rat.">Characterization of oleic acid-induced acute respiratory distress syndrome model in rat.</a> Indian Journal of Experimental Biology. 52 (7), 712-719 (2014).</li><li>Meinhardt, J. P., Friess, U., Bender, H. J., Hirschl, R. B., Quintel, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+among+cardiac+index,+inspiration/expiration+ratio,+and+perfluorocarbon+dose+during+partial+liquid+ventilation+in+an+oleic+acid+model+of+acute+lung+injury+in+sheep.">Relationship among cardiac index, inspiration/expiration ratio, and perfluorocarbon dose during partial liquid ventilation in an oleic acid model of acute lung injury in sheep.</a> Journal of Pediatric Surgery. 40 (9), 1395-1403 (2005).</li><li>Zhu, Y. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atrial+natriuretic+peptide+attenuates+inflammatory+responses+on+oleic+acid-induced+acute+lung+injury+model+in+rats.">Atrial natriuretic peptide attenuates inflammatory responses on oleic acid-induced acute lung injury model in rats.</a> Chinese Medical Journal (English. 126 (4), 747-750 (2013).</li><li>Gould, D. A., Baun, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Role+of+the+Pulmonary+Afferent+Receptors+in+Producing+Hemodynamic+Changes+during+Hyperinflation+and+Endotracheal+Suctioning+in+an+Oleic+Acid-Injured+Animal+Model+of+Acute+Respiratory+Failure.">The Role of the Pulmonary Afferent Receptors in Producing Hemodynamic Changes during Hyperinflation and Endotracheal Suctioning in an Oleic Acid-Injured Animal Model of Acute Respiratory Failure.</a> Biology Research for Nursing. 1 (3), 179-189 (2000).</li><li>Galie, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2015+ESC/ERS+Guidelines+for+the+diagnosis+and+treatment+of+pulmonary+hypertension.">2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.</a> European Heart Journal. 37, 67-119 (2015).</li><li>Galie, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2015+ESC/ERS+Guidelines+for+the+diagnosis+and+treatment+of+pulmonary+hypertension:+The+Joint+Task+Force+for+the+Diagnosis+and+Treatment+of+Pulmonary+Hypertension+of+the+European+Society+of+Cardiology+(ESC)+and+the+European+Respiratory+Society+(ERS),+Endorsed+by:+Association+for+European+Paediatric+and+Congenital+Cardiology+(AEPC),+International+Society+for+Heart+and+Lung+Transplantation+(ISHLT).">2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).</a> European Respiratory Journal. 46, 903-975 (2015).</li><li>Oliveira, R. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Usefulness+of+pulmonary+capillary+wedge+pressure+as+a+correlate+of+left+ventricular+filling+pressures+in+pulmonary+arterial+hypertension.">Usefulness of pulmonary capillary wedge pressure as a correlate of left ventricular filling pressures in pulmonary arterial hypertension.</a> Journal of Heart and Lung Transplantation. 33 (4), 459 (2014).</li><li>Hoeper, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+global+view+of+pulmonary+hypertension.">A global view of pulmonary hypertension.</a> Lancet Respiratory Medicine. 4, 306-322 (2016).</li><li>Nagy, A. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+pulmonary+capillary+wedge+pressure+accurately+reflects+both+normal+and+elevated+left+atrial+pressure.">The pulmonary capillary wedge pressure accurately reflects both normal and elevated left atrial pressure.</a> American Heart Journal. 167 (6), 876-883 (2014).</li><li>Daughters, G. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+the+pericardium+on+left+ventricular+diastolic+filling+and+systolic+performance+early+after+cardiac+operations.">Effects of the pericardium on left ventricular diastolic filling and systolic performance early after cardiac operations.</a> Journal of Thoracic and Cardiovascular Surgery. 104 (4), 1084-1091 (1992).</li><li>Zimmerman, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Posttransfusion+Increase+of+Hematocrit+per+se+Does+Not+Improve+Circulatory+Oxygen+Delivery+due+to+Increased+Blood+Viscosity.">Posttransfusion Increase of Hematocrit per se Does Not Improve Circulatory Oxygen Delivery due to Increased Blood Viscosity.</a> Anesthesia &amp; Analgesia. 124 (5), 1547-1554 (2017).</li><li>Giglioli, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemodynamic+effects+in+patients+with+atrial+fibrillation+submitted+to+electrical+cardioversion.">Hemodynamic effects in patients with atrial fibrillation submitted to electrical cardioversion.</a> International Journal of Cardiology. 168 (4), 4447-4450 (2013).</li></ol>

ARDS, complicated by pulmonary hypertension, is a very deadly disease. For patients suffering from this condition, further information about treating it is necessary. When working and researching with living creatures, it is very important to be as sensible as possible. In this case it is necessary to gather as much information as possible in one experiment.
There are some critical surgical steps in an open-beating heart model like this. To not use pigs unnecessarily, there must be an experien...

Right ventricular (RV) dysfunction is a major cause of morbidity and mortality in patients with heart failure1, especially if the underlying cause is pulmonary hypertension2. The RV pumps blood into the low-resistance pulmonary system, which is normally associated with high compliance. Therefore, the RV is characterized by low peak systolic pressure. It also generates one sixth the stroke work compared with the left ventricle (LV)3. Due to its thinner muscle, the RV is very vulnerable to a change in pre- and afterload4,5. The isovolumic phases of contraction and relaxation during systole and diastole in the RV are not as distinct as in the LV. The examination of left and right ventricular hemodynamic parameters is highly important in therapy of critically ill patients with acute right heart distress4,7, because RV failure increases short-term mortality significantly6.
Preload parameters like the central venous pressure (CVP) and left ventricular preload parameters like pulmonary capillary wedge pressure (PCWP) have been used for a long time to determine volume status of patients. Lately, it has been shown that these parameters alone are not suitable to detect a patient&#39;s need of fluids8,9,10. Recognizing fluid responsiveness is essential to detect and treat volume deprivation and volume overload in patients with RV dysfunction. Avoiding volume overload is essential to decrease the mortality and length of intensive care unit (ICU) stay in these patients.
With this study, we established a pig model of right ventricular dysfunction that is consistent and replicable. Due to its similarity to humans, it is necessary to establish consistent and reproducible experimental large animal models of cardiac hemodynamics and measurements for research purpose.

<table>
	<tbody>
		<tr>
			<td>Animal Bio Amp</td>
			<td>ADInstruments</td>
			<td>FE136</td>
			<td></td>
		</tr>
		<tr>
			<td>Quad BridgeAmp</td>
			<td>ADInstruments</td>
			<td>FE224</td>
			<td></td>
		</tr>
		<tr>
			<td>Power Lab 16/35</td>
			<td>ADInstruments</td>
			<td>5761-E</td>
			<td></td>
		</tr>
		<tr>
			<td>LabChart 8.1.8 Windows</td>
			<td>ADInstruments</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Pulmonary artery catheter 7 F</td>
			<td>Edwards Lifesciences Corporation</td>
			<td>&#160;&#160;131F7&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Prelude Sheath Introducer 8 F</td>
			<td>Merit Medical Systems, Inc.</td>
			<td>SI-8F-11-035</td>
			<td></td>
		</tr>
		<tr>
			<td>COnfidence Cardiac Output Flowprobes</td>
			<td>Transonic</td>
			<td>AU-IFU-PAUProbes-EN Rev. A 4/13</td>
			<td></td>
		</tr>
		<tr>
			<td>Adrenalin</td>
			<td>Sanofi</td>
			<td>6053210</td>
			<td></td>
		</tr>
		<tr>
			<td>Oleic acid</td>
			<td>Sigma Aldrich</td>
			<td>112-80-1</td>
			<td></td>
		</tr>
		<tr>
			<td>Magnesium Verla</td>
			<td>Verla</td>
			<td>7244946</td>
			<td></td>
		</tr>
		<tr>
			<td>Ketamin</td>
			<td>Richter Pharma AG</td>
			<td>BE-V433246</td>
			<td></td>
		</tr>
		<tr>
			<td>Azaperon</td>
			<td>Sanochemia Pharmazeutika AG</td>
			<td>QN05AD90</td>
			<td></td>
		</tr>
		<tr>
			<td>Midazolam</td>
			<td>Roche Pharma AG</td>
			<td>3085793</td>
			<td></td>
		</tr>
	</tbody>
</table>

invasive hemodynamic monitoring of aortic and pulmonary artery hemodynamics in a large animal model of ards

One of the leading causes of morbidity and mortality in patients with heart failure is right ventricular (RV) dysfunction, especially if it is due to pulmonary hypertension. For a better understanding and treatment of this disease, precise hemodynamic monitoring of left and right ventricular parameters is important. For this reason, it is essential to establish experimental pig models of cardiac hemodynamics and measurements for research purpose. 
This article shows the induction of ARDS by using oleic acid (OA) and consequent right ventricular dysfunction, as well as the instrumentation of the pigs and the data acquisition process that is needed to assess hemodynamic parameters. To achieve right ventricular dysfunction, we used oleic acid (OA) to cause ARDS and accompanied this with pulmonary artery hypertension (PAH). With this model of PAH and consecutive right ventricular dysfunction, many hemodynamic parameters can be measured, and right ventricular volume load can be detected. 
All vital parameters, including respiratory rate (RR), heart rate (HR) and body temperature were recorded throughout the whole experiment. Hemodynamic parameters including femoral artery pressure (FAP), aortic pressure (AP), right ventricular pressure (peak systolic, end systolic and end diastolic right ventricular pressure), central venous pressure (CVP), pulmonary artery pressure (PAP) and left arterial pressure (LAP) were measured as well as perfusion parameters including ascending aortic flow (AAF) and pulmonary artery flow (PAF). Hemodynamic measurements were performed using transcardiopulmonary thermodilution to provide cardiac output (CO). Furthermore, the PiCCO2 system (Pulse Contour Cardiac Output System 2) was used to receive parameters such as stroke volume variance (SVV), pulse pressure variance (PPV), as well as extravascular lung water (EVLW) and global end-diastolic volume (GEDV). Our monitoring procedure is suitable for detecting right ventricular dysfunction and monitoring hemodynamic findings before and after volume administration.

Our animal model shows a broad variety of hemodynamic parameters in pigs. Due to its similarity in size and hemodynamics, one can easily use the exact same equipment as used in humans to get similar results.&#160;However, anesthesia values are based on experience and may change based on weight/ age/ strain of pig.&#160; A veterinarian should be consulted to evaluate anesthetic plan.
Results of previous OA induced acute lung inju...

Watch this Scientific Journal Video about Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS at JoVE.com

Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS

We present a protocol of creating right ventricular dysfunction in a pig model by inducing ARDS. We demonstrate invasive monitoring of left and right ventricular cardiac output using flow probes around the aorta and the pulmonary artery, as well as blood pressure measurements in the aorta and pulmonary artery.

One of the leading causes of morbidity and mortality in patients with heart failure is right ventricular (RV) dysfunction, especially if it is due to ...

Research

JoVE Journal

Medicine

Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants

Perinatal brain injury remains a significant cause of infant mortality  and morbidity, but there is not yet an effective bedside tool that can  accurately ...

Ferric Chloride-induced Canine Carotid Artery Thrombosis: A Large Animal Model of Vascular Injury

Occlusive arterial thrombosis leading to cerebral ischemic stroke and myocardial infarction contributes to ~13 million deaths every year globally. Here, ...

Induction and Phenotyping of Acute Right Heart Failure in a Large Animal Model of Chronic Thromboembolic Pulmonary Hypertension

The development of acute right heart failure (ARHF) in the context of chronic pulmonary hypertension (PH) is associated with poor short-term outcomes. The ...

Isometric Contractility Measurement of the Mouse Mesenteric Artery Using Wire Myography

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and ...

Invasive Hemodynamic Assessment for the Right Ventricular System and Hypoxia-Induced Pulmonary Arterial Hypertension in Mice

Pulmonary arterial hypertension (PAH) is a chronic and severe cardiopulmonary disorder. Mice are a popular animal model used to mimic this disease. ...

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Acute kidney injury (AKI) is associated with higher risk for morbidity and mortality post-operatively. Ischemia-reperfusion injury (IRI) is the most ...

A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position

The Ross operation for aortic valve disease has regained new interest due to its outstanding long-term results. Nonetheless, when employed as freestanding ...

Multiple Intravenous Bolus Dosing and Invasive Hemodynamic Assessment in a Hypoxia-Induced Mouse Pulmonary Artery Hypertension Model

Pulmonary arterial hypertension (PAH) is a progressive life-threatening disease, primarily affecting small pulmonary arterioles of the lung. Currently, ...