ArticleIntensive care medicine experimental2023
Effect of norepinephrine on the vascular waterfall and tissue perfusion in vasoplegic hypotensive patients: a prospective, observational, applied physiology study in cardiac surgery.
Article in Intensive care medicine experimental, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 20 citations in OpenAlex.
- Risk Factors for Myocardial Injury During Cardio-Pulmonary Bypass-Assisted Heart Surgery: A Retrospective Single-Center Study.Acta anaesthesiologica Scandinavica · 2026Article
- Neuro-immune interactions in tumors, immune-related disorders, and infections.Signal transduction and targeted therapy · 2026Review
- Current and future strategies aiming at reducing catecholamine exposure in septic shock.Critical care (London, England) · 2026Review
- Comparison of norepinephrine with a combined non-catecholaminergic therapy in a porcine model of refractory cardiac arrest resuscitated with VA-ECMO.Intensive care medicine experimental · 2026Article
- Proof of concept of noninvasive detection of norepinephrine induced stroke volume changes using perfusion index in cardiac surgery.Scientific reports · 2026Observational
- Arteriolar Collapse and Haemodynamic Incoherence in Shock: Rethinking Critical Closing Pressure.Journal of personalized medicine · 2026Review
- Capillary refill time changes are associated with Vascular Waterfall response in post-cardiac surgery patients.Annals of intensive care · 2026Article
- Venous congestion from a vascular waterfall perspective: reframing congestion as a dynamic Starling resistor phenomenon.Intensive care medicine experimental · 2025Review
- The intricate relationship between capillary refill time and systemic hemodynamics in septic shock.Annals of intensive care · 2025Review
- Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation.Journal of personalized medicine · 2025Review
- Predictive value of dynamic arterial elastance for vasopressor withdrawal: a systematic review and meta-analysis.Annals of intensive care · 2024Review
- Significance of critical closing pressures (starling resistors) in arterial circulation.Critical care (London, England) · 2024Article
- Severe Refractory Vasoplegic Shock Syndrome after OPCABG Successfully Treated with Hydroxycobalamin: A Case Report and Review of the Literature.Journal of clinical medicine · 2023Review
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNorepinephrine is a commonly used drug for treating vasoplegic acute circulatory failure in ICU. The prediction of norepinephrine macro- and micro-circulatory response is complicated by its uneven receptors' distribution between the arterial and the venous structures, and by the presence of a physiological vascular waterfall (VW) that disconnects the arterial and the venous circulation in two pressure systems. The objectives of this study were to describe the VW in patients with arterial hypotension due to vasodilatory circulatory shock, and its behavior according to its response to norepinephrine infusion.
methodsA prospective, observational, bi-centric study has included adult patients, for whom the physician decided to initiate norepinephrine during the six first hours following admission to the ICU after cardiac surgery, and unresponsive to a fluid challenge. The mean systemic pressure (MSP) and the critical closing pressure (CCP) were measured at inclusion and after norepinephrine infusion.
resultsThirty patients were included. Norepinephrine increased arterial pressure and total peripheral resistances in all cohort. The cohort was dichotomized as VW responders (patients with a change of VW over the least significant change (≥ 93% increase in VW)), and as VW non-responders. In 19 (63%) of the 30 patients, VW increased from 3.47 [- 14.43;7.71] mmHg to 43.6 [25.8;48.1] mmHg, p < 0.001) with norepinephrine infusion, being classified as VW responders. The VW responders improved cardiac index (from 1.8 (0.6) L min
conclusionsIn post-cardiac surgery patients with vasoplegic arterial hypotension, the vascular waterfall is low. Norepinephrine did not systematically restore the vascular waterfall. Increase of the vascular waterfall was associated with an improvement of laboratory and clinical parameters of tissue perfusion.
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