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Although our study was not aimed at assessing the mechanisms of cardiac output reduction mediated by IAH, our sheep model showed that the increase in preload was able to preserve cardiac output.
During orthostatic stress, patients with CRPS were not able to preserve cardiac output and they had an exaggerated increase in total peripheral resistance.
Thus, it seems that it is possible to preserve cardiac output in patients with ARDS, despite the use of high PEEP levels, by optimizing fluid administration and limiting tidal volumes.
Further, while aggressive volume resuscitation may preserve cardiac output and renal perfusion pressure, in the presence of oliguria it is an independent predictor for developing secondary abdominal compartment syndrome with decreased renal perfusion pressure or can lead to acute respiratory distress syndrome [ 42].
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For example, in a randomized, double-blind study conducted in patients with uncomplicated hypertension, nebivolol (5 mg/day) preserved cardiac output while decreasing peripheral resistance [ 71].
One small RCT in patients with COPD and PH reported significant improvement in dyspnoea score as well as preserved cardiac output after 1 year of nifedipine treatment; however, no significant survival benefits were reported [ 120].
No study has specifically assessed the effects of preserving cardiac output on SSI rates, although investigators in a recent meta-analysis concluded that supplemental hydration by itself, regardless of any specific haemodynamic target, does not affect the wound infection rate [ 62].
Dopamine was used to maintain cardiac output.
As a consequence, cardiac output decreases and higher filling pressures are required to maintain cardiac output.
This on one hand preserves the cardiac output, but has also adverse effects such as sympathetic overdrive, cardiomyocyte apoptosis and necrosis, and arrhythmias on the long term.
A flow-directed haemodynamic therapy aimed at optimising DO2 by preserving or increasing cardiac output may preserve the microbicidal function of immune cells and may protect organs particularly at risk for perioperative hypoperfusion [ 8], avoiding gut barrier failure and GALT impairment.
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