Hemodynamic Effects of Norepinephrine Reduction on Critical Closing Pressure in Distributive Shock
2026年6月12日 更新者：Bin Du、Peking Union Medical College Hospital
Changes in Critical Closing Pressure and Derived Hemodynamic Parameters Following Norepinephrine Dose Reduction in Distributive Shock Patients: a Prospective Observational Study
This study prospectively observes changes in critical closing pressure (Pcc) and derived hemodynamic parameters in mechanically ventilated distributive shock patients when clinically indicated norepinephrine dose reduction is performed by the attending physician.
Pcc is measured before and 30 minutes after dose reduction using a stepwise inspiratory hold maneuver via PiCCO monitoring.
研究概览
详细说明
In distributive shock patients receiving norepinephrine with MAP maintained in the 75-85 mmHg range, attending physicians may reduce norepinephrine dose based on clinical judgment.
This study observes hemodynamic changes associated with such reductions without any investigator-initiated intervention.
Critical closing pressure (Pcc) and derived parameters including tissue perfusion pressure (TPP), mean systemic filling pressure analogue (Pmsf), and vascular waterfall (VW) are measured at baseline and 30 minutes after dose reduction, provided MAP variability is less than 5 mmHg.
Pcc is derived from linear regression of simultaneously measured cardiac output (CO) and mean arterial pressure (MAP) during stepwise inspiratory hold maneuvers.
Steady-state CO and MAP values are recorded during the final 3 seconds of 12-second inspiratory holds at plateau pressures of 5, 15, 25, and 35 cmH2O.
The x-intercept of the CO-MAP regression line is taken as Pcc.
研究类型
观察性的
注册 (估计的)
30
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习联系方式
- 姓名：Bin Du, Dr
- 电话号码：86+15136289398
- 邮箱：sunyaliii@163.com
学习地点
-
-
Beijing Municipality
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Beijing、Beijing Municipality、中国、100730
- 招聘中
- Peking Union Medical College Hospital
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接触：
- Bin Du
- 电话号码：86-15136289398
- 邮箱：sunyaliii@163.com
-
-
参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
不
取样方法
非概率样本
研究人群
Adult distributive shock patients receiving invasive mechanical ventilation and norepinephrine treatment
描述
Inclusion Criteria:
- Adult distributive shock patients aged ≥18 years;
- Receiving norepinephrine infusion with MAP in the 75-85 mmHg range;
- PiCCO catheter in situ;
- Under mechanical ventilation;
- Clinically indicated norepinephrine dose reduction per attending physician judgment.
Exclusion Criteria:
- Significant cardiac arrhythmia affecting CO measurement reliability;
- Contraindication to airway plateau pressure maneuver;
- Active titration of other vasoactive agents within 30 minutes prior to measurement;
- Hemodynamic instability making it impossible to reduce norepinephrine dose.
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
队列和干预
团体/队列 |
干预/治疗 |
|---|---|
|
Distributive shock patients undergoing norepinephrine dose reduction
Mechanically ventilated distributive shock patients in whom the attending physician clinically indicated norepinephrine dose reduction, with MAP transitioning from the 75-85 mmHg range to the 65-75 mmHg range.
|
Observation of hemodynamic parameters before and after clinically indicated norepinephrine dose reduction.
No investigator-initiated intervention was performed.
|
研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Change in critical closing pressure (Pcc, Unit: mmHg) before and after norepinephrine dose reduction
大体时间：Baseline and 30 minutes after norepinephrine dose reduction
|
Pcc is derived from linear regression of simultaneously measured cardiac output against mean arterial pressure during stepwise inspiratory hold maneuvers via PiCCO monitoring.
The x-intercept of the regression line (at zero flow) represents Pcc.
Measurement is performed at baseline and 30 minutes after norepinephrine dose reduction.
|
Baseline and 30 minutes after norepinephrine dose reduction
|
|
Change in tissue perfusion pressure (TPP, unit: mmHg) before and after norepinephrine dose reduction
大体时间：Baseline and 30 minutes after norepinephrine dose reduction
|
TPP is calculated as the difference between mean arterial pressure (MAP) and critical closing pressure (Pcc): TPP = MAP minus Pcc, unit: mmHg
|
Baseline and 30 minutes after norepinephrine dose reduction
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Change in mean systemic filling pressure analogue (Pmsf, unit: mmHg) before and after norepinephrine dose reduction
大体时间：Baseline and 30 minutes after norepinephrine dose reduction
|
Pmsf is estimated as the x-intercept of the linear regression of cardiac output against central venous pressure (CVP), representing the venous pressure at zero flow.
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Baseline and 30 minutes after norepinephrine dose reduction
|
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Change in Vascular waterfall (VW, unit: mmHg) before and after norepinephrine dose reduction
大体时间：Baseline and 30 minutes after norepinephrine dose reduction
|
Vascular waterfall (VW) is calculated as Pcc minus Pmsf.
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Baseline and 30 minutes after norepinephrine dose reduction
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Change in capillary refill time (CRT, unit: seconds）
大体时间：Baseline and 30 minutes after norepinephrine dose reduction
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Capillary refill time is assessed by applying pressure to the fingertip for 5 seconds and measuring the time for color to return after release.
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Baseline and 30 minutes after norepinephrine dose reduction
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (实际的)
2025年9月1日
初级完成 (估计的)
2027年7月1日
研究完成 (估计的)
2027年9月1日
研究注册日期
首次提交
2026年6月8日
首先提交符合 QC 标准的
2026年6月12日
首次发布 (实际的)
2026年6月17日
研究记录更新
最后更新发布 (实际的)
2026年6月17日
上次提交的符合 QC 标准的更新
2026年6月12日
最后验证
2026年6月1日
更多信息
与本研究相关的术语
其他相关的 MeSH 术语
其他研究编号
- pumch-micu202606
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