{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:24:42Z","timestamp":1787304282699,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Intraoperative hypotension during major abdominal surgery is common and can result from changes in preload, afterload, or myocardial contractility. Recognising the underlying cause is essential for targeted haemodynamic management. Arterial dP\/dtmax has been proposed as a surrogate marker for ventricular systolic function, but its behaviour during fluid and vasopressor administration under general anaesthesia remains not fully understood. This study evaluated changes in radial arterial dP\/dtmax following protocol-guided fluid administration and norepinephrine boluses during intraoperative hypotension. Methods: This prospective observational study involved 88 adult patients undergoing elective major abdominal surgery with continuous radial arterial waveform monitoring. Hypotensive episodes were defined as a mean arterial pressure &lt;65 mmHg persisting for at least 60 s and were managed according to a predefined algorithm based on stroke volume variation and dynamic arterial elastance. The primary outcome was the change in arterial dP\/dtmax from baseline to 5 min after fluid administration. Linear mixed-effects models were used to account for repeated intervention episodes within patients. Results: A total of 502 protocol-guided intervention episodes contributed by 76 patients were included in the primary analysis: 228 fluid-treated episodes and 274 norepinephrine-treated episodes. Estimated mean arterial dP\/dtmax increased from 517 mmHg\u00b7s\u22121 (95% CI 477\u2013557) at baseline to 631 mmHg\u00b7s\u22121 (95% CI 591\u2013671) at 5 min during fluid-treated episodes and from 575 mmHg\u00b7s\u22121 (95% CI 536\u2013615) to 647 mmHg\u00b7s\u22121 (95% CI 608\u2013686) during norepinephrine-treated episodes (both p &lt; 0.001). A significant intervention-condition-by-time interaction was observed (F = 5.55, p = 0.019), indicating that temporal evolution of arterial dP\/dtmax differed between the two algorithm-defined haemodynamic conditions. Conclusions: Radial arterial dP\/dtmax increased after both fluid administration and norepinephrine, confirming its sensitivity to haemodynamic loading conditions. It should therefore be interpreted as an integrated haemodynamic variable influenced by ventricular performance, preload, and arterial properties rather than as a direct measure of intrinsic myocardial contractility.<\/jats:p>","DOI":"10.3390\/jcm15166471","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:14:01Z","timestamp":1787300041000},"page":"6471","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Arterial dP\/dtmax Response to Fluids and Norepinephrine During Intraoperative Hypotension: A Prospective Physiological Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Andrea","family":"Russo","sequence":"first","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1849-2114","authenticated-orcid":false,"given":"Manuel Ignacio","family":"Monge Garc\u00eda","sequence":"additional","affiliation":[{"name":"Unidad de Cuidados Intensivos, Hospital Universitario de Puerto Real, 11510 Puerto Real, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-504X","authenticated-orcid":false,"given":"Antonio Maria","family":"Dell\u2019Anna","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6481-2540","authenticated-orcid":false,"given":"Tiziano","family":"Torce\u2019","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7789-1059","authenticated-orcid":false,"given":"Salvatore Silvio","family":"Melcore","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1945-4470","authenticated-orcid":false,"given":"Giuseppe","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4428-879X","authenticated-orcid":false,"given":"Francesco","family":"Scialanga","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Iacobucci","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4064-4794","authenticated-orcid":false,"given":"Flaminio","family":"Sessa","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5489-2898","authenticated-orcid":false,"given":"Tiziana","family":"Bove","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3007-1670","authenticated-orcid":false,"given":"Massimo","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0228-0603","authenticated-orcid":false,"given":"Paola","family":"Aceto","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/ALN.0b013e3182a10e26","article-title":"Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: Toward an empirical definition of hypotension","volume":"119","author":"Walsh","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/ALN.0000000000000756","article-title":"Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery","volume":"123","author":"Monk","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/ALN.0000000000000765","article-title":"Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery","volume":"123","author":"Sun","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/ALN.0000000000000922","article-title":"Association between Intraoperative Hypotension and Myocardial Injury after Vascular Surgery","volume":"124","author":"Wijeysundera","year":"2016","journal-title":"Anesthesiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/ALN.0b013e3182472320","article-title":"Intraoperative hypotension and perioperative ischemic stroke after general surgery: A nested case-control study","volume":"116","author":"Bijker","year":"2012","journal-title":"Anesthesiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/ALN.0000000000001432","article-title":"Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis","volume":"126","author":"Salmasi","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1161\/01.RES.35.1.117","article-title":"Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle","volume":"35","author":"Suga","year":"1974","journal-title":"Circ. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1161\/01.RES.56.4.586","article-title":"Optimal arterial resistance for the maximal stroke work studied in isolated canine left ventricle","volume":"56","author":"Sunagawa","year":"1985","journal-title":"Circ. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1186\/s13054-019-2654-8","article-title":"Continual measurement of arterial dP\/dtmax enables minimally invasive monitoring of left ventricular contractility in patients with acute heart failure","volume":"23","author":"Ostadal","year":"2019","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00134-013-2861-8","article-title":"Assessment of left ventricular function by pulse wave analysis in critically ill patients","volume":"39","author":"Scolletta","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2261-12-13","article-title":"Arterial dP\/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved","volume":"12","author":"Morimont","year":"2012","journal-title":"BMC Cardiovasc. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/EJA.0000000000002162","article-title":"A dynamic elastance-based protocol to guide intra-operative fluid management in major abdominal surgery: A randomised clinical trial","volume":"42","author":"Russo","year":"2025","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1161\/01.CIR.86.2.513","article-title":"Effective arterial elastance as index of arterial vascular load in humans","volume":"86","author":"Kelly","year":"1992","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1016\/S0735-1097(01)01651-5","article-title":"Noninvasive single-beat determination of left ventricular end-systolic elastance in humans","volume":"38","author":"Chen","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1097\/CCM.0000000000004515","article-title":"Volume Infusion Markedly Increases Femoral dP\/dtmax in Fluid-Responsive Patients Only","volume":"48","author":"Vaquer","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10877-021-00653-9","article-title":"Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: A prospective observational study","volume":"36","author":"Saugel","year":"2022","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1093\/bja\/aeg135","article-title":"Effects of sevoflurane on sympathetic neurotransmission in human omental arteries and veins","volume":"90","author":"Thorlacius","year":"2003","journal-title":"Br. J. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1093\/bja\/66.4.504","article-title":"Myocardial metabolism during anaesthesia with propofol\u2014Low dose fentanyl for coronary artery bypass surgery","volume":"66","author":"Vermeyen","year":"1991","journal-title":"Br. J. Anaesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/00000542-199205000-00010","article-title":"Sympathetic responses to induction of anesthesia in humans with propofol or etomidate","volume":"76","author":"Ebert","year":"1992","journal-title":"Anesthesiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1113\/expphysiol.2013.073833","article-title":"Preload-adjusted left ventricular dP\/dtmax: A sensitive, continuous, load-independent contractility index","volume":"98","author":"Blaudszun","year":"2013","journal-title":"Exp. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/s13054-018-2260-1","article-title":"Performance comparison of ventricular and arterial dP\/dtmax for assessing left ventricular systolic function during different experimental loading and contractile conditions","volume":"22","author":"Jian","year":"2018","journal-title":"Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1093\/cvr\/27.10.1735","article-title":"Modulation of cardiac contractility by alpha 1 adrenoceptors","volume":"27","author":"Fedida","year":"1993","journal-title":"Cardiovasc. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/0024-3205(90)90062-V","article-title":"Function of myocardial alpha-adrenoceptors","volume":"46","author":"Benfey","year":"1990","journal-title":"Life Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Rola, P., Kattan, E., Siuba, M.T., Haycock, K., Crager, S., Spiegel, R., Hockstein, M., Bhardwaj, V., Miller, A., and Kenny, J.E. (2025). Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation. J. Pers. Med., 15.","DOI":"10.20944\/preprints202503.1988.v1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1161\/01.CIR.63.6.1223","article-title":"The end-systolic pressure-volume relation of the ventricle: Definition, modifications and clinical use","volume":"63","author":"Sagawa","year":"1981","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1007\/s10877-023-01017-1","article-title":"Hypotension Prediction Index guided Goal Directed therapy and the amount of Hypotension during Major Gynaecologic Oncologic Surgery: A Randomized Controlled clinical Trial","volume":"37","author":"Frassanito","year":"2023","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"110981","DOI":"10.1016\/j.jclinane.2022.110981","article-title":"Effect of hypotension prediction index in the prevention of intraoperative hypotension during noncardiac surgery: A systematic review","volume":"83","author":"Li","year":"2022","journal-title":"J. Clin. Anesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6471\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:34:59Z","timestamp":1787301299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6471"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":27,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166471"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166471","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}