{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:33:28Z","timestamp":1776706408226,"version":"3.51.2"},"reference-count":38,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T00:00:00Z","timestamp":1671667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>After fluid status optimization, norepinephrine infusion represents the cornerstone of septic shock treatment. De-escalation of vasopressors should be considered with caution, as hypotension increases the risk of mortality. In this prospective observational study including 42 patients, we assess the role of dynamic elastance (EaDyn), i.e., the ratio between pulse pressure variation and stroke volume variation, which can be measured noninvasively by the MostCare monitoring system, to predict a mean arterial pressure (MAP) drop &gt; 10% 30 min after norepinephrine reduction. Patients were divided into responders (MAP falling &gt; 10%) and non-responders (MAP falling &lt; 10%). The receiver-operating-characteristic curve identified an area under the curve of the EaDyn value to predict a MAP decrease &gt; 10% of 0.84. An EaDyn cut-off of 0.84 predicted a MAP drop &gt; 10% with a sensitivity of 0.71 and a specificity of 0.89. In a multivariate logistic regression, EaDyn was significantly and independently associated with MAP decrease (OR 0.001, 95% confidence interval 0.00001\u20130.081, p &lt; 0.001). The nomogram model for the probability of MAP decrease &gt; 10% showed a C-index of 0.90. In conclusion, in a septic shock cohort, EaDyn correlates well with the risk of decrease of MAP &gt; 10% after norepinephrine reduction.<\/jats:p>","DOI":"10.3390\/life13010028","type":"journal-article","created":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T02:36:46Z","timestamp":1671763006000},"page":"28","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Dynamic Arterial Elastance to Predict Mean Arterial Pressure Decrease after Reduction of Vasopressor in Septic Shock Patients"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-5148","authenticated-orcid":false,"given":"Paolo","family":"Persona","sequence":"first","affiliation":[{"name":"Institute of Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum\u2014University of Bologna, 40126 Bologna, Italy"},{"name":"Anesthesiology and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S. Orsola, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Valeri","sequence":"additional","affiliation":[{"name":"Institute of Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1446-1169","authenticated-orcid":false,"given":"Emanuele","family":"Pivetta","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine and High Dependency Unit, AOU Citt\u00e0 della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, 10124 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5217-9669","authenticated-orcid":false,"given":"Francesco","family":"Zarantonello","sequence":"additional","affiliation":[{"name":"Institute of Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6745-8919","authenticated-orcid":false,"given":"Tommaso","family":"Pettenuzzo","sequence":"additional","affiliation":[{"name":"Institute of Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"De Cassai","sequence":"additional","affiliation":[{"name":"Institute of Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3733-3453","authenticated-orcid":false,"given":"Paolo","family":"Navalesi","sequence":"additional","affiliation":[{"name":"Institute of Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy"},{"name":"Department of Medicine (DIMED), University of Padua, Via Vincenzo Gallucci 13, 35121 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1097\/01.CCM.0000157788.20591.23","article-title":"Increasing Mean Arterial Pressure in Patients with Septic Shock: Effects on Oxygen Variables and Renal Function","volume":"33","author":"Bourgoin","year":"2005","journal-title":"Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.jor.2020.10.012","article-title":"Management of Vasopressor Induced Ischemia","volume":"22","author":"Livesey","year":"2020","journal-title":"J. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1097\/CCM.0000000000004476","article-title":"Evaluation of Vasopressor Exposure and Mortality in Patients with Septic Shock","volume":"48","author":"Roberts","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1186\/s13054-016-1564-2","article-title":"Early-Phase Cumulative Hypotension Duration and Severe-Stage Progression in Oliguric Acute Kidney Injury with and without Sepsis: An Observational Study","volume":"20","author":"Izawa","year":"2016","journal-title":"Crit. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s00134-018-5218-5","article-title":"The Relationship between ICU Hypotension and In-Hospital Mortality and Morbidity in Septic Patients","volume":"44","author":"Maheshwari","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/01.CCM.OB013E318161FEC4","article-title":"Effects of Changes in Vascular Tone on the Agreement between Pulse Contour and Transpulmonary Thermodilution Cardiac Output Measurements within an up to 6-Hour Calibration-Free Period","volume":"36","author":"Hamzaoui","year":"2008","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1097\/01.CCM.0000201896.45809.E3","article-title":"Does Dopamine Administration in Shock Influence Outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study","volume":"34","author":"Sakr","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"R155","DOI":"10.1186\/cc7149","article-title":"Norepinephrine Weaning in Septic Shock Patients by Closed Loop Control Based on Fuzzy Logic","volume":"12","author":"Merouani","year":"2008","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1186\/cc10088","article-title":"Pulse Pressure Variation, Stroke Volume Variation and Dynamic Arterial Elastance","volume":"15","author":"Giraud","year":"2011","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13054-014-0732-5","article-title":"Dynamic Arterial Elastance Predicts Mean Arterial Pressure Decrease Associated with Decreasing Norepinephrine Dosage in Septic Shock","volume":"19","author":"Guinot","year":"2015","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.bja.2018.01.032","article-title":"Dynamic Arterial Elastance Measured by Uncalibrated Pulse Contour Analysis Predicts Arterial-Pressure Response to a Decrease in Norepinephrine","volume":"121","author":"Bar","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s00134-016-4666-z","article-title":"Monitoring Dynamic Arterial Elastance as a Means of Decreasing the Duration of Norepinephrine Treatment in Vasoplegic Syndrome Following Cardiac Surgery: A Prospective, Randomized Trial","volume":"43","author":"Guinot","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1007\/s10877-016-9898-5","article-title":"A Systematic Review of Pulse Pressure Variation and Stroke Volume Variation to Predict Fluid Responsiveness during Cardiac and Thoracic Surgery","volume":"31","author":"Piccioni","year":"2017","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"R179","DOI":"10.1186\/cc8161","article-title":"Variations in Arterial Blood Pressure Are Associated with Parallel Changes in FlowTrac\/Vigileo\u00ae-Derived Cardiac Output Measurements: A Prospective Comparison Study","volume":"13","author":"Eleftheriadis","year":"2009","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/00000542-198103000-00010","article-title":"Direct Blood Pressure Measurement \u2014Dynamic Response Requirements","volume":"54","author":"Gardner","year":"1981","journal-title":"J. Am. Soc. Anesthesiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1097\/00003246-200208000-00027","article-title":"Assessment of Cardiac Output from Systemic Arterial Pressure in Humans","volume":"30","author":"Romano","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1007\/s00134-017-4752-x","article-title":"Predicting Vasopressor Needs Using Dynamic Parameters","volume":"43","author":"Pinsky","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_19","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_20","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/AIA.0b013e3181c3dc11","article-title":"The PiCCO Monitor","volume":"48","year":"2010","journal-title":"Int. Anesthesiol. Clin."},{"key":"ref_21","first-page":"234","article-title":"Pitfalls of Hemodynamic Monitoring Techniques: Troubles in Research or in Clinical Practice?","volume":"81","author":"Franchi","year":"2015","journal-title":"Minerva Anestesiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1007\/s00134-017-4836-7","article-title":"The Dynamic Arterial Elastance: A Call for a Cautious Interpretation: Discussion on \u201cPredicting Vasopressor Needs Using Dynamic Parameters\u201d","volume":"43","author":"Jozwiak","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1097\/EJA.0000000000001437","article-title":"Dynamic Arterial Elastance Measured with Pressure Recording Analytical Method, and Mean Arterial Pressure Responsiveness in Hypotensive Preload Dependent Patients Undergoing Cardiac Surgery: A Prospective Cohort Study","volume":"38","author":"Lerose","year":"2021","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1186\/s13054-014-0626-6","article-title":"Dynamic Arterial Elastance as a Predictor of Arterial Pressure Response to Fluid Administration: A Validation Study","volume":"18","author":"Romero","year":"2014","journal-title":"Crit. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/EJA.0000000000001289","article-title":"Multivariable Haemodynamic Approach to Predict the Fluid Challenge Response: A Multicentre Cohort Study","volume":"38","author":"Messina","year":"2021","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1007\/s00134-022-06808-9","article-title":"How Can Assessing Hemodynamics Help to Assess Volume Status?","volume":"48","author":"Aissaoui","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13054-018-1967-3","article-title":"Vasoplegia Treatments: The Past, the Present, and the Future","volume":"22","author":"Levy","year":"2018","journal-title":"Crit. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"818386","DOI":"10.3389\/fmed.2022.818386","article-title":"Arterial Hypotension Following Norepinephrine Decrease in Septic Shock Patients Is Not Related to Preload Dependence: A Prospective, Observational Cohort Study","volume":"9","author":"Andrei","year":"2022","journal-title":"Front. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/cc9986","article-title":"Defining the Boundaries of Bedside Pulse Contour Analysis: Dynamic Arterial Elastance","volume":"15","author":"Pinsky","year":"2011","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3146","DOI":"10.1097\/CCM.0b013e318260c6c3","article-title":"Effects of Norepinephrine on Mean Systemic Pressure and Venous Return in Human Septic Shock","volume":"40","author":"Persichini","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1097\/ALN.0b013e31824f9669","article-title":"Comparison of Equipressor Doses of Norepinephrine, Epinephrine, and Phenylephrine on Septic Myocardial Dysfunction","volume":"116","author":"Ducrocq","year":"2012","journal-title":"Anesthesiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.trsl.2010.07.011","article-title":"Dobutamine-Norepinephrine, but Not Vasopressin, Restores the Ventriculoarterial Matching in Experimental Cardiogenic Shock","volume":"156","author":"How","year":"2010","journal-title":"Transl. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13054-019-2414-9","article-title":"Cardiovascular Determinants of Resuscitation from Sepsis and Septic Shock","volume":"23","author":"Guarracino","year":"2019","journal-title":"Crit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ccc.2014.08.005","article-title":"Functional Hemodynamic Monitoring","volume":"31","author":"Pinsky","year":"2015","journal-title":"Crit. Care Clin."},{"key":"ref_35","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_36","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1186\/s13054-021-03808-x","article-title":"Early Prediction of Hemodynamic Interventions in the Intensive Care Unit Using Machine Learning","volume":"25","author":"Rahman","year":"2021","journal-title":"Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1001\/jama.2016.12310","article-title":"Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?","volume":"316","author":"Bentzer","year":"2016","journal-title":"JAMA-J. Am. Med. Assoc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1213\/ANE.0000000000000442","article-title":"The Use of Pulse Pressure Variation and Stroke Volume Variation in Spontaneously Breathing Patients to Assess Dynamic Arterial Elastance and to Predict Arterial Pressure Response to Fluid Administration","volume":"120","author":"Cecconi","year":"2015","journal-title":"Anesth. Analg."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/1\/28\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:11Z","timestamp":1760147291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/1\/28"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,22]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["life13010028"],"URL":"https:\/\/doi.org\/10.3390\/life13010028","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,22]]}}}