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Transesophageal echocardiography-associated tracheal microaspiration and ventilator-associated pneumonia in intubated critically ill patients: a multicenter prospective observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:679. [PMID: 33287866 PMCID: PMC7719845 DOI: 10.1186/s13054-020-03380-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Microaspiration of gastric and oropharyngeal secretions is the main causative mechanism of ventilator-associated pneumonia (VAP). Transesophageal echocardiography (TEE) is a routine investigation tool in intensive care unit and could enhance microaspiration. This study aimed at evaluating the impact of TEE on microaspiration and VAP in intubated critically ill adult patients. METHODS It is a four-center prospective observational study. Microaspiration biomarkers (pepsin and salivary amylase) concentrations were quantitatively measured on tracheal aspirates drawn before and after TEE. The primary endpoint was the percentage of patients with TEE-associated microaspiration, defined as: (1) ≥ 50% increase in biomarker concentration between pre-TEE and post-TEE samples, and (2) a significant post-TEE biomarker concentration (> 200 μg/L for pepsin and/or > 1685 IU/L for salivary amylase). Secondary endpoints included the development of VAP within three days after TEE and the evolution of tracheal cuff pressure throughout TEE. RESULTS We enrolled 100 patients (35 females), with a median age of 64 (53-72) years. Of the 74 patients analyzed for biomarkers, 17 (23%) got TEE-associated microaspiration. However, overall, pepsin and salivary amylase levels were not significantly different between before and after TEE, with wide interindividual variability. VAP occurred in 19 patients (19%) within 3 days following TEE. VAP patients had a larger tracheal tube size and endured more attempts of TEE probe introduction than their counterparts but showed similar aspiration biomarker concentrations. TEE induced an increase in tracheal cuff pressure, especially during insertion and removal of the probe. CONCLUSIONS We could not find any association between TEE-associated microaspiration and the development of VAP during the three days following TEE in intubated critically ill patients. However, our study cannot formally rule out a role for TEE because of the high rate of VAP observed after TEE and the limitations of our methods.
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Sanfilippo F, Huang S, Herpain A, Balik M, Chew MS, Clau-Terré F, Corredor C, De Backer D, Fletcher N, Geri G, Mekontso-Dessap A, McLean A, Morelli A, Orde S, Petrinic T, Slama M, van der Horst ICC, Vignon P, Mayo P, Vieillard-Baron A. The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies. Intensive Care Med 2020; 47:1-13. [PMID: 33275163 DOI: 10.1007/s00134-020-06262-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/25/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Echocardiography is a common tool for cardiac and hemodynamic assessments in critical care research. However, interpretation (and applications) of results and between-study comparisons are often difficult due to the lack of certain important details in the studies. PRICES (Preferred Reporting Items for Critical care Echocardiography Studies) is a project endorsed by the European Society of Intensive Care Medicine and conducted by the Echocardiography Working Group, aiming at producing recommendations for standardized reporting of critical care echocardiography (CCE) research studies. METHODS The PRICE panel identified lists of clinical and echocardiographic parameters (the "items") deemed important in four main areas of CCE research: left ventricular systolic and diastolic functions, right ventricular function and fluid management. Each item was graded using a critical index (CI) that combined the relative importance of each item and the fraction of studies that did not report it, also taking experts' opinion into account. RESULTS A list of items in each area that deemed essential for the proper interpretation and application of research results is recommended. Additional items which aid interpretation were also proposed. CONCLUSION The PRICES recommendations reported in this document, as a checklist, represent an international consensus of experts as to which parameters and information should be included in the design of echocardiography research studies. PRICES recommendations provide guidance to scientists in the field of CCE with the objective of providing a recommended framework for reporting of CCE methodology and results.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - Stephen Huang
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Antoine Herpain
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fernando Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos Corredor
- Department of Perioperative Medicine, Bart's Heart Centre St. Bartholomew's Hospital, W. Smithfield, London, UK
| | - Daniel De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Nick Fletcher
- Cardiothoracic Critical Care, St Georges Hospital, St Georges University of London, London, UK
| | - Guillaume Geri
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.,INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Armand Mekontso-Dessap
- Service de réanimation médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Anthony McLean
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Andrea Morelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - Sam Orde
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Tatjana Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Michel Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, University Maastricht, Maastricht, The Netherlands
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Inserm CIC 1435, Limoges University Hospital, Limoges, France
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
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103
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Fraile Gutiérrez V, Ayuela Azcárate JM, Pérez-Torres D, Zapata L, Rodríguez Yakushev A, Ochagavía A. [Ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): narrative review]. Med Intensiva 2020; 44:551-565. [PMID: 32527471 PMCID: PMC7198178 DOI: 10.1016/j.medin.2020.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS) and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with an adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.
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Affiliation(s)
- V Fraile Gutiérrez
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España.
| | | | - D Pérez-Torres
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España
| | - L Zapata
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - A Rodríguez Yakushev
- Servicio de Medicina Intensiva, Área de Críticos, Corporación Sanitaria Parc Taulí Sabadell, Barcelona, España
| | - A Ochagavía
- Servicio de Medicina Intensiva, Área de Críticos, Corporación Sanitaria Parc Taulí Sabadell, Barcelona, España
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104
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Narrative review of ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): clinical applications in intensive care medicine. MEDICINA INTENSIVA (ENGLISH EDITION) 2020. [PMCID: PMC7605822 DOI: 10.1016/j.medine.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS), and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with a adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.
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105
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Abstract
PURPOSE OF REVIEW To appraise the basic and more advanced methods available for hemodynamic monitoring, and describe the definitions and criteria for the use of hemodynamic variables. RECENT FINDINGS The hemodynamic assessment in critically ill patients suspected of circulatory shock follows a step-by-step algorithm to help determine diagnosis and prognosis. Determination of accurate diagnosis and prognosis in turn is crucial for clinical decision-making. Basic monitoring involving clinical examination in combination with hemodynamic variables obtained with an arterial catheter and a central venous catheter may be sufficient for the majority of patients with circulatory shock. In case of uncertainty of the underlying cause or to guide treatment in severe shock may require additional advanced hemodynamic technologies, and each is utilized for different indications and has specific limitations. Future developments include refining the clinical examination and performing studies that demonstrate better patient outcomes by targeting hemodynamic variables using advanced hemodynamic monitoring. SUMMARY Determination of accurate diagnosis and prognosis for patients suspected of circulatory shock is essential for optimal decision-making. Numerous techniques are available, and each has its specific indications and value.
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106
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Del Castillo Gordillo C, Yañez Vidal F, Begazo Gonzales A, Alfaro Diaz M. Description of the position and performance of an echocardiogram by subcostal view during the prone position in a patient with severe pneumonia caused by COVID-19. BMJ Case Rep 2020; 13:13/11/e239230. [PMID: 33168541 PMCID: PMC7654104 DOI: 10.1136/bcr-2020-239230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Cesar Del Castillo Gordillo
- Cardiovascular Center, Hospital Clinico San Borja Arriaran, Santiago, Chile .,Cardiovascular Center, Hospital DIPRECA, Santiago, Chile
| | | | | | - Mario Alfaro Diaz
- Cardiovascular Center, Hospital Clinico San Borja Arriaran, Santiago, Chile
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107
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Sanfilippo F, Murabito P, Oliveri F, Astuto M. The value of E/e' ratio in critically ill patients should not be underestimated. Echocardiography 2020; 38:155-156. [PMID: 33155294 DOI: 10.1111/echo.14918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Policlinico San Marco, Presidio "G. Rodolico", Catania, Italy
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Policlinico San Marco, Presidio "G. Rodolico", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Francesco Oliveri
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Policlinico San Marco, Presidio "G. Rodolico", Catania, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Policlinico San Marco, Presidio "G. Rodolico", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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108
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Bonnemain J, Pegolotti L, Liaudet L, Deparis S. Implementation and Calibration of a Deep Neural Network to Predict Parameters of Left Ventricular Systolic Function Based on Pulmonary and Systemic Arterial Pressure Signals. Front Physiol 2020; 11:1086. [PMID: 33071803 PMCID: PMC7533610 DOI: 10.3389/fphys.2020.01086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/06/2020] [Indexed: 01/06/2023] Open
Abstract
The evaluation of cardiac contractility by the assessment of the ventricular systolic elastance function is clinically challenging and cannot be easily obtained at the bedside. In this work, we present a framework characterizing left ventricular systolic function from clinically readily available data, including systemic and pulmonary arterial pressure signals. We implemented and calibrated a deep neural network (DNN) consisting of a multi-layer perceptron with 4 fully connected hidden layers and with 16 neurons per layer, which was trained with data obtained from a lumped model of the cardiovascular system modeling different levels of cardiac function. The lumped model included a function of circulatory autoregulation from carotid baroreceptors in pulsatile conditions. Inputs for the DNN were systemic and pulmonary arterial pressure curves. Outputs from the DNN were parameters of the lumped model characterizing left ventricular systolic function, especially end-systolic elastance. The DNN adequately performed and accurately recovered the relevant hemodynamic parameters with a mean relative error of less than 2%. Therefore, our framework can easily provide complex physiological parameters of cardiac contractility, which could lead to the development of invaluable tools for the clinical evaluation of patients with severe cardiac dysfunction.
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Affiliation(s)
- Jean Bonnemain
- Adult Intensive Care and Burn Unit, University Hospital and University of Lausanne, Lausanne, Switzerland.,SCI-SB-SD, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, Institute of Mathematics, Lausanne, Switzerland
| | - Luca Pegolotti
- SCI-SB-SD, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, Institute of Mathematics, Lausanne, Switzerland
| | - Lucas Liaudet
- Adult Intensive Care and Burn Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Simone Deparis
- SCI-SB-SD, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, Institute of Mathematics, Lausanne, Switzerland
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109
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Schott CK, Kode KR, Mader MJ. Teaching vs learning: Impact of deliberate practice and formative feedback on developing point of care ultrasound skills. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:437-442. [PMID: 32542756 DOI: 10.1002/jcu.22878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The study investigators hypothesized that Point of Care Ultrasound (POCUS) training through bolus didactic and workshop experiences may be sufficient for trainees to learn the cognitive aspects, while an extended period of exposure with formative feedback is responsible for developing the psychomotor skills critical for POCUS. METHODS The investigators studied trainees over the course of an academic year. They compared trainees' performance on written (cognitive) and observed image acquisition (psychomotor) exams at baseline and at each subsequent quarter, using a stepped-wedge design. They performed linear regression analysis to determine which variables contributed to knowledge and psychomotor skill development. RESULTS Twenty-six trainees met the study requirements and participated in the POCUS curriculum. Participating in a POCUS rotation was consistently associated with an increase in psychomotor scores. There was no consistent variable to predict an increase in trainee's score on written knowledge assessments. CONCLUSIONS Extended exposure to POCUS over a 4-week rotation with direct and indirect formative feedback can explain difference in scores on psychomotor skills assessments. Trainees scored similarly on the written assessment with or without a POCUS rotation. Training through didactic and workshop experiences may be sufficient to learn the cognitive aspects, but not psychomotor skills required for POCUS.
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Affiliation(s)
- Christopher K Schott
- VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Karthik R Kode
- Department of Medicine, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Michael J Mader
- Department of Research and Development, South Texas Veterans Health Care System, San Antonio, Texas, USA
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110
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Sanfilippo F, Di Falco D, Noto A, Santonocito C, Morelli A, Bignami E, Scolletta S, Vieillard-Baron A, Astuto M. Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: a systematic review and meta-analysis. Br J Anaesth 2020; 126:319-330. [PMID: 32988600 DOI: 10.1016/j.bja.2020.07.059] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Weaning from mechanical ventilation is a challenging step during recovery from critical illness. Weaning failure or early reintubation are associated with increased morbidity and mortality, exposing patients to life-threatening complications. Cardiac dysfunction represents the most common cause of weaning failure. We conducted a systematic review and meta-analysis to evaluate the association between transthoracic echocardiographic parameters and weaning failure. METHODS We performed a systematic search of MEDLINE and EMBASE screening for prospective studies providing echocardiographic data collected just before the beginning of spontaneous breathing trial and outcome of the weaning attempt. We primarily focused on parameters currently recommended for evaluation of left ventricular (LV) systolic or diastolic dysfunction. RESULTS We included 11 studies in our primary analysis, which included data on LV ejection fraction (LVEF, n=10 studies) and parameters recommended for the assessment of LV diastolic function (E/e' ratio n=10; E/A ratio n=9; E wave n=8; and e' wave n=7). Weaning failure was significantly associated to a higher E/e' ratio (standardised mean difference [SMD]=1.70, 95% confidence interval [CI; 0.78-2.62]; P<0.001), lower e' wave (SMD=-1.22, 95% CI [-2.33 to -0.11]; P=0.03), and higher E wave (SMD=0.97, 95% CI [0.29-1.65]; P=0.005). We found no association between weaning failure and LVEF (SMD=-0.86, 95% CI [-1.92-0.20]; P=0.11) and E/A ratio (SMD=0.00, 95% CI [-0.30-0.31]; P=0.98). CONCLUSIONS Weaning failure is associated with parameters indicating worse LV diastolic function (E/e', e' wave, E wave) and increased LV filling pressure (E/e' ratio). The association between weaning failure and LV systolic dysfunction as evaluated by LVEF is more unclear. More studies are needed to clarify this aspect and regarding the role of right ventricular function.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy.
| | - Davide Di Falco
- School of Anaesthesia and Intensive Care, University Hospital 'G. Rodolico', University of Catania, Catania, Italy
| | - Alberto Noto
- Department of Anesthesia and Critical Care, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Andrea Morelli
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, University of Rome, 'La Sapienza', Rome, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sabino Scolletta
- Department of Urgency and Emergency, of Organ Transplantation, Anesthesia and Intensive Care, Siena University Hospital, Siena, Italy
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy; School of Anaesthesia and Intensive Care, University Hospital 'G. Rodolico', University of Catania, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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111
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Flower L, Madhivathanan PR, Andorka M, Olusanya O, Roshdy A, Sanfilippo F. Getting the most from the subcostal view: The rescue window for intensivists. J Crit Care 2020; 63:202-210. [PMID: 32958350 DOI: 10.1016/j.jcrc.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Luke Flower
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, United Kingdom.
| | - Pradeep R Madhivathanan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Matyas Andorka
- Department of Critical Care, Surrey and Sussex Healthcare NHS Trust, London, United Kingdom
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ashraf Roshdy
- Department of Critical Care, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Critical Care Medicine department, Alexandria University, Alexandria, Egypt
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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112
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Colombo L, Panizzardi F, Rusconi I, Roncoroni A, Bergamaschi M, Macheda A. Can Left ventricular outflow tract aortic velocity time integral guide fluid resuscitation in septic patients? - A case report. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.8817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hemodynamic monitoring of unstable patients is an everyday issue for Emergency Physicians (EP). Considering the difficulty, in Emergency Department (ED) settings, to assess invasively Stroke Volume (SV), Cardiac Output (CO) and Peripheral Vascular Resistance (PVR), EP should be familiar with non-invasive, easy and reproducible methods that can estimate these parameters. The use of Left Ventricular Outflow Tract aortic Velocity Time Integral (LVOT-VTI) with echocardiography, as estimate of SV, integrated with inferior vena cava collapse index and clinical examination could give the opportunity to non-invasively understand at which point of an ideal cardiac output/central venous pressure relation (according to the Frank Starling law) the patient is situated. In this case report we describe a septic patient accessing the ED with both respiratory and cardiac failure, and we show that the use of aortic LVOT-VTI is an easy and reproducible approach to understand cardiac hemodynamic in scenarios involving multiple pathologic mechanisms.
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113
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Valette X, Ribstein P, Ramakers M, du Cheyron D. Subcostal versus transhepatic view to assess the inferior vena cava in critically ill patients. Echocardiography 2020; 37:1171-1176. [PMID: 32757463 DOI: 10.1111/echo.14802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/29/2020] [Accepted: 07/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Evaluation of the inferior vena cava (IVC) is not always possible through the subcostal (SC) window. METHODS Inferior vena cava diameters measured by transhepatic (TH) and SC views were compared by Bland and Altman analysis. RESULTS 131 patients were enrolled, including 88 (67%) under mechanical ventilation. The echogenicity was statistically poorer through the TH view in comparison with the SC view (P = .002). The correlation between the SC and TH views was good and better for respiratory variation than for end-expiratory or end-inspiratory diameter measurements (r = 0.86). Despite low bias, the limits of agreement were wide (-7.5 and 7.7 mm for end-expiratory diameter, -8.7 and 8.5 mm for end-inspiratory diameter, and -5.3 and 5.8 mm for respiratory variation). Complementary analysis showed that the concordance between the SC and the TH views was better when the IVC was distended. However, the limits of agreement remained broad. CONCLUSIONS Although feasible in almost all patients, the TH view does not provide better echogenicity in comparison with the SC view. Despite a good correlation with the SC view and a low bias, the limits of agreement were wide, especially when the IVC has an ellipsoidal shape, suggesting caution in the interpretation of data obtained by the TH view.
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Affiliation(s)
- Xavier Valette
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
| | - Pierre Ribstein
- Department of Intensive Care, Center Hospitalier General Mémorial France Etats-Unis, Saint Lô, France
| | - Michel Ramakers
- Department of Intensive Care, Center Hospitalier General Mémorial France Etats-Unis, Saint Lô, France
| | - Damien du Cheyron
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
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114
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Flower L, Dempsey M, White A, Sanfilippo F, Olusanya O, Madhivathanan PR. Training and Accreditation Pathways in Critical Care and Perioperative Echocardiography. J Cardiothorac Vasc Anesth 2020; 35:235-247. [PMID: 32768252 DOI: 10.1053/j.jvca.2020.07.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
In recent years, there has been a dramatic rise in the use of echocardiography in perioperative and critical care medicine. It is now recommended widely as a first-line diagnostic tool when approaching patients in shock, due to its ability to identify shock etiology and response to treatment noninvasively. To match the increasing training demand, and to ensure maintenance of high-quality and reproducible scanning, several accreditation pathways have been developed worldwide. Critical care echocardiography training pathways can include both transthoracic and transesophageal scanning and range from basic focused protocols to advanced comprehensive scans. The complexity of each individual training program is reflected in its accreditation process. While basic accreditations may require only course attendance and a relatively brief logbook, comprehensive accreditations often require extensive logbooks and written and practical examinations. Currently, the use of transoesophageal echocardiography remains restricted largely to cardiothoracic anesthesia and critical care; however, its use in the general intensive care setting is growing. This narrative review summarizes the most common training pathways, their curricula, and accreditation requirements. The authors initially focus on echocardiography training in the United Kingdom, and then go on to describe similar international accreditations available in Europe, North America, and Australasia.
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Affiliation(s)
- Luke Flower
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, United Kingdom.
| | - Martin Dempsey
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Alexander White
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Pradeep R Madhivathanan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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115
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Sanfilippo F, Murabito P, La Rosa V, Oliveri F, Astuto M. Successful spontaneous breathing trial, early reintubation and mechanisms of weaning failure. Intensive Care Med 2020; 46:1960-1961. [PMID: 32661616 PMCID: PMC7358284 DOI: 10.1007/s00134-020-06176-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U., "Policlinico-Vittorio Emanuele" University Hospital, Catania, Italy.
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, A.O.U., "Policlinico-Vittorio Emanuele" University Hospital, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Valeria La Rosa
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Francesco Oliveri
- Department of Anaesthesia and Intensive Care, A.O.U., "Policlinico-Vittorio Emanuele" University Hospital, Catania, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U., "Policlinico-Vittorio Emanuele" University Hospital, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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Jain SS, Liu Q, Raikhelkar J, Fried J, Elias P, Poterucha TJ, DeFilippis EM, Rosenblum H, Wang EY, Redfors B, Clerkin K, Griffin JM, Wan EY, Abdalla M, Bello NA, Hahn RT, Shimbo D, Weiner SD, Kirtane AJ, Kodali SK, Burkhoff D, Rabbani LE, Schwartz A, Leon MB, Homma S, Di Tullio MR, Sayer G, Uriel N, Anstey DE. Indications for and Findings on Transthoracic Echocardiography in COVID-19. J Am Soc Echocardiogr 2020; 33:1278-1284. [PMID: 32782131 PMCID: PMC7298489 DOI: 10.1016/j.echo.2020.06.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
Background Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease. Methods A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. Results Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = −0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. Conclusions This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.
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Affiliation(s)
- Sneha S Jain
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Qi Liu
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jayant Raikhelkar
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Justin Fried
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Pierre Elias
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Timothy J Poterucha
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Hannah Rosenblum
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth Y Wang
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Bjorn Redfors
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Kevin Clerkin
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jan M Griffin
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marwah Abdalla
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Rebecca T Hahn
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Daichi Shimbo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Shepard D Weiner
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ajay J Kirtane
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Daniel Burkhoff
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - LeRoy E Rabbani
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Allan Schwartz
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Martin B Leon
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Shunichi Homma
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marco R Di Tullio
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - D Edmund Anstey
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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Abstract
The role of cardiothoracic anesthesiology intensivists has expanded over the past few decades. Cardiothoracic anesthesiology intensivists are taking on larger roles in cardiac critical care specializing in cardiogenic shock and extracorporeal membrane oxygenation.
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118
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Boissier F, Bagate F, Mekontso Dessap A. Hemodynamic monitoring using trans esophageal echocardiography in patients with shock. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:791. [PMID: 32647716 PMCID: PMC7333117 DOI: 10.21037/atm-2020-hdm-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Circulatory shock is a life-threatening condition responsible for inadequate tissue perfusion. The objectives of hemodynamic monitoring in this setting are multiple: identifying the mechanisms of shock (hypovolemic, distributive, cardiogenic, obstructive); choosing the adequate therapeutic intervention, and evaluating the patient's response. Echocardiography is proposed as a first line tool for this assessment in the intensive care unit. As compared to trans-thoracic echocardiography (TTE), trans-esophageal echocardiography (TEE) offers a better echogenicity and is the best way to evaluate deep anatomic structures. The therapeutic implication of TEE leads to frequent changes in clinical management. It also allows depicting sources of inaccuracy of thermodilution-based hemodynamic monitoring. It is a semi invasive tool with a low rate of complications. The first step in the hemodynamic evaluation of shock is to characterize the mechanisms of circulatory failure among hypovolemia, vasoplegia, cardiac dysfunction, and obstruction. Echocardiographic evaluation includes evaluation of LV systolic and diastolic function, as well as RV function, pericardium, measure of stroke volume and cardiac output, and evaluation of hypovolemia and fluid responsiveness. TEE can be used as a semi-continuous monitoring tool and can be repeated before and after therapeutic interventions (vasopressors, inotropes, fluid therapy, specific treatment such as pericardial effusion evacuation) to evaluate efficacy and tolerance of therapeutic interventions. In conclusion, TEE plays an important role in the management of circulatory failure when TTE is not enough to answer to the questions, although it is not a continuous tool of monitoring. TEE results must be integrated in a global evaluation, the first step being clinical examination. Whether TEE-directed therapy and close hemodynamic monitoring of shock has an impact on outcome remains debated.
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Affiliation(s)
- Florence Boissier
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France.,INSERM CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France
| | - François Bagate
- AP-HP, Hôpital Henri Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.,UPEC (Université Paris Est Créteil), Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, F-94010, Créteil, France
| | - Armand Mekontso Dessap
- AP-HP, Hôpital Henri Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.,UPEC (Université Paris Est Créteil), Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, F-94010, Créteil, France
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119
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Abstract
Purpose of Review To briefly review epidemiology and pathophysiology of SICM and provide a more extensive review of the data on diagnostic and management strategies. Recent Findings SICM is likely underdiagnosed and that has mortality implications. Current evidence supports speckle tracking echocardiography to identify decreased contractility irrespective of left ventricular ejection fraction for the diagnosis of SICM. There continues to be a dearth of large clinical trials evaluating the treatment of SICM and current consensus focuses on supportive measures such as vasopressors and inotropes. Summary Sepsis is a significant cause of mortality, and sepsis-induced cardiomyopathy has both prognostic and management implications for these patients. Individualized work-up and management of these patients is crucial to improving outcomes.
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Affiliation(s)
- Michael L'Heureux
- Division of Pulmonary Disease & Critical Care Medicine, Virginia Commonwealth University, P.O. Box 980050, Richmond, VA, 23298-0050, USA.
| | - Michael Sternberg
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Lisa Brath
- Division of Pulmonary Disease & Critical Care Medicine, Virginia Commonwealth University, P.O. Box 980050, Richmond, VA, 23298-0050, USA
| | - Jeremy Turlington
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Markos G Kashiouris
- Division of Pulmonary Disease & Critical Care Medicine, Virginia Commonwealth University, P.O. Box 980050, Richmond, VA, 23298-0050, USA
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120
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Huang S, Sanfilippo F, Herpain A, Balik M, Chew M, Clau-Terré F, Corredor C, De Backer D, Fletcher N, Geri G, Mekontso-Dessap A, McLean A, Morelli A, Orde S, Petrinic T, Slama M, van der Horst ICC, Vignon P, Mayo P, Vieillard-Baron A. Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel. Ann Intensive Care 2020; 10:49. [PMID: 32335780 PMCID: PMC7183522 DOI: 10.1186/s13613-020-00662-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal. Methods We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other “topic-specific” items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item. Results From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure. Conclusion This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.
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Affiliation(s)
- S Huang
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - F Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - A Herpain
- Department of Intensive Care, Erasme University Hospital, Univeristé Libre de Bruxelles, Brussels, Belgium
| | - M Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Chew
- Department of Anaesthesiology and Intensive Care, Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - F Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Corredor
- Department of Perioperative Medicine, Bart's Heart Centre St. Bartholomew's Hospital, W. Smithfield, London, UK
| | - D De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - N Fletcher
- Cardiothoracic Critical Care, St Georges Hospital, St Georges University of London, London, UK
| | - G Geri
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - A Mekontso-Dessap
- Service de réanimation médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - A McLean
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - A Morelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza," Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - S Orde
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - T Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - M Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - I C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, University Maastricht, Maastricht, The Netherlands
| | - P Vignon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, Inserm CIC 1435, Limoges, France
| | - P Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA
| | - A Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
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121
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Volpicelli G, Mayo P, Rovida S. Focus on ultrasound in intensive care. Intensive Care Med 2020; 46:1258-1260. [PMID: 32236645 DOI: 10.1007/s00134-020-06027-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy.
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, Hempstead, NY, USA
| | - Serena Rovida
- Department of Emergency Medicine, Linköping University Hospital, Linköping, Sweden
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122
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Scheeren TWL, Kaufmann T. Textbook of Echocardiography for Intensivists and Emergency Physicians, 2nd ed. Anesth Analg 2020. [DOI: 10.1213/ane.0000000000004566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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123
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Tuinman PR, Jonkman AH, Dres M, Shi ZH, Goligher EC, Goffi A, de Korte C, Demoule A, Heunks L. Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients-a narrative review. Intensive Care Med 2020; 46:594-605. [PMID: 31938825 PMCID: PMC7103016 DOI: 10.1007/s00134-019-05892-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
Respiratory muscle ultrasound is used to evaluate the anatomy and function of the respiratory muscle pump. It is a safe, repeatable, accurate, and non-invasive bedside technique that can be successfully applied in different settings, including general intensive care and the emergency department. Mastery of this technique allows the intensivist to rapidly diagnose and assess respiratory muscle dysfunction in critically ill patients and in patients with unexplained dyspnea. Furthermore, it can be used to assess patient-ventilator interaction and weaning failure in critically ill patients. This paper provides an overview of the basic and advanced principles underlying respiratory muscle ultrasound with an emphasis on the diaphragm. We review different ultrasound techniques useful for monitoring of the respiratory muscle pump and possible therapeutic consequences. Ideally, respiratory muscle ultrasound is used in conjunction with other components of critical care ultrasound to obtain a comprehensive evaluation of the critically ill patient. We propose the ABCDE-ultrasound approach, a systematic ultrasound evaluation of the heart, lungs and respiratory muscle pump, in patients with weaning failure.
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Affiliation(s)
- Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Annemijn H Jonkman
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Martin Dres
- Department of Pulmology and Medical Intensive Care, APHP Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Zhong-Hua Shi
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Department of Critical Care Medicine, Capital Medical University, Beijing Tiantan Hospital, Beijing, 100050, China
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, ON, Canada.,Critical Care Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Critical Care Medicine, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Chris de Korte
- Department of Radiology, Radboud UMC, Nijmegen, The Netherlands
| | - Alexandre Demoule
- Department of Pulmology and Medical Intensive Care, APHP Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
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124
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Rodriguez-Fanjul J, Perez-Baena L, Perez A. Cardiopulmonary resuscitation in newborn infants with ultrasound in the delivery room. J Matern Fetal Neonatal Med 2019; 34:2399-2402. [PMID: 31455141 DOI: 10.1080/14767058.2019.1661379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Point of care ultrasound has emerged as useful tool in cardiac arrest situations in adult population. Despite of these, there is not a protocol for cardiopulmonary resuscitation in the delivery room for newborns. We describe two case were ultrasound helped to rule out the cardiopulmonary arrest case and we propose and algorithm were ultrasound is integrated in the newborn resuscitation and may help to diagnose the cardiac arrest cause.
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Affiliation(s)
- Javier Rodriguez-Fanjul
- Pediatric Intensive Care Unit, Pediatric Department, Joan XXIII University Hospital in Tarragona, Tarragona, Spain
| | - Luis Perez-Baena
- Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Alberto Perez
- Neonatal Intensive Care Unit, Hospital Universitario Basurto, Bilbao, Spain
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125
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Weaning failure due to left ventricular non-compaction myocardium. Intensive Care Med 2019; 45:1830-1831. [PMID: 31432218 DOI: 10.1007/s00134-019-05737-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022]
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126
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Blanco P, Abdo-Cuza A. Point-of-care ultrasound in the critically ill pregnant or postpartum patient: what every intensivist should know. Intensive Care Med 2019; 45:1123-1126. [PMID: 31270577 DOI: 10.1007/s00134-019-05682-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/26/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Pablo Blanco
- Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., 7630, Necochea, Argentina.
| | - Anselmo Abdo-Cuza
- Intensive Care Unit, Centro de Investigaciones Médico-Quirúrgicas, 11-13 and 216 St., 12100, Siboney, La Habana, Cuba
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127
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Ramalingam G, Choi S, Agarwal S, Kunst G, Gill R, Fletcher SN, Klein AA, Shashidaran P, Waghmare K, Kadayam R, Flynn F, Gavin N, Mairead‐Machugh U, Bell M, Hawthorn A, Sajgalik P, Burri N, Meraglia A. Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care. Anaesthesia 2019; 75:21-26. [DOI: 10.1111/anae.14734] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 12/26/2022]
Affiliation(s)
- G. Ramalingam
- Department of Anaesthesia and Intensive Care Royal Papworth Hospital CambridgeUK
| | - S.‐W. Choi
- Department of Anaesthesiology Faculty of Medicine The University of Hong Kong HongKongHKSAR
| | - S. Agarwal
- Department of Cardiothoracic Anaesthesia Manchester Royal Infirmary ManchesterUK
| | - G. Kunst
- Department of Cardiothoracic Anaesthesia Kings College Hospital LondonUK
| | - R. Gill
- Department of Cardiothoracic Anaesthesia University Hospital Southampton UK
| | - S. N. Fletcher
- Department of Cardiothoracic Anaesthesia St Georges University Hospitals London UK
| | - A. A. Klein
- Department of Anaesthesia and Intensive Care Royal Papworth Hospital CambridgeUK
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Cholley B. Echocardiography in the intensive care unit: beyond "eyeballing". A plea for the broader use of the aortic velocity-time integral measurement. Intensive Care Med 2019; 45:898-901. [PMID: 30997543 DOI: 10.1007/s00134-019-05618-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Bernard Cholley
- Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.
- Université PAris Descartes, Sorbonne Paris Cité, Paris, France.
- Unité INSERM UMR_S1140, Paris, France.
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