1
|
Chen R, Zheng A, Wang Y, Guo L, Dou H, Lu L, Rafiq M, Li P, Chen X, Xiao Q. Salvianolic acid B improves mitochondrial dysfunction of septic cardiomyopathy via enhancing ATF5-mediated mitochondrial unfolded protein response. Toxicol Appl Pharmacol 2024; 491:117072. [PMID: 39153513 DOI: 10.1016/j.taap.2024.117072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/06/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
AIMS Septic cardiomyopathy is characterized by impaired contractile function and mitochondrial activity dysregulation. Salvianolic acid B (Sal B) is a potent therapeutic compound derived from the traditional Chinese medicine Salvia miltiorrhiza. This study explored the protective effects of Sal B on septic heart injury, emphasizing the mitochondrial unfolded protein response (UPRmt). MATERIALS AND METHODS An in vivo mouse model of lipopolysaccharide (LPS)-induced heart injury was utilized to assess Sal B's protective role in septic cardiomyopathy. Additionally, cell models stimulated by LPS were developed to investigate the mechanisms of Sal B on UPRmt. Quantitative polymerase chain reaction, western blotting, immunohistochemistry, and immunofluorescence were employed for molecular analysis. RESULTS Sal B, administered at doses of 10, 30, and 60 mg/kg, demonstrated protective effects on cardiac contractile function, reduced heart inflammation, and mitigated cardiac injury in LPS-exposed mice. In cardiomyocytes, LPS induced apoptosis, elevated mitochondrial ROS levels, promoted mitochondrial fission, and decreased mitochondrial membrane potential, all of which were alleviated by Sal B. Mechanistically, Sal B was found to induce UPRmt both in vivo and in vitro. ATF5, identified as a UPRmt activator, was modulated by LPS and Sal B, resulting in increased ATF5 expression and its translocation from the cytosol to the nucleus. ATF5-siRNA delivery reversed UPRmt upregulation, exacerbating mitochondrial dysfunction in LPS-stimulated cardiomyocytes and counteracting the mitochondrial function enhancement in Sal B-treated cardiomyocytes. CONCLUSIONS This study provides evidence that Sal B confers cardiac protection by enhancing UPRmt, highlighting its potential as a therapeutic approach for mitigating mitochondrial dysfunction in septic cardiomyopathy.
Collapse
Affiliation(s)
- Renshan Chen
- Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Avenue, Guangzhou 510800, PR China
| | - Anran Zheng
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China
| | - Yunjing Wang
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China
| | - Liyou Guo
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China
| | - Huaqian Dou
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China
| | - Liangyan Lu
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China
| | - Muhammad Rafiq
- Department of Biosciences, COMSATS University Islamabad, Park Road, Tarlai Kalan, Islamabad 45550, Pakistan
| | - Peihua Li
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China
| | - Xiuhui Chen
- Key Laboratory of Precision Pharmacy and Pharmaceutical Basic Research, Department of Pharmacy & the Eighth People's Hospital of Dongguan, Dongguan Children's Hospital Affiliated to Guangdong Medical University, 68 South Xihu Third Road, Shilong Town, Dongguan 523000, China.
| | - Qing Xiao
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, 1 Xinzao Road, Panyu District, Guangzhou 511436, PR China.
| |
Collapse
|
2
|
Orso D, Federici N, Lio C, Mearelli F, Bove T. Hemodynamic goals in sepsis and septic shock resuscitation: An umbrella review of systematic reviews and meta-analyses with trial sequential analysis. Aust Crit Care 2024; 37:818-826. [PMID: 38609748 DOI: 10.1016/j.aucc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE The objective of this study was to verify whether any parameter among those used as the target for haemodynamic optimisation (e.g., mean arterial pressure, central venous oxygen saturation, systolic or diastolic dysfunction, CO2 gap, lactates, right ventricular dysfunction, and PvaCO2/CavO2 ratio) is correlated with mortality in an undifferentiated population with sepsis or septic shock. METHODS An umbrella review, searching MEDLINE, the Cochrane Database of Systematic Reviews, Health Technology Assessment Database, and the JBI Database of Systematic Reviews and Implementation Reports, was performed. We included systematic reviews and meta-analyses enrolling a population of unselected patients with sepsis or septic shock. The main outcome was mortality. Two authors conducted data extraction and risk-of-bias assessments independently. We used a random-effects model to pool binary and continuous data and summarised estimates of effect using equivalent odds ratios (eORs). We used the ROBIS tool to assess risk of bias and the assessment of multiple systematic reviews 2 score to assess global quality. DATA SYNTHESIS 17 systematic reviews and meta-analyses (15 828 patients) were included in the quantitative analysis. Diastolic dysfunction (eOR: 1.42; 95% confidence interval [CI]: 1.14-1.76), PvaCO2/CavO2 ratio (eOR: 2.15; 95% CI: 1.37-3.37), and CO2 gap (eOR: 1.86; 95% CI: 1.07-3.25) showed a significant correlation with mortality. Lactates were the parameter with highest inconsistency (I2 = 92%). Central venous oxygen saturation and right ventricle dysfunction showed significant statistical excess test of significance (p-value = 0.009 and 0.005, respectively). None of the considered parameters showed statistically significant publication bias. CONCLUSIONS According to this umbrella review, diastolic dysfunction is the haemodynamic variable that is most closely linked to the prognosis of septic patients. The PvaCO2/CavO2 ratio and the CO2gap are significantly related to the mortality of septic patients, but the poor quality of evidence or the low number of cases, studied so far, limit their clinical applicability. CLINICAL TRIAL REGISTRATION PROSPERO: International prospective register of systematic reviews, 2023, CRD42023432813 (Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023432813).
Collapse
Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy.
| | - Nicola Federici
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Cristina Lio
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy; Department of Medical Sciences (DAME), University of Udine, Udine, Italy
| | - Filippo Mearelli
- Department of Internal Medicine, ASUGI University Hospital of Trieste, Trieste, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy; Department of Medical Sciences (DAME), University of Udine, Udine, Italy
| |
Collapse
|
3
|
Evrard B, Sinha P, Delucchi K, Hendrickson CM, Kangelaris KN, Liu KD, Willmore A, Wu N, Neyton L, Schmiege E, Gomez A, Kerchberger VE, Zalucky A, Matthay MA, Ware LB, Calfee CS. Causes and attributable fraction of death from ARDS in inflammatory phenotypes of sepsis. Crit Care 2024; 28:164. [PMID: 38745253 PMCID: PMC11092165 DOI: 10.1186/s13054-024-04943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Hypoinflammatory and hyperinflammatory phenotypes have been identified in both Acute Respiratory Distress Syndrome (ARDS) and sepsis. Attributable mortality of ARDS in each phenotype of sepsis is yet to be determined. We aimed to estimate the population attributable fraction of death from ARDS (PAFARDS) in hypoinflammatory and hyperinflammatory sepsis, and to determine the primary cause of death within each phenotype. METHODS We studied 1737 patients with sepsis from two prospective cohorts. Patients were previously assigned to the hyperinflammatory or hypoinflammatory phenotype using latent class analysis. The PAFARDS in patients with sepsis was estimated separately in the hypo and hyperinflammatory phenotypes. Organ dysfunction, severe comorbidities, and withdrawal of life support were abstracted from the medical record in a subset of patients from the EARLI cohort who died (n = 130/179). Primary cause of death was defined as the organ system that most directly contributed to death or withdrawal of life support. RESULTS The PAFARDS was 19% (95%CI 10,28%) in hypoinflammatory sepsis and, 14% (95%CI 6,20%) in hyperinflammatory sepsis. Cause of death differed between the two phenotypes (p < 0.001). Respiratory failure was the most common cause of death in hypoinflammatory sepsis, whereas circulatory shock was the most common cause in hyperinflammatory sepsis. Death with severe underlying comorbidities was more frequent in hypoinflammatory sepsis (81% vs. 67%, p = 0.004). CONCLUSIONS The PAFARDS is modest in both phenotypes whereas primary cause of death among patients with sepsis differed substantially by phenotype. This study identifies challenges in powering future clinical trials to detect changes in mortality outcomes among patients with sepsis and ARDS.
Collapse
Affiliation(s)
- Bruno Evrard
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.
| | - Pratik Sinha
- Division of Clinical and Translational Research, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Anesthesia, Division of Critical Care, Washington University, Saint Louis, MO, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Carolyn M Hendrickson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Kirsten N Kangelaris
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Andrew Willmore
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Nelson Wu
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Lucile Neyton
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emma Schmiege
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Antonio Gomez
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - V Eric Kerchberger
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Zalucky
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Matthay
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
4
|
Guo L, Li P, Wang Y, Wang J, Lei J, Zhao J, Wu X, He W, Jia J, Miao J, Wang D, Cui H. YIQIFUMAI INJECTION AMELIORATED SEPSIS-INDUCED CARDIOMYOPATHY BY INHIBITION OF FERROPTOSIS VIA XCT/GPX4 AXIS. Shock 2024; 61:638-645. [PMID: 37983962 DOI: 10.1097/shk.0000000000002257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT Sepsis-induced cardiomyopathy ( SIC ) is a distinct form of myocardial injury that disrupts tissue perfusion and stands as the significant cause of mortality among sepsis patients. Currently, effective preventive or treatment strategies for SIC are lacking. YiQiFuMai injection (YQFM), composed of Panax ginseng C.A. Mey., Ophiopogon japonicus (Thunb.) Ker Gawl., and Schisandra chinensis (Turcz.) Baill., is widely used in China to treat cardiovascular diseases, such as coronary heart disease, heart failure, and SIC . Research has shown that YQFM can improve cardiac function and alleviate heart failure through multiple pathways. Nevertheless, the mechanisms through which YQFM exerts its effects on SIC remain to be fully elucidated. In this study, we firstly investigated the therapeutic effects of YQFM on a SIC rat model and explored its effects on myocardial ferroptosis in vivo. Then, LPS-induced myocardial cell death model was used to evaluate the effects of YQFM on ferroptosis and xCT/GPX4 axis in vitro . Furthermore, using GPX4 inhibitors, we aimed to verify whether YQFM improved cardiomyocyte ferroptosis through the xCT/GPX4 axis. The results showed that YQFM was effective in alleviating myocardial injury in septic model rats. Besides, the concentrations of iron and the levels of lipid peroxidation-related factors (ROS, MDA, and 4-HNE) were significantly decreased and the expression of xCT/GPX4 axis was upregulated in SIC rats after YQFM treatment. In vitro studies also showed that YQFM alleviated iron overload and lipid peroxidation and activated xCT/GPX4 axis in LPS-induced myocardial cell death model. Moreover, GPX4 inhibitor could abolish the effects above. In summary, the study highlights the regulatory effect of YQFM in mitigating myocardial injury. It probably achieves this ameliorative effect by enhancing xCT/GPX4 axis and further reducing ferroptosis.
Collapse
Affiliation(s)
- Liying Guo
- Tianjin Second People's Hospital, Tianjin, China
| | - Peng Li
- Tianjin Second People's Hospital, Tianjin, China
| | - Yuming Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Wang
- Tianjin Second People's Hospital, Tianjin, China
| | - Jinyan Lei
- Tianjin Second People's Hospital, Tianjin, China
| | - Jie Zhao
- Tianjin Second People's Hospital, Tianjin, China
| | - Xiliang Wu
- Tianjin Second People's Hospital, Tianjin, China
| | - Wenju He
- First Central Hospital Affiliated to Nankai University; Tianjin First Central Hospital, Tianjin, China
| | - Jianwei Jia
- Tianjin Second People's Hospital, Tianjin, China
| | - Jing Miao
- Tianjin Second People's Hospital, Tianjin, China
| | - Dongqiang Wang
- First Central Hospital Affiliated to Nankai University; Tianjin First Central Hospital, Tianjin, China
| | - Huantian Cui
- Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
5
|
Wang L, Ma X, Chen Y, Gao S, Pan W, Chen J, Su L, He H, Long Y, Yin C, Zhou X. Factors influencing DVT formation in sepsis. Thromb J 2024; 22:11. [PMID: 38229151 DOI: 10.1186/s12959-024-00582-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION Sepsis is a global public health burden. Deep vein thrombosis (DVT) is the third most common cause of death from cardiovascular disease after heart attacks and strokes. We designed this experiment to investigate the factors influencing DVT formation in patients with sepsis. METHODS In this survey, 918 septic patients admitted to Peking Union Medical College Hospital, who underwent DVT screening were enrolled. The data were collected from June 8, 2013 to October 12, 2022. The differences between septic patients with and without DVT were studied from following aspects: basic information, comorbidities, inflammatory cytokines, albumin, source of infection, sequential organ failure assessment (SOFA) score, coagulation and prognosis. MAIN RESULTS In this study, the prevalence of DVT in patients with sepsis was 0.23. Elderly patients with sepsis were prone to DVT (p value < 0.001). In terms of comorbidities, septic patients with hypertension and atrial fibrillation were prone to DVT (p value 0.045 and 0.048). Inflammatory cytokines, such as procalcitonin (PCT), C-reactive protein (CRP), interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, had no significant correlation with DVT in patients with sepsis (p value 0.364, 0.882, 0.912, 0.789, 0.245, and 0.780). Levels of serum albumin correlated with DVT in patients with sepsis (p value 0.003). The SOFA total score had no relationship with DVT formation (p value 0.254). Coagulation and respiration function were negatively correlated with DVT (p value 0.018). Liver function was positively correlated with DVT (p value 0.020). Patients in the DVT group had longer duration of mechanical ventilation and longer intensive care unit (ICU) stays (p value < 0.001 and 0.006). There was no significant difference in survival in septic patients with and without DVT (p value 0.868). CONCLUSIONS The SOFA total score had no relationship with DVT formation. The function of each organ had different effects on DVT formation. Better coagulation and respiration function, easier DVT formation. Poorer liver function, easier DVT formation. DVT was associated with longer duration of mechanical ventilation and longer ICU stays.
Collapse
Affiliation(s)
- Lu Wang
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xudong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Yujie Chen
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Sifa Gao
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Wei Pan
- Information Center Department, Department of Information Management, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jieqing Chen
- Information Center Department, Department of Information Management, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Longxiang Su
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Huaiwu He
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yun Long
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Chang Yin
- National Institute of Hospital Administration, Beijing, 100730, China.
| | - Xiang Zhou
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Information Center Department, Department of Information Management, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| |
Collapse
|
6
|
Feng X, Zhu S, Shen Y, Zhu H, Yan M, Cai G, Ning G. Multi-organ spatiotemporal information aware model for sepsis mortality prediction. Artif Intell Med 2024; 147:102746. [PMID: 38184353 DOI: 10.1016/j.artmed.2023.102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Sepsis is a syndrome involving multi-organ dysfunction, and the mortality in sepsis patients correlates with the number of lesioned organs. Precise prognosis models play a pivotal role in enabling healthcare practitioners to administer timely and accurate interventions for sepsis, thereby augmenting patient outcomes. Nevertheless, the majority of available models consider the overall physiological attributes of patients, overlooking the asynchronous spatiotemporal interactions among multiple organ systems. These constraints hinder a full application of such models, particularly when dealing with limited clinical data. To surmount these challenges, a comprehensive model, denoted as recurrent Graph Attention Network-multi Gated Recurrent Unit (rGAT-mGRU), was proposed. Taking into account the intricate spatiotemporal interactions among multiple organ systems, the model predicted in-hospital mortality of sepsis using data collected within the 48-hour period post-diagnosis. MATERIAL AND METHODS Multiple parallel GRU sub-models were formulated to investigate the temporal physiological variations of single organ systems. Meanwhile, a GAT structure featuring a memory unit was constructed to capture spatiotemporal connections among multi-organ systems. Additionally, an attention-injection mechanism was employed to govern the data flowing within the network pertaining to multi-organ systems. The proposed model underwent training and testing using a dataset of 10,181 sepsis cases extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. To evaluate the model's superiority, it was compared with the existing common baseline models. Furthermore, ablation experiments were designed to elucidate the rationale and robustness of the proposed model. RESULTS Compared with the baseline models for predicting mortality of sepsis, the rGAT-mGRU model demonstrated the largest area under the receiver operating characteristic curve (AUROC) of 0.8777 ± 0.0039 and the maximum area under the precision-recall curve (AUPRC) of 0.5818 ± 0.0071, with sensitivity of 0.8358 ± 0.0302 and specificity of 0.7727 ± 0.0229, respectively. The proposed model was capable of delineating the varying contribution of the involved organ systems at distinct moments, as specifically illustrated by the attention weights. Furthermore, it exhibited consistent performance even in the face of limited clinical data. CONCLUSION The rGAT-mGRU model has the potential to indicate sepsis prognosis by extracting the dynamic spatiotemporal interplay information inherent in multi-organ systems during critical diseases, thereby providing clinicians with auxiliary decision-making support.
Collapse
Affiliation(s)
- Xue Feng
- Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Siyi Zhu
- Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Yanfei Shen
- Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China
| | - Huaiping Zhu
- Department of Mathematics and Statistics, York University, Toronto M3J1P3, Canada
| | - Molei Yan
- Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China
| | - Guolong Cai
- Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China.
| | - Gangmin Ning
- Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China; Research Center for Healthcare Data Science, Zhejiang Lab, Hangzhou 311121, China.
| |
Collapse
|
7
|
Zhu MY, Tang XK, Gao Y, Xu JJ, Gong YQ. Impact of heart failure on outcomes in patients with sepsis: A systematic review and meta-analysis. World J Clin Cases 2023; 11:3511-3521. [PMID: 37383893 PMCID: PMC10294198 DOI: 10.12998/wjcc.v11.i15.3511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/06/2023] [Accepted: 04/06/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Heart failure (HF) often affects the progress of sepsis patients, although its impact on outcomes is inconsistent and inconclusive.
AIM To conduct a systematic review and meta-analysis of the impact of HF on mortality in patients with sepsis.
METHODS PubMed, Embase, Web of Science, and the Cochrane Library databases were searched to compare the outcomes of sepsis patients with HF. A random effect model was used to summarize the mortality data, and the odds ratio (OR) and 95% confidence interval (CI) were calculated as effect indicators.
RESULTS Among 18001 records retrieved in the literature search, 35712 patients from 10 separate studies were included. The results showed that sepsis patients with HF were associated with increased total mortality (OR = 1.80, 95%CI: 1.34-2.43; I2 = 92.1%), with high heterogeneity between studies. Significant subgroup differences according to age, geographical location, and HF patient sample were observed. HF did not increase the 1-year mortality of patients (OR = 1.11, 95%CI: 0.75-1.62; I2 = 93.2%), and the mortality of patients with isolated right ventricular dysfunction (OR=2.32, 95%CI: 1.29-4.14; I2 = 91.5%) increased significantly.
CONCLUSION In patients with sepsis, HF is often associated with adverse outcomes and mortality. Our results call for more high-quality research and strategies to improve outcomes for sepsis patients with HF.
Collapse
Affiliation(s)
- Ming-Yu Zhu
- Department of the Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Kai Tang
- Department of the Orthopaedic, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yi Gao
- Department of the Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jing-Jing Xu
- Department of the Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yuan-Qi Gong
- Department of the Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| |
Collapse
|
8
|
Zhang H, Lian H, Wang X, Zhang Q, Liu D. Tricuspid annular plane systolic excursion/mitral annular plane systolic excursion ratio in critically ill patients: an index of right- and left-ventricular function mismatch and a risk factor for cardiogenic pulmonary edema. BMC Anesthesiol 2023; 23:175. [PMID: 37217863 DOI: 10.1186/s12871-023-02142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND This study aimed to explore whether the tricuspid annular systolic excursion (TAPSE)/mitral annular systolic excursion (MAPSE) ratio was associated with the occurrence of cardiogenic pulmonary edema (CPE) in critically ill patients. MATERIALS AND METHODS This was a prospective observational study conducted in a tertiary hospital. Adult patients admitted to the intensive care unit who were on mechanical ventilation or in need of oxygen therapy were prospectively screened for enrolment. The diagnosis of CPE was determined based on lung ultrasound and echocardiography findings. TAPSE ≥ 17 mm and MAPSE ≥ 11 mm were used as normal references. RESULTS Among the 290 patients enrolled in this study, 86 had CPE. In the logistic regression analysis, the TASPE/MAPSE ratio was independently associated with the occurrence of CPE (odds ratio 4.855, 95% CI: 2.215-10.641, p < 0.001). The patients' heart function could be categorized into four types: normal TAPSE in combination with normal MAPSE (TAPSE↑/MAPSE↑) (n = 157), abnormal TAPSE in combination with abnormal MAPSE (TAPSE↓/MAPSE↓) (n = 40), abnormal TAPSE in combination with normal MAPSE (TAPSE↓/MAPSE↑) (n = 50) and normal TAPSE in combination with abnormal MAPSE (TAPSE↑/MAPSE↓) (n = 43). The prevalence of CPE in patients with TAPSE↑/MAPSE↓ (86.0%) was significantly higher than that in patients with TAPSE↑/MAPSE↑ (15.3%), TAPSE↓/MAPSE↓ (37.5%), or TAPSE↓/MAPSE↑ (20.0%) (p < 0.001). The ROC analysis showed that the area under the curve for the TAPSE/MAPSE ratio was 0.761 (95% CI: 0.698-0.824, p < 0.001). A TAPSE/MAPSE ratio of 1.7 allowed the identification of patients at risk of CPE with a sensitivity of 62.8%, a specificity of 77.9%, a positive predictive value of 54.7% and a negative predictive value of 83.3%. CONCLUSIONS The TAPSE/MAPSE ratio can be used to identify critically ill patients at higher risk of CPE.
Collapse
Affiliation(s)
- Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
| | - Hui Lian
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
| | - Qing Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| |
Collapse
|
9
|
Joshi S, Kundu S, Priya VV, Kulhari U, Mugale MN, Sahu BD. Anti-inflammatory activity of carvacrol protects the heart from lipopolysaccharide-induced cardiac dysfunction by inhibiting pyroptosis via NLRP3/Caspase1/Gasdermin D signaling axis. Life Sci 2023; 324:121743. [PMID: 37120013 DOI: 10.1016/j.lfs.2023.121743] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
AIMS Lipopolysaccharide (LPS) is a well-known agent to induce septic conditions. Sepsis-induced cardiomyopathy has an overwhelming death rate. Carvacrol (CVL), a monoterpene phenol, has anti-inflammatory and antioxidant properties. The research aimed to investigate the effect of CVL on LPS-induced dysfunction in the heart. In this study, we evaluated the effect of CVL in LPS-stimulated H9c2 cardiomyoblast cells and Balb/c mice. MAIN METHODS LPS was used to induce septic conditions in H9c2 cardiomyoblast cells in vitro and in Balb/C mice. A survival study was conducted to assess the survival rate of mice after LPS and/or CVL treatment. KEY FINDINGS In vitro studies indicated that CVL inhibits reactive oxygen species (ROS) generation and abates pyroptosis mediated by NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome in H9c2 cells. In mice, CVL intervention improved the survival rate in septic conditions. The CVL administration markedly improved the echocardiographic parameters and alleviated the LPS-induced reduction in the ejection fraction (%) and fraction shortening (%). The CVL intervention restored the myocardial antioxidants and histopathological alterations and decreased the pro-inflammatory cytokine contents in the heart. Further findings disclosed that CVL reduced the protein levels of NLRP3, apoptosis-associated speck-like protein (ASC), caspase 1, interleukin (IL)-18, IL-1β, and the pyroptosis-indicative protein, gasdermin-D (GSDMD) in the heart. The autophagy-indicative proteins, beclin 1, and p62, in the heart were also restored in the CVL-treated group. SIGNIFICANCE Altogether, our findings demonstrated that CVL has a beneficial effect and can be a potential molecule against sepsis-induced myocardial dysfunction.
Collapse
Affiliation(s)
- Shubhang Joshi
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, 781101, Assam, India
| | - Sourav Kundu
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, 781101, Assam, India
| | - Vikram Vamsi Priya
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, 781101, Assam, India
| | - Uttam Kulhari
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, 781101, Assam, India
| | - Madhav Nilakanth Mugale
- Toxicology & Experimental Medicine, CSIR- Central Drug Research Institute (CDRI), Lucknow 226 031, India
| | - Bidya Dhar Sahu
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, 781101, Assam, India.
| |
Collapse
|
10
|
Shao R, Lou X, Xue J, Ning D, Chen G, Jiang L. Review: the role of GSDMD in sepsis. Inflamm Res 2022; 71:1191-1202. [PMID: 35969260 PMCID: PMC9376580 DOI: 10.1007/s00011-022-01624-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Gasdermin D (GSDMD) is a cytoplasmic protein that is encoded by the gasdermin family GSDMD gene and is the ultimate executor of pyroptosis. Pyroptosis is a mode of lysis and inflammation that regulates cell death, ultimately leading to cell swelling and rupture. In sepsis, a dysregulated host response to infection frequently results in hyperinflammatory responses and immunosuppression, eventually leading to multiple organ dysfunction. Pyroptosis regulates innate immune defenses and plays an important role in the process of inflammatory cell death, and the absence of any link in the entire pathway from GSDMD to pyroptosis causes bacterial clearance to be hampered. Under normal conditions, the process of pyroptosis occurs much faster than apoptosis, and the threat to the body is also much greater. MATERIALS AND METHODS We conducted a systematic review of relevant reviews and experimental articles using the keywords sepsis, Gasdermin D, and Pyroptosis in the PubMed, Scopus, Google Scholar, and Web of Science databases. CONCLUSION Combined with the pathogenesis of sepsis, it is not difficult to find that pyroptosis plays a key role in bacterial inflammation and sepsis. Therefore, GSDMD inhibitors may be used as targeted drugs to treat sepsis by reducing the occurrence of pyroptosis. This review mainly discusses the key role of GSDMD in sepsis.
Collapse
Affiliation(s)
- Ruifei Shao
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
- Medical School, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
| | - Xiran Lou
- Medical School, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
| | - Jinfang Xue
- Medical School, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
| | - Deyuan Ning
- Medical School, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
| | - Guobing Chen
- Department of Emergency Medicine, The First People's Hospital of Yunnan Province, Xishan District, No 157 Jinbi Road, Kunming, 650032, China.
| | - Lihong Jiang
- Department of Cardiovascular Surgery, The First People' Hospital of Yunnan Province, Xishan District, No 157 Jinbi Road, Kunming, 650032, People's Republic of China.
| |
Collapse
|
11
|
Zhang H, Liu D. Sepsis-related cardiomyopathy: Not an easy task for ICU physicians. JOURNAL OF INTENSIVE MEDICINE 2022; 2:257-259. [PMID: 36788939 PMCID: PMC9923957 DOI: 10.1016/j.jointm.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 06/18/2023]
Abstract
Sepsis-induced myocardial dysfunction is common. In addition to acute coronary syndrome, at least two types of left ventricular dysfunction can occur in septic patients: typical septic cardiomyopathy (SC) and sepsis-related takotsubo cardiomyopathy (ST). Although the definition of septic cardiomyopathy is based on left ventricular (LV) systolic dysfunction, both ventricles can be affected. In this context, it has been increasingly recognized that right ventricular (RV) systolic dysfunction is associated with long-term prognosis in septic patients. Unlike typical SC, ST patients usually displayed LV apical and circumferential mid-ventricular hypokinesia and basal hypercontractility. Timely and precise evaluation of heart dysfunction in sepsis patients is not easy but obviously mandatory. Further studies are still warranted regarding the mechanism, evaluation, and management of septic cardiomyopathy.
Collapse
|
12
|
Liu Z, Li W, Cao Y, Zhang X, Yang K, Yin F, Yang M, Peng P. Effects of the interaction of Notch and TLR4 pathways on inflammation and heart function in septic heart. Open Life Sci 2022; 17:744-755. [PMID: 35891967 PMCID: PMC9281592 DOI: 10.1515/biol-2022-0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/22/2022] [Accepted: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
We investigated the role of the interaction between the Notch and Toll-like receptor 4 (TLR4) pathways in septic myocardial injury. The sepsis model was induced in rats with lipopolysaccharide (LPS). Rats were divided into control, LPS, LPS + TAK242 ((6R)-6-[N-(2-chloro-4-fluorophenyl)sulfamoyl]cyclohex-1-ene-1-carboxylate) and LPS + DAPT (N-[N-(3,5-difluorophenacetyl)-l-alanyl]-s-phenylglycinetbutylester) groups. Heart function was evaluated with a Cardiac Doppler ultrasound. Myocardial morphological changes were detected by hematoxylin-eosin staining (H&E). Apoptosis was assessed by a TUNEL assay. The mRNA and protein levels were detected with real-time PCR, Western blot, and immunohistochemistry analysis. We found that heart function in the LPS + TAK242 group was significantly improved, but not in the LPS + DAPT group. LPS + TAK242 had a lower level of degeneration and necrosis of cardiomyocytes and inflammatory cell infiltration, as well as lower apoptosis and caspase-3 expression than the LPS group. Compared with the LPS group, the inflammatory cell infiltration was reduced in the LPS + DAPT group, while the degeneration and necrosis of cardiomyocytes were not obviously improved. Additionally, the expression levels of tumor necrosis factor-α and Interleukin-6, the protein contents of Notch intracellular domain and Hes1, and the P65 nuclear factor kappa-B (NF-κB) to P-P65 NF-κB ratio in LPS + TAK242 group and LPS + DAPT group were significantly lower than those in LPS group. Conclusively, the interaction between TLR4 and Notch signaling pathways enhances the inflammatory response in the septic heart by activating NF-κB. Blocking the TLR4 pathway with TAK242 can improve heart dysfunction and myocardial damage in sepsis, while blocking the Notch pathway with DAPT cannot effectively prevent heart dysfunction and myocardial damage in sepsis.
Collapse
Affiliation(s)
- Ziyang Liu
- Intensive Care Unit, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Wenli Li
- Emergency Department of Internal Medicine, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Yang Cao
- Intensive Care Unit, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Xiaoxia Zhang
- Intensive Care Unit, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Kai Yang
- Intensive Care Unit, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Fukang Yin
- Intensive Care Unit, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Meng Yang
- Intensive Care Unit, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Peng Peng
- Intensive Care Unit, Emergency Trauma Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| |
Collapse
|
13
|
Wong A, Robba C, Mayo P. Critical care ultrasound. Intensive Care Med 2022; 48:1069-1071. [PMID: 35648197 DOI: 10.1007/s00134-022-06735-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/09/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK.
| | - Chiara Robba
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy.,Italy and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa, Italy
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA
| |
Collapse
|
14
|
Girón-Arango L, D’Empaire PP. Is There a Role for Transesophageal Echocardiography in the Perioperative Trauma Patient? CURRENT ANESTHESIOLOGY REPORTS 2022; 12:210-216. [PMID: 35340714 PMCID: PMC8933763 DOI: 10.1007/s40140-022-00526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review
This review article summarizes the advantages and potential uses of focused transesophageal echocardiography (TEE) in the perioperative period for trauma patients. We suggest a locally developed TEE protocol for trauma and provide strategies to achieve widespread use of TEE in the anesthesia care of trauma patients. Recent Findings In recent years, TEE has gained interest as an additional modality as point-of-care ultrasound (POCUS) for the resuscitation of acutely ill patients in whom transthoracic echocardiography is not feasible or non-diagnostic. Nevertheless, its use among non-cardiac anesthesiologists is still limited compared to the more traditional POCUS applications. Summary A goal-directed, focused TEE can be performed at the bedside in different locations and mechanically ventilated patients. TEE provides relevant diagnostic information to guide the resuscitation of acutely injured patients, particularly to identify life-threatening hidden thoracic injuries in the scenario of patients with multi-system trauma.
Collapse
|
15
|
Busch K, Kny M, Huang N, Klassert TE, Stock M, Hahn A, Graeger S, Todiras M, Schmidt S, Chamling B, Willenbrock M, Groß S, Biedenweg D, Heuser A, Scheidereit C, Butter C, Felix SB, Otto O, Luft FC, Slevogt H, Fielitz J. Inhibition of the NLRP3/IL-1β axis protects against sepsis-induced cardiomyopathy. J Cachexia Sarcopenia Muscle 2021; 12:1653-1668. [PMID: 34472725 PMCID: PMC8718055 DOI: 10.1002/jcsm.12763] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Septic cardiomyopathy worsens the prognosis of critically ill patients. Clinical data suggest that interleukin-1β (IL-1β), activated by the NLRP3 inflammasome, compromises cardiac function. Whether or not deleting Nlrp3 would prevent cardiac atrophy and improve diastolic cardiac function in sepsis was unclear. Here, we investigated the role of NLRP3/IL-1β in sepsis-induced cardiomyopathy and cardiac atrophy. METHODS Male Nlrp3 knockout (KO) and wild-type (WT) mice were exposed to polymicrobial sepsis by caecal ligation and puncture (CLP) surgery (KO, n = 27; WT, n = 33) to induce septic cardiomyopathy. Sham-treated mice served as controls (KO, n = 11; WT, n = 16). Heart weights and morphology, echocardiography and analyses of gene and protein expression were used to evaluate septic cardiomyopathy and cardiac atrophy. IL-1β effects on primary and immortalized cardiomyocytes were investigated by morphological and molecular analyses. IonOptix and real-time deformability cytometry (RT-DC) analysis were used to investigate functional and mechanical effects of IL-1β on cardiomyocytes. RESULTS Heart morphology and echocardiography revealed preserved systolic (stroke volume: WT sham vs. WT CLP: 33.1 ± 7.2 μL vs. 24.6 ± 8.7 μL, P < 0.05; KO sham vs. KO CLP: 28.3 ± 8.1 μL vs. 29.9 ± 9.9 μL, n.s.; P < 0.05 vs. WT CLP) and diastolic (peak E wave velocity: WT sham vs. WT CLP: 750 ± 132 vs. 522 ± 200 mm/s, P < 0.001; KO sham vs. KO CLP: 709 ± 152 vs. 639 ± 165 mm/s, n.s.; P < 0.05 vs. WT CLP) cardiac function and attenuated cardiac (heart weight-tibia length ratio: WT CLP vs. WT sham: -26.6%, P < 0.05; KO CLP vs. KO sham: -3.3%, n.s.; P < 0.05 vs. WT CLP) and cardiomyocyte atrophy in KO mice during sepsis. IonOptix measurements showed that IL-1β decreased contractility (cell shortening: IL-1β: -15.4 ± 2.3%, P < 0.001 vs. vehicle, IL-1RA: -6.1 ± 3.3%, P < 0.05 vs. IL-1β) and relaxation of adult rat ventricular cardiomyocytes (time-to-50% relengthening: IL-1β: 2071 ± 225 ms, P < 0.001 vs. vehicle, IL-1RA: 564 ± 247 ms, P < 0.001 vs. IL-1β), which was attenuated by an IL-1 receptor antagonist (IL-1RA). RT-DC analysis indicated that IL-1β reduced cardiomyocyte size (P < 0.001) and deformation (P < 0.05). RNA sequencing showed that genes involved in NF-κB signalling, autophagy and lysosomal protein degradation were enriched in hearts of septic WT but not in septic KO mice. Western blotting and qPCR disclosed that IL-1β activated NF-κB and its target genes, caused atrophy and decreased myosin protein in myocytes, which was accompanied by an increased autophagy gene expression. These effects were attenuated by IL-1RA. CONCLUSIONS IL-1β causes atrophy, impairs contractility and relaxation and decreases deformation of cardiomyocytes. Because NLRP3/IL-1β pathway inhibition attenuates cardiac atrophy and cardiomyopathy in sepsis, it could be useful to prevent septic cardiomyopathy.
Collapse
Affiliation(s)
- Katharina Busch
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Melanie Kny
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Nora Huang
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Department of Cardiology, Heart Center Brandenburg and Medical School Brandenburg (MHB), Bernau, Germany
| | - Tilman E Klassert
- ZIK Septomics, Host Septomics, Jena, Germany.,Jena University Hospital, Integrated Research and Treatment Center - Center for Sepsis Control and Care (CSCC), Jena, Germany
| | - Magdalena Stock
- ZIK Septomics, Host Septomics, Jena, Germany.,Jena University Hospital, Integrated Research and Treatment Center - Center for Sepsis Control and Care (CSCC), Jena, Germany
| | - Alexander Hahn
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sebastian Graeger
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Mihail Todiras
- Laboratory of Molecular Biology of Peptide Hormones, Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Nicolae Testemiţanu State University of Medicine and Pharmacy, Chișinău, Moldova
| | - Sibylle Schmidt
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Bishwas Chamling
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, Molecular Cardiology, University Medicine Greifswald, Greifswald, Germany
| | - Michael Willenbrock
- Signal Transduction in Development and Cancer, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Stefan Groß
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, Molecular Cardiology, University Medicine Greifswald, Greifswald, Germany
| | - Doreen Biedenweg
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Centre for Innovation Competence - Humoral Immune Response in Cardiovascular Diseases, University of Greifswald, Greifswald, Germany
| | - Arnd Heuser
- Animal Phenotyping Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Claus Scheidereit
- Signal Transduction in Development and Cancer, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg and Medical School Brandenburg (MHB), Bernau, Germany
| | - Stephan B Felix
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, Molecular Cardiology, University Medicine Greifswald, Greifswald, Germany
| | - Oliver Otto
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Centre for Innovation Competence - Humoral Immune Response in Cardiovascular Diseases, University of Greifswald, Greifswald, Germany
| | - Friedrich C Luft
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Hortense Slevogt
- ZIK Septomics, Host Septomics, Jena, Germany.,Jena University Hospital, Integrated Research and Treatment Center - Center for Sepsis Control and Care (CSCC), Jena, Germany
| | - Jens Fielitz
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, Molecular Cardiology, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
16
|
Comparative Early Hemodynamic Profiles in Patients Presenting to the Emergency Department with Septic and Nonseptic Acute Circulatory Failure Using Focused Echocardiography. Shock 2021; 53:695-700. [PMID: 31568225 PMCID: PMC7237072 DOI: 10.1097/shk.0000000000001449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Objective: We evaluated the early hemodynamic profile of patients presenting with acute circulatory failure to the Emergency Department (ED) using focused echocardiography performed by emergency physicians after a dedicated training program. Methods: Patients presenting to the ED with an acute circulatory failure of any origin were successively examined by a recently trained emergency physician and by an expert in critical care echocardiography. Operators independently performed and interpreted online echocardiographic examinations to determine the leading mechanism of acute circulatory failure. Results: Focused echocardiography could be performed in 100 of 114 screened patients (55 with sepsis/septic shock and 45 with shock of other origin) after a median fluid loading of 500 mL (interquartile range: 187–1,500 mL). A hypovolemic profile was predominantly observed whether the acute circulatory failure was of septic origin or not (33/55 [60%] vs. 23/45 [51%]: P = 0.37). Although a vasoplegic profile associated with a hyperkinetic left ventricle was most frequently identified in septic patients when compared with their counterparts (17/55 [31%] vs. 5/45 [11%]: P = 0.02), early left or right ventricular failure was observed in 31% of them. Hemodynamic profiles were adequately appraised by recently trained emergency physicians, as reflected by a good-to-excellent agreement with the expert's assessment (Κ: 0.61–0.85). Conclusions: Hypovolemia was predominantly identified in patients presenting to the ED with acute circulatory failure. Although vasoplegia was more frequently associated with sepsis, early ventricular dysfunction was also depicted in septic patients. Focused echocardiography seemed reliable when performed by recently trained emergency physicians without previous experience in ultrasound.
Collapse
|
17
|
Bughrara N, Diaz-Gomez JL, Pustavoitau A. Perioperative Management of Patients with Sepsis and Septic Shock, Part II: Ultrasound Support for Resuscitation. Anesthesiol Clin 2020; 38:123-134. [PMID: 32008647 DOI: 10.1016/j.anclin.2019.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Point-of-care ultrasound is capable of identifying the precise causes of hemodynamic failure in patients with septic shock. Patients in shock demonstrate complex alterations in their circulation, including changes in loading conditions (preload and afterload), right and left ventricular function, and development of obstructive physiology, and some of them have a burden of underlying cardiac disease. Knowledge of underlying hemodynamic derangements in such situations allows targeted interventions, that is, fluids, vasoactive, and inotropic medications, to optimize patient's perfusion. One example of competing goals involves a patient with hypertrophic "thick" left ventricle (LV), which is easily identified using point-of-care ultrasound (POCUS). Such patients usually have diastolic dysfunction and commonly require higher filling pressures (mainly grade II and III diastolic dysfunction) to maintain adequate cardiac output. They are vulnerable to the effects of hypovolemia with the potential for dynamic LV outflow tract (LVOT) obstruction. The use of inotrope is harmful under these circumstances and could lead to worsening of the obstructive physiology because of systolic anterior motion of the mitral valve leaflet and mitral regurgitation with rapid progression toward a cardiac arrest. Recognizing the increasingly important role of POCUS in the perioperative arena, in this review, we highlight how POCUS allows anesthesiologists to recognize and manage hemodynamic derangements in patients with sepsis and septic shock. We provide a systematic approach to the evaluation of this patient population using qualitative assessment of myocardial performance, fluid responsiveness, and fluid tolerance. Our approach is based on a limited number of ultrasound views: subcostal, inferior vena cava (IVC), and lung views are obtained in rapid succession. A combination of findings in these views is grouped into distinct hemodynamic phenotypes, each of them requiring their own approach to management.
Collapse
Affiliation(s)
- Nibras Bughrara
- Department of Anesthesiology, Albany Medical College, 47 New Scotland Avenue, MC 131, Albany, NY 12208, USA; Department of Surgery, Albany Medical College, 47 New Scotland Avenue, MC 131, Albany, NY 12208, USA.
| | - Jose L Diaz-Gomez
- Cardiovascular Critical Care, Professional Development, Education, and Clinical Research, Critical Care Medicine, Division of Cardiovascular Anesthesia, Texas Heart Institute - Baylor St. Luke's Medical Center, 6720 Bertner Avenue, Suite 0-520, Houston, TX 77030, USA; Critical Care Echocardiography and Point of Care Ultrasound, Baylor College of Medicine, Houston, TX, USA
| | - Aliaksei Pustavoitau
- Division of Adult Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 297, Baltimore, MD 21287, USA
| |
Collapse
|
18
|
Lazaridis C, Vlachogiannis NI, Bakogiannis C, Spyridopoulos I, Stamatelopoulos K, Kanakakis I, Vassilikos V, Stellos K. Involvement of cardiovascular system as the critical point in coronavirus disease 2019 (COVID-19) prognosis and recovery. Hellenic J Cardiol 2020; 61:381-395. [PMID: 32534109 PMCID: PMC7286275 DOI: 10.1016/j.hjc.2020.05.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has already caused more than 300,000 deaths worldwide. Several studies have elucidated the central role of cardiovascular complications in the disease course. Herein, we provide a concise review of current knowledge regarding the involvement of cardiovascular system in the pathogenesis and prognosis of COVID-19. We summarize data from 21 studies involving in total more than 21,000 patients from Asia, Europe, and the USA indicating that severe disease is associated with the presence of myocardial injury, heart failure, and arrhythmias. Additionally, we present the clinical and laboratory differences between recovered and deceased patients highlighting the importance of cardiac manifestations. For the infected patients, underlying cardiovascular comorbidities and particularly existing cardiovascular disease seem to predispose to the development of cardiovascular complications, which are in turn associated with higher mortality rates. We provide mechanistic insights into the underlying mechanisms including direct myocardial damage by the virus and the consequences of the hyperinflammatory syndrome developed later in the disease course. Finally, we summarize current knowledge on therapeutic modalities and recommendations by scientific societies and experts regarding the cardiovascular management of patients with COVID-19.
Collapse
Affiliation(s)
- Charalampos Lazaridis
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; Third Cardiology Department, Hippokrateion University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nikolaos I Vlachogiannis
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Constantinos Bakogiannis
- Third Cardiology Department, Hippokrateion University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioakim Spyridopoulos
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kimon Stamatelopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stellos
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| |
Collapse
|
19
|
Monge Garcia MI, Guijo González P, Saludes Orduña P, Gracia Romero M, Gil Cano A, Messina A, Rhodes A, Cecconi M. Dynamic Arterial Elastance During Experimental Endotoxic Septic Shock: A Potential Marker of Cardiovascular Efficiency. Front Physiol 2020; 11:562824. [PMID: 33123025 PMCID: PMC7567029 DOI: 10.3389/fphys.2020.562824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
Dynamic arterial elastance (Eadyn), the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), has been suggested as a dynamic parameter relating pressure and flow. We aimed to determine the effects of endotoxic septic shock and hemodynamic resuscitation on Eadyn in an experimental study in 18 New Zealand rabbits. Animals received placebo (SHAM, n = 6) or intravenous lipopolysaccharide (E. Coli 055:B5, 1 mg⋅kg - 1) with or without (EDX-R, n = 6; EDX, n = 6) hemodynamic resuscitation (fluid bolus of 20 ml⋅kg - 1 and norepinephrine for restoring mean arterial pressure). Continuous arterial pressure and aortic blood flow measurements were obtained simultaneously. Cardiovascular efficiency was evaluated by the oscillatory power fraction [%Osc: oscillatory work/left ventricular (LV) total work] and the energy efficiency ratio (EER = LV total work/cardiac output). Eadyn increased in septic animals (from 0.73 to 1.70; p = 0.012) and dropped after hemodynamic resuscitation. Eadyn was related with the %Osc and EER [estimates: -0.101 (-0.137 to -0.064) and -9.494 (-11.964 to -7.024); p < 0.001, respectively]. So, the higher the Eadyn, the better the cardiovascular efficiency (lower %Osc and EER). Sepsis resulted in a reduced %Osc and EER, reflecting a better cardiovascular efficiency that was tracked by Eadyn. Eadyn could be a potential index of cardiovascular efficiency during septic shock.
Collapse
Affiliation(s)
- Manuel Ignacio Monge Garcia
- Unidad de Gestión Clínica de Cuidados Intensivos, Hospital Universitario SAS de Jerez, Jerez de la Frontera, Spain
| | - Pedro Guijo González
- Department of Intensive Care Medicine, St. George's Healthcare NHS Trust and St George's University of London, London, United Kingdom
| | - Paula Saludes Orduña
- Department of Intensive Care Medicine, St. George's Healthcare NHS Trust and St George's University of London, London, United Kingdom
| | - Manuel Gracia Romero
- Department of Intensive Care Medicine, St. George's Healthcare NHS Trust and St George's University of London, London, United Kingdom
| | - Anselmo Gil Cano
- Department of Intensive Care Medicine, St. George's Healthcare NHS Trust and St George's University of London, London, United Kingdom
| | - Antonio Messina
- Department of Intensive Care Medicine, St. George's Healthcare NHS Trust and St George's University of London, London, United Kingdom
| | - Andrew Rhodes
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Italy
| | - Maurizio Cecconi
- Department of Intensive Care Medicine, St. George's Healthcare NHS Trust and St George's University of London, London, United Kingdom.,Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Italy
| |
Collapse
|
20
|
Lafon T, Feydeau P, Baisse A, Bigrat V, Raynaud C, Pihan M, Goudelin M, Evrard B, Vallejo C, Karam HH, Vignon P. Évaluation hémodynamique précoce par échocardiographie ciblée des patients en sepsis ou choc septique (Sepsis-3) au service d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : L’identification du profil hémodynamique des patients septiques au service d’urgence (SU) pourrait permettre d’adapter individuellement les recommandations de la Surviving Sepsis Campaign (SSC). L’objectif de cette étude était de décrire le profil hémodynamique précoce par échocardiographie ciblée chez les patients en sepsis et leur impact thérapeutique.
Méthode : Étude prospective monocentrique incluant les patients septiques (score qSOFA [quick Sepsis-related Organ Failure Assessment] ≥ 2) sur une période de 30 mois. L’échocardiographie était réalisée par des médecins urgentistes de niveau échographie clinique en médecine d’urgence 1 afin de déterminer le profil hémodynamique (hypovolémie, vasoplégie avec hyperkinésie, insuffisance ventriculaire ou profil « normal ») dès le sepsis identifié au SU. L’impact thérapeutique était défini par le nombre de patients pour lesquels l’échocardiographie modifiait le traitement de la SSC.
Résultats : Quatre-vingt-un patients (44 sepsis, 37 chocs septiques) ont été étudiés (âge moyen : 70 ± 15 ans ; hommes [n = 47, 58 %] ; SOFA = 5,3 ± 2,9 ; lactates = 4,6 ± 4,2 mmol/l ; admission en réanimation [n = 30, 37 %] ; mortalité j28 [n = 28, 35 %]) après un remplissage vasculaire médian de 500 ml (écart interquartile : 250–1 500 ml). Les profils hémodynamiques dominants étaient l’hypovolémie (n = 54, 66 %), parfois associée à une vasoplégie (n = 26, 32 %) et l’insuffisance ventriculaire (n = 21, 26 %). L’impact thérapeutique concernait 21 patients (26 %), dont un arrêt précoce du remplissage vasculaire après un volume de 850 ± 740 ml chez huit patients.
Conclusion : La dysfonction ventriculaire précoce est présente chez plus de 20 % des patients septiques. L’impact pronostique d’une évaluation échocardiographique dès l’identification du sepsis au SU reste à déterminer.
Collapse
|
21
|
Vignon P. Continuous cardiac output assessment or serial echocardiography during septic shock resuscitation? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:797. [PMID: 32647722 PMCID: PMC7333154 DOI: 10.21037/atm.2020.04.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Septic shock is the leading cause of cardiovascular failure in the intensive care unit (ICU). Cardiac output is a primary component of global oxygen delivery to organs and a sensitive parameter of cardiovascular failure. Any mismatch between oxygen delivery and rapidly varying metabolic demand may result in tissue dysoxia, hence organ dysfunction. Since the intricate alterations of both vascular and cardiac function may rapidly and widely change over time, cardiac output should be measured repeatedly to characterize the type of shock, select the appropriate therapeutic intervention, and evaluate patient's response to therapy. Among the numerous techniques commercially available for measuring cardiac output, transpulmonary thermodilution (TPT) provides a continuous monitoring with external calibration capability, whereas critical care echocardiography (CCE) offers serial hemodynamic assessments. CCE allows early identification of potential sources of inaccuracy of TPT, including right ventricular failure, severe tricuspid or left-sided regurgitations, intracardiac shunt, very low flow states, or dynamic left ventricular outflow tract obstruction. In addition, CCE has the unique advantage of depicting the distinct components generating left ventricular stroke volume (large cavity size vs. preserved contractility), providing information on left ventricular diastolic properties and filling pressures, and assessing pulmonary artery pressure. Since inotropes may have deleterious effects if misused, their initiation should be based on the documentation of a cardiac dysfunction at the origin of the low flow state by CCE. Experts widely advocate using CCE as a first-line modality to initially evaluate the hemodynamic profile associated with shock, as opposed to more invasive techniques. Repeated assessments of both the efficacy (amplitude of the positive response) and tolerance (absence of side-effect) of therapeutic interventions are required to best guide patient management. Overall, TPT allowing continuous tracking of cardiac output variations and CCE appear complementary rather than mutually exclusive in patients with septic shock who require advanced hemodynamic monitoring.
Collapse
Affiliation(s)
- Philippe Vignon
- Medical-Surgical Intensive Care Unit, Dupuytren Teaching hospital, Limoges, France.,Inserm CIC 1435, Dupuytren Teaching hospital, Limoges, France.,Faculty of Medicine, University of Limoges, Limoges, France
| |
Collapse
|
22
|
Abstract
In the late 19th century, Otto Frank published the first description of a ventricular pressure-volume diagram, thus laid the foundation for modern cardiovascular physiology. Since then, the analysis of the pressure-volume loops became a reference tool for the study of the ventricular pump properties. However, understanding cardiovascular performance requires both the evaluation of ventricular properties and the modulating effects of the arterial system, since the heart and the arterial tree are anatomically and functionally related structures. The study of the coupling between the cardiac function and the properties of the arterial system, or ventriculo-arterial (VA) coupling, provides then a comprehensive characterization of the performance of the cardiovascular system in both health and disease. The assessment of cardiovascular function is an essential element of the hemodynamic evaluation of critically ill patients. Both left and right ventricular dysfunction and arterial system disturbances are frequent in these patients. Since VA coupling ultimately defines de performance and efficiency of the cardiovascular system, the analysis of the interaction between the heart and the arterial system could offer a broader perspective of the hemodynamic disorders associated with common conditions, such as septic shock, heart failure, or right ventricular dysfunction. Moreover, this analysis could also provide valuable information about their pathophysiological mechanisms and may help to determine the best therapeutic strategy to correct them. In this review, we will describe the basic principles of the VA coupling assessment, its limitations, and the most common methods for its estimation at the bedside. Then, we will summarize the current knowledge of the application of VA coupling in critically ill patients and suggest some recommendations for further research.
Collapse
Affiliation(s)
| | - Arnoldo Santos
- Centro de Investigación Biomédica en Red (CIBER). Madrid, España.,ITC Ingeniería y Técnicas Clínicas SA, Madrid, España
| |
Collapse
|
23
|
Monge García MI, Del Rio Lechuga A, Fletcher N, Gil Cano A. Increased atrial contraction contribution to left ventricular filling during early septic shock. J Crit Care 2019; 54:220-227. [PMID: 31630070 DOI: 10.1016/j.jcrc.2019.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/07/2019] [Accepted: 09/10/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the atrial systolic function and the contribution of atrial contraction to left ventricular (LV) filling in septic shock patients as compared with healthy volunteers. METHODS Twenty-seven septic patients evaluated during first 48 h of ICU admission and compared with 27 healthy volunteers. Left atrial (LA) contraction contribution to LV filling was calculated as the active emptying atrial volume/LV end-diastolic volume. Atrial systolic function was evaluated with the atrial kinetic force [LAKE = 0.5 × blood density × LVVactive × (peak A velocity)2] and atrial ejection force [LASF = 0.5 × blood density × mitral annulus area × (peak A velocity)2]. RESULTS LV ejection fraction was lower in septic patients than in control group: 51 ± 14%vs 60 ± 6% (p < 0.01). Contribution of LA contraction to LV preload was greater in septic patients than in normal subjects (26.7 ± 11.3% vs 15.9 ± 5.9%, p < 0.001), even if adjusted for age (0.49 ± 0.19 vs 0.35 ± 0.13, p = 0.004). LAKE and LASF were also significantly larger in septic patients than in normal subjects (21.8 ± 9.1 vs 7.3 ± 3 kdynes·cm, p < 0.001; 16.1 ± 11.7 vs 9.8 ± 4.3 kdynes, p = 0.048, respectively), and remained unchanged during the next 48 h. CONCLUSION In septic shock patients, LA systolic function increased and greatly contributed to support LV filling. These results highlight the role of preserving atrial contraction on the hemodynamic resuscitation in early septic shock.
Collapse
Affiliation(s)
- Manuel Ignacio Monge García
- Unidad de Cuidados Intensivos, Hospital Universitario SAS de Jerez, C/ Circunvalación s/n, 11408 Jerez de la Frontera, Spain.
| | - Ana Del Rio Lechuga
- Unidad de Gestión Clínica de Cardiología, Hospital Universitario SAS de Jerez, C/ Circunvalación s/n, 11408 Jerez de la Frontera, Spain.
| | - Nick Fletcher
- Department of Anesthesia and Critical Care, St Georges University Hospitals NHS Trust, Blackshaw Road, SW17 0QT London, UK.
| | - Anselmo Gil Cano
- Unidad de Cuidados Intensivos, Hospital Universitario SAS de Jerez, C/ Circunvalación s/n, 11408 Jerez de la Frontera, Spain.
| |
Collapse
|
24
|
|
25
|
Huang SH, Xu M, Wu HM, Wan CX, Wang HB, Wu QQ, Liao HH, Deng W, Tang QZ. Isoquercitrin Attenuated Cardiac Dysfunction Via AMPKα-Dependent Pathways in LPS-Treated Mice. Mol Nutr Food Res 2018; 62:e1800955. [PMID: 30359483 DOI: 10.1002/mnfr.201800955] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/11/2018] [Indexed: 12/11/2022]
Abstract
SCOPE Isoquercitrin (IQC) has been reported to play a protective role in many pathological conditions. Here, the effects of IQC on lipopolysaccharide (LPS)-induced cardiac dysfunction are investigated, exploring its potential molecular mechanisms. METHODS AND RESULTS C57BL/6 mice or H9c2 cardiomyoblasts are subjected to LPS challenge for 12 h. Pretreatment with IQC attenuates LPS-induced cardiac dysfunction. IQC remarkably reduces LPS-mediated inflammatory responses by inhibiting the mRNA levels of TNF-α, IL6, and MCP1 as well as the protein levels of p-IKKβ, p-IκBα, and p-p65 in vivo and in vitro. Interestingly, IQC administration also improves energy deficiencies caused by LPS, manifesting as significant increases in cardiac and cellular ATP levels. Furthermore, ATP levels increase due to the upregulation of PGC1β and PPAR-α, which enhances fatty acid oxidation in vivo and in vitro. However, the protective roles of IQC against LPS-mediated increased inflammatory responses and decreased acid fatty oxidation are partially blunted by inhibiting AMPKα in vitro, and suppressing AMPKα partially blocks the increased cardiac function elicited by IQC in LPS-treated mice. CONCLUSION IQC attenuates LPS-induced cardiac dysfunction by inhibiting inflammatory responses and by enhancing fatty acid oxidation, partially by activating AMPKα. IQC might be a potential drug for sepsis-induced cardiac dysfunction.
Collapse
Affiliation(s)
- Si-Hui Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Man Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Hai-Ming Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Chun-Xia Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Hui-Bo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Qing-Qing Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Hai-Han Liao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Wei Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| | - Qi-Zhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, P.R. China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, P.R. China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, P.R. China
| |
Collapse
|
26
|
Sanfilippo F, Scolletta S, Morelli A, Vieillard-Baron A. Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care. Ann Intensive Care 2018; 8:100. [PMID: 30374644 PMCID: PMC6206316 DOI: 10.1186/s13613-018-0447-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/20/2018] [Indexed: 12/26/2022] Open
Abstract
There is growing evidence both in the perioperative period and in the field of intensive care (ICU) on the association between left ventricular diastolic dysfunction (LVDD) and worse outcomes in patients. The recent American Society of Echocardiography and European Association of Cardiovascular Imaging joint recommendations have tried to simplify the diagnosis and the grading of LVDD. However, both an often unknown pre-morbid LV diastolic function and the presence of several confounders-i.e., use of vasopressors, positive pressure ventilation, volume loading-make the proposed parameters difficult to interpret, especially in the ICU. Among the proposed parameters for diagnosis and grading of LVDD, the two tissue Doppler imaging-derived variables e' and E/e' seem most reliable. However, these are not devoid of limitations. In the present review, we aim at rationalizing the applicability of the recent recommendations to the perioperative and ICU areas, discussing the clinical meaning and echocardiographic findings of different grades of LVDD, describing the impact of LVDD on patients' outcomes and providing some hints on the management of patients with LVDD.
Collapse
Affiliation(s)
- F. Sanfilippo
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - S. Scolletta
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - A. Morelli
- Department of Anaesthesiology and Intensive Care, University of Rome, “La Sapienza”, Rome, Italy
| | - A. Vieillard-Baron
- Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| |
Collapse
|
27
|
Alruwaili F, Cluff K, Griffith J, Farhoud H. Passive Self Resonant Skin Patch Sensor to Monitor Cardiac Intraventricular Stroke Volume Using Electromagnetic Properties of Blood. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:1900709. [PMID: 30416893 PMCID: PMC6214405 DOI: 10.1109/jtehm.2018.2870589] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/29/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022]
Abstract
This paper focuses on the development of a passive, lightweight skin patch sensor that can measure fluid volume changes in the heart in a non-invasive, point-of-care setting. The wearable sensor is an electromagnetic, self-resonant sensor configured into a specific pattern to formulate its three passive elements (resistance, capacitance, and inductance). In an animal model, a bladder was inserted into the left ventricle (LV) of a bovine heart, and fluid was injected using a syringe to simulate stoke volume (SV). In a human study, to assess the dynamic fluid volume changes of the heart in real time, the sensor frequency response was obtained from a participant in a 30° head-up tilt (HUT), 10° HUT, supine, and 10° head-down tilt positions over time. In the animal model, an 80-mL fluid volume change in the LV resulted in a downward frequency shift of 80.16 kHz. In the human study, there was a patterned frequency shift over time which correlated with ventricular volume changes in the heart during the cardiac cycle. Statistical analysis showed a linear correlation \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${R} ^{2} = 0.98$
\end{document} and 0.87 between the frequency shifts and fluid volume changes in the LV of the bovine heart and human participant, respectively. In addition, the patch sensor detected heart rate in a continuous manner with a 0.179% relative error compared to electrocardiography. These results provide promising data regarding the ability of the patch sensor to be a potential technology for SV monitoring in a non-invasive, continuous, and non-clinical setting.
Collapse
Affiliation(s)
- Fayez Alruwaili
- Biomedical Engineering DepartmentWichita State UniversityWichitaKS67260USA
| | - Kim Cluff
- Biomedical Engineering DepartmentWichita State UniversityWichitaKS67260USA
| | - Jacob Griffith
- Biomedical Engineering DepartmentWichita State UniversityWichitaKS67260USA
| | | |
Collapse
|
28
|
Krichevskiy LA, Kozlov IA. Natriuretic Peptides in Cardiac Anesthesia and Intensive Care. J Cardiothorac Vasc Anesth 2018; 33:1407-1419. [PMID: 30228053 DOI: 10.1053/j.jvca.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 01/16/2023]
Abstract
Natriuretic peptides, predominantly B-type, are widely used in cardiology as prognostic and diagnostic biomarkers or, much less often, as a substantive treatment tool. They are hormones that are produced mainly in the myocardium in response to overload and ischemia, and their level quite accurately reflects the degree of myocardial dysfunction. Although their use in cardiac anesthesia and intensive care setting seems to be very beneficial for assessing the risk of acute disturbance of myocardial function or its laboratory monitoring, the actual significance of natriuretic peptides in this area is not yet recognized. This is due to the lack of clear diagnostic and prognostic values for these biomarkers supported by high-quality researches. On the basis of the available data, main advantages, existing difficulties, and most effective ways of using natriuretic peptides for determining the risk of heart surgery and assessing the severity of sepsis, pneumonia, and other critical conditions have been discussed in this review. In addition, the expediency of using natriuretic peptides as target parameters for goal-oriented therapy and as a substantive tool for treatment is considered.
Collapse
Affiliation(s)
- Lev A Krichevskiy
- Department of Anesthesiology and Intensive Care, City Clinical Hospital n.a. S.S.Yudin, Department of Health of Moscow, Moscow, Russia.
| | - Igor A Kozlov
- Department of Anaesthesiology, Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy, Moscow, Russia
| |
Collapse
|
29
|
Zhang H, Wang X, Chen X, Zhang Q, Liu D. Tricuspid annular plane systolic excursion and central venous pressure in mechanically ventilated critically ill patients. Cardiovasc Ultrasound 2018; 16:11. [PMID: 30081914 PMCID: PMC6091201 DOI: 10.1186/s12947-018-0130-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background The tricuspid annular plane systolic excursion (TAPSE) is commonly recommended for estimating the right ventricular systolic function. The central venous pressure (CVP), which is determined by venous return and right heart function, was found to be associated with right ventricular outflow fractional shortening. This study thus aimed to investigate the relationship between the TAPSE and CVP in mechanically ventilated critically ill patients. Methods This is a prospective observational study. From October 1 to December 31, 2017, patients admitted to the intensive care unit with CVP monitoring and controlled mechanical ventilation were screened for enrolment. Echocardiographic parameters, including the TAPSE, mitral annular plane systolic excursion (MAPSE), left ventricular ejection fraction (LVEF), and internal diameter of inferior vena cava (dIVC), and haemodynamic parameters, including the CVP, were collected. Results Seventy-four patients were included. Thirty-one were included in the low LVEF (< 55%) group, and 43 were included in the high LVEF (≥55%) group. In the high LVEF group, the TAPSE and CVP were not correlated (r = − 0.234, P = 0.151). In the low LVEF group, partial correlation analysis indicated that the TAPSE and CVP were correlated (r = − 0.516, P = 0.006), and multivariable linear regression analysis indicated that the TAPSE was independently associated with the CVP (standard coefficient: − 0.601, p < 0.001). Additionally, in the low LVEF group, a ROC analysis showed that the area under the curve of the TAPSE for the detection of CVP greater than 8 mmHg was 0.860 (95% confidence interval: 0.730–0.991; P = 0.001). The optimum cut-off value was 1.52 cm, which resulted in a sensitivity of 75.0%, a specificity of 86.7%, a positive predictive value of 84.6% and a negative predictive value of 77.8%. Conclusions The TAPSE is inversely correlated with the CVP in mechanically ventilated critically ill patients who have a LVEF less than 55%.
Collapse
Affiliation(s)
- Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Xiukai Chen
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburg, PA, 15261, USA
| | - Qing Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
| |
Collapse
|
30
|
Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet 2018; 392:75-87. [PMID: 29937192 DOI: 10.1016/s0140-6736(18)30696-2] [Citation(s) in RCA: 1144] [Impact Index Per Article: 190.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 12/11/2022]
Abstract
Sepsis is a common condition that is associated with unacceptably high mortality and, for many of those who survive, long-term morbidity. Increased awareness of the condition resulting from ongoing campaigns and the evidence arising from research in the past 10 years have increased understanding of this problem among clinicians and lay people, and have led to improved outcomes. The World Health Assembly and WHO made sepsis a global health priority in 2017 and have adopted a resolution to improve the prevention, diagnosis, and management of sepsis. In 2016, a new definition of sepsis (Sepsis-3) was developed. Sepsis is now defined as infection with organ dysfunction. This definition codifies organ dysfunction using the Sequential Organ Failure Assessment score. Ongoing research aims to improve definition of patient populations to allow for individualised management strategies matched to a patient's molecular and biochemical profile. The search continues for improved diagnostic techniques that can facilitate this aim, and for a pharmacological agent that can improve outcomes by modifying the disease process. While waiting for this goal to be achieved, improved basic care driven by education and quality-improvement programmes offers the best hope of increasing favourable outcomes.
Collapse
Affiliation(s)
- Maurizio Cecconi
- Department of Anaesthesia and Intensive Care, IRCCS Istituto Clinico Humanitas, Humanitas University, Milan, Italy.
| | - Laura Evans
- NYU School of Medicine, Bellevue Hospital Center, New York, NY, USA
| | - Mitchell Levy
- Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew Rhodes
- Department of Intensive Care Medicine, St George's University Hospitals Foundation Trust, London, UK
| |
Collapse
|
31
|
Riera J, Romay E, Ferrer R. Management of myocardial dysfunction in septic shock. Potential role of extracorporeal membrane oxygenation. Med Intensiva 2017; 42:301-305. [PMID: 29179994 DOI: 10.1016/j.medin.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/08/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022]
Affiliation(s)
- J Riera
- Intensive Care Department, Vall d'Hebron University Hospital, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute, CIBER Enfermedades Respiratorias, Spain
| | - E Romay
- Intensive Care Department, Vall d'Hebron University Hospital, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute, CIBER Enfermedades Respiratorias, Spain
| | - R Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute, CIBER Enfermedades Respiratorias, Spain.
| |
Collapse
|
32
|
Impact of Simulator-Based Training in Focused Transesophageal Echocardiography: A Randomized Controlled Trial. Anesth Analg 2017; 125:1140-1148. [PMID: 28817424 DOI: 10.1213/ane.0000000000002351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of the study was to determine if training in transesophageal echocardiography (TEE) using a TEE simulator improves the ability of novice operators to perform and interpret a focused critical care TEE. METHODS In this prospective, randomized, controlled study with blinded outcome assessment, 44 intensive care unit trainees were randomly assigned to a control group receiving 4 hours of lecture-based training only, or an intervention group which was additionally trained for 4 hours using a TEE simulator. After the training intervention, each participant performed 2 TEEs in intensive care unit patients which were evaluated by blinded assessors. The imaging quality of TEEs was measured using a predefined examination quality score ranging from 0 to 100 points. The correct quantification of pathologies and the interpretation of the TEEs were evaluated by blinded assessors using focused and comprehensive expert TEEs as comparators. RESULTS A total of 114 TEEs were assessed. The mean examination quality score was 55.9 (95% confidence interval [CI], 50.3-61.5) for TEEs of the control group, 75.6 (95% CI, 70.1-81.0) for TEEs of the intervention group, and 88.5 (95% CI, 79.3-97.7) for TEEs in the expert group. The multiple comparisons revealed significant differences between all groups (19.7 [95% CI, 12.8-26.6], P < .001 for intervention versus control; 32.6 [95% CI, 23.0-42.3], P < .001 for expert versus control; 12.9 [95% CI, 3.4-22.5], P = .008 for expert versus intervention). Substantial agreement of the quantification and interpretation ratings of basic TEEs by the intervention (86.7% for quantification and 97.1% for interpretation) or expert group (93.2% for quantification and 98.4% for interpretation) with blinded assessors was detected. The control groups TEEs agreed less (75.6% for quantification and 91.8% for interpretation). CONCLUSIONS Simulation-based TEE training improves the ability of novice operators to perform a focused critical care TEE in comparison to lecture-based education only. After 8 hours of simulator and lecture-based training, the majority of TEEs of novices are of sufficient quality for clinical use. Furthermore, a substantial skill level in correct quantification and interpretation of imaging is achieved.
Collapse
|
33
|
Sanfilippo F, Corredor C, Arcadipane A, Landesberg G, Vieillard-Baron A, Cecconi M, Fletcher N. Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis. Br J Anaesth 2017; 119:583-594. [DOI: 10.1093/bja/aex254] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
|
34
|
Clementi A, Virzì GM, Brocca A, Ronco C. The Role of Endotoxin in the Setting of Cardiorenal Syndrome Type 5. Cardiorenal Med 2017; 7:276-283. [PMID: 29118766 PMCID: PMC5662967 DOI: 10.1159/000475846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lipopolysaccharide or endotoxin, the major cell wall component of gram-negative bacteria, plays a pivotal role in the pathogenesis of sepsis. It is able to activate the host defense system through the interaction with Toll-like receptor 4, thus triggering pro-inflammatory mechanisms. When the production of inflammatory mediators becomes uncontrolled and excessive, septic shock develops with multiple organ dysfunction, such as myocardial and renal impairment, which are hallmarks of cardiorenal syndrome type 5. In this review, we will analyze the role of endotoxin in the pathogenesis of sepsis, its effects on cardiac and renal interactions in the setting of cardiorenal syndrome type 5 and the possible use of extracorporeal therapies in this clinical condition.
Collapse
Affiliation(s)
- Anna Clementi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology and Dialysis, San Giovanni Di Dio Hospital, Agrigento, Italy
| | - Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
- Department of Medicine DIMED, University of Padova Medical School, Padova, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
35
|
Lansink MO, Patyk V, de Groot H, Effenberger-Neidnicht K. Melatonin reduces changes to small intestinal microvasculature during systemic inflammation. J Surg Res 2017; 211:114-125. [DOI: 10.1016/j.jss.2016.11.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 10/26/2016] [Accepted: 11/30/2016] [Indexed: 12/15/2022]
|
36
|
Affiliation(s)
- Alain Combes
- Medical–Surgical Intensive Care Unit, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, F-75013 Paris, France
- Sorbonne Pierre-Marie Curie University Paris, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| |
Collapse
|
37
|
Virzì GM, Clementi A, Brocca A, Ronco C. Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes. Blood Purif 2017; 44:314-326. [PMID: 29161706 DOI: 10.1159/000480424] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/10/2017] [Indexed: 01/03/2023]
Abstract
Gram-negative sepsis is a major cause of morbidity and mortality in critical ill patients. Recent findings in molecular biology and in signaling pathways have enhanced our understanding of its pathogenesis and opened up opportunities of innovative therapeutic approaches. Endotoxin plays a pivotal role in the pathogenesis of multi-organ dysfunction in the setting of gram-negative sepsis. Indeed, heart and kidney impairments seem to be induced by the release of circulating pro-inflammatory and pro-apoptotic mediators triggered by endotoxin interaction with immune cells. These molecules are responsible for cellular apoptosis, autophagy, cell cycle arrest, and microRNAs activation. Therefore, the early identification of sepsis-associated acute kidney injury and heart dysfunction may improve the patient clinical outcome. In this report, we will consider the role of endotoxin in the pathogenesis of sepsis, its effects on both cardiac and renal functions, and the interactions between these 2 systems in the setting of cardiorenal syndromes (CRS), particularly in CRS type 5. Finally, we will discuss the possible role of extracorporeal therapies in reducing endotoxin levels.
Collapse
Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Agrigento, Italy
| | | | | | | |
Collapse
|
38
|
Standage SW, Bennion BG, Knowles TO, Ledee DR, Portman MA, McGuire JK, Liles WC, Olson AK. PPARα augments heart function and cardiac fatty acid oxidation in early experimental polymicrobial sepsis. Am J Physiol Heart Circ Physiol 2016; 312:H239-H249. [PMID: 27881386 DOI: 10.1152/ajpheart.00457.2016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/20/2016] [Accepted: 11/11/2016] [Indexed: 12/23/2022]
Abstract
Children with sepsis and multisystem organ failure have downregulated leukocyte gene expression of peroxisome proliferator-activated receptor-α (PPARα), a nuclear hormone receptor transcription factor that regulates inflammation and lipid metabolism. Mouse models of sepsis have likewise demonstrated that the absence of PPARα is associated with decreased survival and organ injury, specifically of the heart. Using a clinically relevant mouse model of early sepsis, we found that heart function increases in wild-type (WT) mice over the first 24 h of sepsis, but that mice lacking PPARα (Ppara-/-) cannot sustain the elevated heart function necessary to compensate for sepsis pathophysiology. Left ventricular shortening fraction, measured 24 h after initiation of sepsis by echocardiography, was higher in WT mice than in Ppara-/- mice. Ex vivo working heart studies demonstrated greater developed pressure, contractility, and aortic outflow in WT compared with Ppara-/- mice. Furthermore, cardiac fatty acid oxidation was increased in WT but not in Ppara-/- mice. Regulatory pathways controlling pyruvate incorporation into the citric acid cycle were inhibited by sepsis in both genotypes, but the regulatory state of enzymes controlling fatty acid oxidation appeared to be permissive in WT mice only. Mitochondrial ultrastructure was not altered in either genotype indicating that severe mitochondrial dysfunction is unlikely at this stage of sepsis. These data suggest that PPARα expression supports the hyperdynamic cardiac response early in the course of sepsis and that increased fatty acid oxidation may prevent morbidity and mortality. NEW & NOTEWORTHY In contrast to previous studies in septic shock using experimental mouse models, we are the first to demonstrate that heart function increases early in sepsis with an associated augmentation of cardiac fatty acid oxidation. Absence of peroxisome proliferator-activated receptor-α (PPARα) results in reduced cardiac performance and fatty acid oxidation in sepsis.
Collapse
Affiliation(s)
- Stephen W Standage
- Center for Lung Biology, University of Washington School of Medicine, Seattle, Washington; .,Department of Pediatrics (Critical Care Medicine), University of Washington School of Medicine, Seattle, Washington
| | - Brock G Bennion
- Center for Lung Biology, University of Washington School of Medicine, Seattle, Washington.,Department of Pediatrics (Critical Care Medicine), University of Washington School of Medicine, Seattle, Washington
| | - Taft O Knowles
- Center for Lung Biology, University of Washington School of Medicine, Seattle, Washington.,Department of Pediatrics (Critical Care Medicine), University of Washington School of Medicine, Seattle, Washington
| | - Dolena R Ledee
- Department of Pediatrics (Cardiology), University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - Michael A Portman
- Department of Pediatrics (Cardiology), University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - John K McGuire
- Center for Lung Biology, University of Washington School of Medicine, Seattle, Washington.,Department of Pediatrics (Critical Care Medicine), University of Washington School of Medicine, Seattle, Washington
| | - W Conrad Liles
- Center for Lung Biology, University of Washington School of Medicine, Seattle, Washington.,Department of Medicine, University of Washington School of Medicine, Seattle, Washington; and
| | - Aaron K Olson
- Department of Pediatrics (Cardiology), University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Circulatory failure is a frequent complication during acute respiratory distress syndrome (ARDS) and is associated with a poor outcome. This review aims at clarifying the mechanisms of circulatory failure during ARDS. RECENT FINDINGS For the past decades, the right ventricle (RV) has gained a crucial interest since many authors confirmed the high incidence of acute cor pulmonale during ARDS and showed a potential role of the acute cor pulmonale in the poor outcome of ARDS patients. The most important recent progress demonstrated in ARDS ventilatory strategy is represented by the prone position, which has a huge beneficial effect on RV afterload. This review will focus on the mechanisms responsible for the RV dysfunction/failure during ARDS and on the strategy, which allows improving the right ventricular function. SUMMARY The RV has a pivotal role in the circulatory failure of ARDS patients. The ventilatory strategy during ARDS has to pay a peculiar attention to the RV to rigorously control its afterload.
Collapse
|
40
|
Bloch A, Berger D, Takala J. Understanding circulatory failure in sepsis. Intensive Care Med 2016; 42:2077-2079. [PMID: 27620288 DOI: 10.1007/s00134-016-4514-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Bloch
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - David Berger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Jukka Takala
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| |
Collapse
|
41
|
Beta-blockers in septic shock to optimize hemodynamics? No. Intensive Care Med 2016; 42:1610-1612. [DOI: 10.1007/s00134-016-4407-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023]
|
42
|
Nußbaum BL, McCook O, Hartmann C, Matallo J, Wepler M, Antonucci E, Kalbitz M, Huber-Lang M, Georgieff M, Calzia E, Radermacher P, Hafner S. Left ventricular function during porcine-resuscitated septic shock with pre-existing atherosclerosis. Intensive Care Med Exp 2016; 4:14. [PMID: 27271248 PMCID: PMC4894859 DOI: 10.1186/s40635-016-0089-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/31/2016] [Indexed: 02/07/2023] Open
Abstract
Background Reversible, depressed cardiac function is frequently encountered during septic shock and commonly called septic cardiomyopathy. Previous studies demonstrated reduced ejection fraction and left ventricular dilatation in both humans and animal models. However, the majority of the studies in humans excluded pre-existing cardiac disease and animal studies were performed on healthy specimen and/or without vasopressor support during sepsis. In order to more closely mimic the actual patients’ conditions on intensive care units and to assess the influence of both cardiac comorbidity and vasopressor support on septic cardiomyopathy, we evaluated the left ventricular function in a porcine model of resuscitated septic shock with pre-existing atherosclerosis. Methods Hypercholesterolaemic, atherosclerotic pigs due to homozygous low-density lipoprotein receptor mutation and high-fat diet were anaesthetised and surgically instrumented. Faecal peritonitis was induced by inoculation of autologous faeces into the peritoneal cavity in n = 8 animals; n = 5 pigs underwent sham procedure. Sepsis resuscitation included administration of fluids and noradrenaline. Left ventricular function was analysed via pressure-conductance catheters before, 12 and 24 h after the induction of sepsis. Results The main findings were impaired ventricular dilatation (no significant change in the left ventricular end-diastolic volume) and unchanged ejection fraction in septic pigs with pre-existing atherosclerosis. The relaxation time constant τ decreased while dp/dtmax increased. Cardiac nitrotyrosine formation increased while expression of the endogenous hydrogen sulphide (H2S)-producing enzyme cystathionine γ-lyase (CSE) decreased. Conclusions The data of the present study are in conflict with previously published data from healthy animal models, most likely as a result of ongoing resuscitation including noradrenaline treatment or intrinsic pathophysiologic processes of the pre-existing atherosclerosis. Moreover, increased nitrotyrosine formation and decreased expression of CSE suggest the implication of augmented oxidative/nitrosative stress and/or reduced bioavailability of nitric oxide as well as diminished endogenous H2S release in the pathophysiology of septic cardiomyopathy. Electronic supplementary material The online version of this article (doi:10.1186/s40635-016-0089-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Benedikt L Nußbaum
- Klinik für Anästhesiologie, Universitätsklinik Ulm, Ulm, Germany. .,Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany.
| | - Oscar McCook
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - Clair Hartmann
- Klinik für Anästhesiologie, Universitätsklinik Ulm, Ulm, Germany.,Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - José Matallo
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - Martin Wepler
- Klinik für Anästhesiologie, Universitätsklinik Ulm, Ulm, Germany.,Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - Elena Antonucci
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genova, Genova, Italy
| | - Miriam Kalbitz
- Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Germany
| | - Markus Huber-Lang
- Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Germany
| | | | - Enrico Calzia
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - Sebastian Hafner
- Klinik für Anästhesiologie, Universitätsklinik Ulm, Ulm, Germany.,Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik Ulm, Helmholtzstraße 8/1, 89081, Ulm, Germany
| |
Collapse
|
43
|
|
44
|
Funcke S, Sander M, Goepfert MS, Groesdonk H, Heringlake M, Hirsch J, Kluge S, Krenn C, Maggiorini M, Meybohm P, Salzwedel C, Saugel B, Wagenpfeil G, Wagenpfeil S, Reuter DA. Practice of hemodynamic monitoring and management in German, Austrian, and Swiss intensive care units: the multicenter cross-sectional ICU-CardioMan Study. Ann Intensive Care 2016; 6:49. [PMID: 27246463 PMCID: PMC4887453 DOI: 10.1186/s13613-016-0148-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/26/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hemodynamic instability is frequent and outcome-relevant in critical illness. The understanding of complex hemodynamic disturbances and their monitoring and management plays an important role in treatment of intensive care patients. An increasing number of treatment recommendations and guidelines in intensive care medicine emphasize hemodynamic goals, which go beyond the measurement of blood pressures. Yet, it is not known to which extent the infrastructural prerequisites for extended hemodynamic monitoring are given in intensive care units (ICUs) and how hemodynamic management is performed in clinical practice. Further, it is still unclear which factors trigger the use of extended hemodynamic monitoring. METHODS In this multicenter, 1-day (November 7, 2013, and the preceding 24 h) cross-sectional study, we retrieved data on patient monitoring from ICUs in Germany, Austria, and Switzerland by means of a web-based case report form. One hundred and sixty-one intensive care units contributed detailed information on availability of hemodynamic monitoring. In addition, detailed information on hemodynamic monitoring of 1789 patients that were treated on due date was collected, and independent factors triggering the use of extended hemodynamic monitoring were identified by multivariate analysis. RESULTS Besides basic monitoring with electrocardiography (ECG), pulse oximetry, and blood pressure monitoring, the majority of patients received invasive arterial (77.9 %) and central venous catheterization (55.2 %). All over, additional extended hemodynamic monitoring for assessment of cardiac output was only performed in 12.3 % of patients, while echocardiographic examination was used in only 1.9 %. The strongest independent predictors for the use of extended hemodynamic monitoring of any kind were mechanical ventilation, the need for catecholamine therapy, and treatment backed by protocols. In 71.6 % of patients in whom extended hemodynamic monitoring was added during the study period, this extension led to changes in treatment. CONCLUSIONS Extended hemodynamic monitoring, which goes beyond the measurement of blood pressures, to date plays a minor role in the surveillance of critically ill patients in German, Austrian, and Swiss ICUs. This includes also consensus-based recommended diagnostic and monitoring applications, such as echocardiography and cardiac output monitoring. Mechanical ventilation, the use of catecholamines, and treatment backed by protocol could be identified as factors independently associated with higher use of extended hemodynamic monitoring.
Collapse
Affiliation(s)
- Sandra Funcke
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Michael Sander
- Department of Anaesthesiology and Intensive Care Medicine, UKGM University Hospital Gießen, Justus-Liebig-University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Matthias S Goepfert
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Heinrich Groesdonk
- Department of Anaesthesiology, Critical Care Medicine and Pain Medicine, University Hospital of Homburg/Saar, Kirrberger Strasse 100, 66421, Homburg, Germany
| | - Matthias Heringlake
- Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jan Hirsch
- Department of Anaesthesia, Intensive Care, Emergency and Pain Medicine, Hospital Mechernich, St.-Elisabeth-Strasse 2-6, 53894, Mechernich, Germany
| | - Stefan Kluge
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Claus Krenn
- Department of Anaesthesiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marco Maggiorini
- Department of Intensive Care Medicine, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Patrick Meybohm
- Department of Anaesthesiology and Intensive Care Medicine, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Cornelie Salzwedel
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Bernd Saugel
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Gudrun Wagenpfeil
- Department of Clinical Medicine, Saarland University, Campus Homburg, Kirrberger Strasse 100, 66421, Homburg, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Kirrberger Strasse 100, 66421, Homburg, Germany
| | - Daniel A Reuter
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | |
Collapse
|
45
|
Begot E, Vignon P. Dysfonction cardiaque au cours du sepsis : mythe ou réalité ? MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
46
|
Abstract
Echocardiography is a noninvasive and accurate tool used in the intensive care unit to assess cardiac function and monitor hemodynamics in shocked patients. During severe sepsis or septic shock, several mechanisms can lead to hemodynamic failure and have to be quickly and precisely diagnosed to propose adequate, personalized, and timely hemodynamic therapy. Echocardiography truly provides intensivists with this diagnostic possibility, whether or not there is fluid responsiveness, cardiac dysfunction, or persistent vasoplegia. Acquiring skills in critical care echocardiography is mandatory in improving management and monitoring of patients with sepsis at the bedside. How critical care echocardiography in managing patients with septic shock improves prognosis remains to be elucidated.
Collapse
Affiliation(s)
- Laurent Guérin
- Intensive Care Unit, Section Thorax-Vascular Diseases-Abdomen-Metabolism, Hôpital Ambroise Paré, AP-HP, University Hospital Ambroise Paré, 9 Avenue Charles de Gaulle, Boulogne Billancourt 92104, France; Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint Quentin en Yvelines, Versailles 78000, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Section Thorax-Vascular Diseases-Abdomen-Metabolism, Hôpital Ambroise Paré, AP-HP, University Hospital Ambroise Paré, 9 Avenue Charles de Gaulle, Boulogne Billancourt 92104, France; Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint Quentin en Yvelines, Versailles 78000, France; INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif 94807, France.
| |
Collapse
|
47
|
Paonessa JR, Brennan T, Pimentel M, Steinhaus D, Feng M, Celi LA. Hyperdynamic left ventricular ejection fraction in the intensive care unit. Crit Care 2015; 19:288. [PMID: 26250903 PMCID: PMC4528812 DOI: 10.1186/s13054-015-1012-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/12/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction Limited information exists on the etiology, prevalence, and significance of hyperdynamic left ventricular ejection fraction (HDLVEF) in the intensive care unit (ICU). Our aim in the present study was to compare characteristics and outcomes of patients with HDLVEF with those of patients with normal left ventricular ejection fraction in the ICU using a large, public, deidentified critical care database. Methods We conducted a longitudinal, single-center, retrospective cohort study of adult patients who underwent echocardiography during a medical or surgical ICU admission at the Beth Israel Deaconess Medical Center using the Multiparameter Intelligent Monitoring in Intensive Care II database. The final cohort had 2867 patients, of whom 324 had HDLVEF, defined as an ejection fraction >70 %. Patients with an ejection fraction <55 % were excluded. Results Compared with critically ill patients with normal left ventricular ejection fraction, the finding of HDLVEF in critically ill patients was associated with female sex, increased age, and the diagnoses of hypertension and cancer. Patients with HDLVEF had increased 28-day mortality compared with those with normal ejection fraction in multivariate logistic regression analysis adjusted for age, sex, Sequential Organ Failure Assessment score, Elixhauser score for comorbidities, vasopressor use, and mechanical ventilation use (odds ratio 1.38, 95 % confidence interval 1.039–1.842, p =0.02). Conclusions The presence of HDLVEF portended increased 28-day mortality, and may be helpful as a gravity marker for prognosis in patients admitted to the ICU. Further research is warranted to gain a better understanding of how these patients respond to common interventions in the ICU and to determine if pharmacologic modulation of HDLVEF improves outcomes.
Collapse
Affiliation(s)
- Joseph R Paonessa
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,, Present address: 1122 N. Clark Street, Apt. 3709, Chicago, IL, 60610, USA.
| | - Thomas Brennan
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA, 02139, USA.
| | - Marco Pimentel
- Institute of Biomedical Engineering, Oxford University, Headington, Oxford, OX3 7DQ, UK.
| | - Daniel Steinhaus
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Mengling Feng
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA, 02139, USA.
| | - Leo Anthony Celi
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA, 02139, USA.
| |
Collapse
|
48
|
Vignon P, Huang SJ. Global longitudinal strain in septic cardiomyopathy: the hidden part of the iceberg? Intensive Care Med 2015; 41:1851-3. [PMID: 26183488 DOI: 10.1007/s00134-015-3962-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Philippe Vignon
- Réanimation Polyvalente, CHU Limoges, 2 Avenue Martin Luther King, 87000, Limoges Cedex, France. .,INSERM, CIC1435, 87000, Limoges, France. .,Université Limoges, UMR1092, Limoges, France.
| | - Stephen J Huang
- Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Sydney, NSW, 2750, Australia
| |
Collapse
|
49
|
Timsit JF, Perner A, Bakker J, Bassetti M, Benoit D, Cecconi M, Curtis JR, Doig GS, Herridge M, Jaber S, Joannidis M, Papazian L, Peters MJ, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Citerio G, Azoulay E. Year in review in Intensive Care Medicine 2014: III. Severe infections, septic shock, healthcare-associated infections, highly resistant bacteria, invasive fungal infections, severe viral infections, Ebola virus disease and paediatrics. Intensive Care Med 2015; 41:575-88. [PMID: 25810214 PMCID: PMC4491096 DOI: 10.1007/s00134-015-3755-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Jean-François Timsit
- APHP-Hopital Bichat-Medical and Infectious Diseases ICU, UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Sanfilippo F, Corredor C, Fletcher N, Landesberg G, Benedetto U, Foex P, Cecconi M. Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis. Intensive Care Med 2015; 41:1004-13. [DOI: 10.1007/s00134-015-3748-7] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/09/2015] [Indexed: 12/23/2022]
|