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Yang J, Zou X, Wang R, Kang Y, Ou X, Wang B. MEAN ARTERIAL PRESSURE/NOREPINEPHRINE EQUIVALENT DOSE INDEX AS AN EARLY MEASURE FOR MORTALITY RISK IN PATIENTS WITH SHOCK ON VASOPRESSORS. Shock 2024; 61:253-259. [PMID: 38157472 DOI: 10.1097/shk.0000000000002298] [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: 01/03/2024]
Abstract
ABSTRACT Purpose: We aimed to investigate the association between the early mean arterial pressure (MAP)/norepinephrine equivalent dose (NEQ) index and mortality risk in patients with shock on vasopressors and further identify the breakpoint value of the MAP/NEQ index for high mortality risk. Methods: Based on the Medical Information Mart for Intensive Care IV database, we conducted a retrospective cohort study involving 19,539 eligible intensive care unit records assigned to three groups (first tertile, second tertile, and third tertile) by different MAP/NEQ indexes within 24 h of intensive care unit admission. The study outcomes were 7-, 14-, 21-, and 28-day mortality. A Cox model was used to examine the risk of mortality following different MAP/NEQ indexes. The receiving operating characteristic curve was used to evaluate the predictive ability of the MAP/NEQ index. The restricted cubic spline was applied to fit the flexible correlation between the MAP/NEQ index and risk of mortality, and segmented regression was further used to identify the breakpoint value of the MAP/NEQ index for high mortality risk. Results: Multivariate Cox analysis showed that a high MAP/NEQ index was independently associated with decreased mortality risks. The areas under the receiving operating characteristic curve of the MAP/NEQ index for different mortality outcomes were nearly 0.7. The MAP/NEQ index showed an L-shaped association with mortality outcomes or mortality risks. Exploration of the breakpoint value of the MAP/NEQ index suggested that a MAP/NEQ index less than 183 might be associated with a significantly increased mortality risk. Conclusions: An early low MAP/NEQ index was indicative of poor prognosis in patients with shock on vasopressors.
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Affiliation(s)
- Jie Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xia Zou
- Clinical Research Management Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaofeng Ou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Prager R, Bowdridge J, Pratte M, Cheng J, McInnes MDF, Arntfield R. Indications, Clinical Impact, and Complications of Critical Care Transesophageal Echocardiography: A Scoping Review. J Intensive Care Med 2023; 38:245-272. [PMID: 35854414 PMCID: PMC9806486 DOI: 10.1177/08850666221115348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Critical care transesophageal echocardiography (ccTEE) is an increasingly popular tool used by intensivists to characterize and manage hemodynamics at the bedside. Its usage appears to be driven by expanded diagnostic scope as well as the limitations of transthoracic echocardiography (TTE) - lack of acoustic windows, patient positioning, and competing clinical interests (eg, the need to perform chest compressions). The objectives of this scoping review were to determine the indications, clinical impact, and complications of ccTEE. METHODS MEDLINE, EMBASE, Cochrane, and six major conferences were searched without a time or language restriction on March 31st, 2021. Studies were included if they assessed TEE performed for adult critically ill patients by intensivists, emergency physicians, or anesthesiologists. Intraoperative or post-cardiac surgical TEE studies were excluded. Study demographics, indication for TEE, main results, and complications were extracted in duplicate. RESULTS Of the 4403 abstracts screened, 289 studies underwent full-text review, with 108 studies (6739 patients) included. Most studies were retrospective (66%), performed in academic centers (84%), in the intensive care unit (73%), and were observational (55%). The most common indications for ccTEE were hemodynamic instability, trauma, cardiac arrest, respiratory failure, and procedural guidance. Across multiple indications, ccTEE was reported to change the diagnosis in 52% to 78% of patients and change management in 32% to79% patients. During cardiac arrest, ccTEE identified the cause of arrest in 25% to 35% of cases. Complications of ccTEE included two cases of significant gastrointestinal bleeding requiring intervention, but no other major complications (death or esophageal perforation) reported. CONCLUSIONS The use of ccTEE has been described for the diagnosis and management of a broad range of clinical problems. Overall, ccTEE was commonly reported to offer additional diagnostic yield beyond TTE with a low observed complication rate. Additional high quality ccTEE studies will permit stronger conclusions and a more precise understanding of the trends observed in this scoping review.
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Affiliation(s)
- Ross Prager
- Division of Critical Care, Western University, Stn B. London, ON, Canada,Ross Prager, Critical Care Trauma Centre,
Victoria Hospital. Rm # D2-528 London Health Sciences Centre, 800 Commissioners
Rd. E, London, ON N6A 5W9, Canada.
| | - Joshua Bowdridge
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Pratte
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jason Cheng
- Division of Critical Care, Western University, Stn B. London, ON, Canada
| | - Matthew DF McInnes
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada, Clinical Epidemiology Program, The Ottawa Hospital Research
Institute, Ottawa, ON, Canada
| | - Robert Arntfield
- Division of Critical Care, Western University, Stn B. London, ON, Canada
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Boissier F, Bagate F, Mekontso Dessap A. Hemodynamic monitoring using trans esophageal echocardiography in patients with shock. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:791. [PMID: 32647716 PMCID: PMC7333117 DOI: 10.21037/atm-2020-hdm-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Circulatory shock is a life-threatening condition responsible for inadequate tissue perfusion. The objectives of hemodynamic monitoring in this setting are multiple: identifying the mechanisms of shock (hypovolemic, distributive, cardiogenic, obstructive); choosing the adequate therapeutic intervention, and evaluating the patient's response. Echocardiography is proposed as a first line tool for this assessment in the intensive care unit. As compared to trans-thoracic echocardiography (TTE), trans-esophageal echocardiography (TEE) offers a better echogenicity and is the best way to evaluate deep anatomic structures. The therapeutic implication of TEE leads to frequent changes in clinical management. It also allows depicting sources of inaccuracy of thermodilution-based hemodynamic monitoring. It is a semi invasive tool with a low rate of complications. The first step in the hemodynamic evaluation of shock is to characterize the mechanisms of circulatory failure among hypovolemia, vasoplegia, cardiac dysfunction, and obstruction. Echocardiographic evaluation includes evaluation of LV systolic and diastolic function, as well as RV function, pericardium, measure of stroke volume and cardiac output, and evaluation of hypovolemia and fluid responsiveness. TEE can be used as a semi-continuous monitoring tool and can be repeated before and after therapeutic interventions (vasopressors, inotropes, fluid therapy, specific treatment such as pericardial effusion evacuation) to evaluate efficacy and tolerance of therapeutic interventions. In conclusion, TEE plays an important role in the management of circulatory failure when TTE is not enough to answer to the questions, although it is not a continuous tool of monitoring. TEE results must be integrated in a global evaluation, the first step being clinical examination. Whether TEE-directed therapy and close hemodynamic monitoring of shock has an impact on outcome remains debated.
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Affiliation(s)
- Florence Boissier
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France.,INSERM CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France
| | - François Bagate
- AP-HP, Hôpital Henri Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.,UPEC (Université Paris Est Créteil), Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, F-94010, Créteil, France
| | - Armand Mekontso Dessap
- AP-HP, Hôpital Henri Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.,UPEC (Université Paris Est Créteil), Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, F-94010, Créteil, France
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5
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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.
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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
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Saran S, Gurjar M, Azim A, Mishra P, Ghosh PS, Baronia AK, Poddar B, Singh RK. Trans-Esophageal Doppler Assessment of Acute Hemodynamic Changes Due to Prone Positioning in Acute Respiratory Distress Syndrome Patients. Shock 2019; 52:e39-e44. [DOI: 10.1097/shk.0000000000001290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dual SA, Pergantis P, Schoenrath F, Keznickl-Pulst J, Falk V, Meboldt M, Daners MS. Acute changes in preload and the QRS amplitude in advanced heart failure patients. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab23e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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8
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Geri G, Vignon P, Aubry A, Fedou AL, Charron C, Silva S, Repessé X, Vieillard-Baron A. Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis. Intensive Care Med 2019; 45:657-667. [PMID: 30888443 DOI: 10.1007/s00134-019-05596-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Mechanisms of circulatory failure are complex and frequently intricate in septic shock. Better characterization could help to optimize hemodynamic support. METHODS Two published prospective databases from 12 different ICUs including echocardiographic monitoring performed by a transesophageal route at the initial phase of septic shock were merged for post hoc analysis. Hierarchical clustering in a principal components approach was used to define cardiovascular phenotypes using clinical and echocardiographic parameters. Missing data were imputed. FINDINGS A total of 360 patients (median age 64 [55; 74]) were included in the analysis. Five different clusters were defined: patients well resuscitated (cluster 1, n = 61, 16.9%) without left ventricular (LV) systolic dysfunction, right ventricular (RV) failure or fluid responsiveness, patients with LV systolic dysfunction (cluster 2, n = 64, 17.7%), patients with hyperkinetic profile (cluster 3, n = 84, 23.3%), patients with RV failure (cluster 4, n = 81, 22.5%) and patients with persistent hypovolemia (cluster 5, n = 70, 19.4%). Day 7 mortality was 9.8%, 32.8%, 8.3%, 27.2%, and 23.2%, while ICU mortality was 21.3%, 50.0%, 23.8%, 42.0%, and 38.6% in clusters 1, 2, 3, 4, and 5, respectively (p < 0.001 for both). CONCLUSION Our clustering approach on a large population of septic shock patients, based on clinical and echocardiographic parameters, was able to characterize five different cardiovascular phenotypes. How this could help physicians to optimize hemodynamic support should be evaluated in the future.
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Affiliation(s)
- Guillaume Geri
- Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.,UFR des Sciences de la Santé Simone Veil, Université Versailles Saint Quentin, Versailles, France.,INSERM UMR1018, Team Kidney and Heart, CESP, Villejuif, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, Limoges, France.,Faculty of Medicine, University of Limoges, Limoges, France.,INSERM CIC 1435, Limoges University Hospital, Limoges, France
| | - Alix Aubry
- Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.,UFR des Sciences de la Santé Simone Veil, Université Versailles Saint Quentin, Versailles, France
| | - Anne-Laure Fedou
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, Limoges, France
| | - Cyril Charron
- Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Stein Silva
- Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France
| | - Xavier Repessé
- Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Antoine Vieillard-Baron
- Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. .,UFR des Sciences de la Santé Simone Veil, Université Versailles Saint Quentin, Versailles, France. .,INSERM UMR1018, Team Kidney and Heart, CESP, Villejuif, France.
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Hastie J, Panzer OPF, Weyker P, Flynn BC. Miniaturized Echocardiography in the Cardiac Intensive Care Unit. J Cardiothorac Vasc Anesth 2018; 33:1540-1547. [PMID: 30243874 DOI: 10.1053/j.jvca.2018.08.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 11/11/2022]
Abstract
Miniaturized transesophageal echocardiography has become more common in cardiac intensive care units. There are potential benefits to this mode of technology, many of which have been described in the literature. However, image acquisition and quality have been cited as being less optimal when compared to traditional transesophageal echocardiography. This review will discuss the current options available for miniaturized transesophageal echocardiography along with a literature review of this emerging assessment modality.
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Affiliation(s)
- Jonathan Hastie
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Oliver P F Panzer
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Brigid C Flynn
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.
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11
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Vieillard-Baron A, Aneman A. Cardiovascular issues in the ICU: a call for papers. Intensive Care Med 2017; 43:1892-1893. [PMID: 28948307 DOI: 10.1007/s00134-017-4907-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Antoine Vieillard-Baron
- Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, 78280, Saint-Quentin en Yvelines, France. .,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94807, Villejuif, France.
| | - Anders Aneman
- Intensive Care Unit, South Western Sydney Local Health District, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.,Australian School of Advance Medicine, Macquarie University, Sydney, Australia
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Vignon P, Begot E, Mari A, Silva S, Chimot L, Delour P, Vargas F, Filloux B, Vandroux D, Jabot J, François B, Pichon N, Clavel M, Levy B, Slama M, Riu-Poulenc B. Hemodynamic Assessment of Patients With Septic Shock Using Transpulmonary Thermodilution and Critical Care Echocardiography: A Comparative Study. Chest 2017; 153:55-64. [PMID: 28866112 DOI: 10.1016/j.chest.2017.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/28/2017] [Accepted: 08/01/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To assess the agreement between transpulmonary thermodilution (TPT) and critical care echocardiography (CCE) in ventilated patients with septic shock. METHODS Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study. Patients were assessed successively using TPT and CCE in random order. Data were interpreted independently at bedside by two investigators who proposed therapeutic changes on the basis of predefined algorithms. TPT and CCE hemodynamic assessments were reviewed offline by two independent experts who identified potential sources of discrepant results by consensus. Lactate clearance and outcome were studied. RESULTS A total of 137 patients were studied (71 men; age, 61 ± 15 years; Simplified Acute Physiologic Score, 58 ± 18; Sequential Organ Failure Assessment, 10 ± 3). TPT and CCE interpretations at bedside were concordant in 87/132 patients (66%) without acute cor pulmonale (ACP), resulting in a moderate agreement (kappa, 0.48; 95% CI, 0.37-0.60). Experts' adjudications were concordant in 100/129 patients without ACP (77.5%), resulting in a good intertechnique agreement (kappa, 0.66; 95% CI, 0.55-0.77). In addition to ACP (n = 8), CCE depicted a potential source of TPT inaccuracy in 8/29 patients (28%). Lactate clearance at H6 was similar irrespective of the concordance of online interpretations of TPT and CCE (55/84 [65%] vs 32/45 [71%], P = .55). ICU and day 28 mortality rates were similar between patients with concordant and discordant interpretations (29/87 [36%] vs 13/45 [29%], P = .60; and 31/87 [36%] vs 16/45 [36%], P = .99, respectively). CONCLUSIONS Agreement between TPT and CCE was moderate when interpreted at bedside and good when adjudicated offline by experts, but without impact on lactate clearance and mortality.
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Affiliation(s)
- Philippe Vignon
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France.
| | - Emmanuelle Begot
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Arnaud Mari
- Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France
| | - Stein Silva
- Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France
| | - Loïc Chimot
- Medical Intensive Care Unit, Hospital of Périgueux, Périgueux, France
| | - Pierre Delour
- Medical Intensive Care Unit, Hospital of Périgueux, Périgueux, France
| | - Frédéric Vargas
- Medical Intensive Care Unit, Teaching Hospital of Bordeaux, Bordeaux, France
| | - Bruno Filloux
- Medical Intensive Care Unit, Teaching Hospital of Bordeaux, Bordeaux, France
| | - David Vandroux
- Medical-Surgical Intensive Care Unit, Teaching Hospital of La Réunion, La Réunion, France
| | - Julien Jabot
- Medical-Surgical Intensive Care Unit, Teaching Hospital of La Réunion, La Réunion, France
| | - Bruno François
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Nicolas Pichon
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Marc Clavel
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Bruno Levy
- Medical Intensive Care Unit, Teaching Hospital of Nancy, Nancy, France
| | - Michel Slama
- Medical Intensive Care Unit, Teaching Hospital of Amiens, Amiens, France
| | - Béatrice Riu-Poulenc
- Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France
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Ten reasons for performing hemodynamic monitoring using transesophageal echocardiography. Intensive Care Med 2017; 43:1048-1051. [PMID: 28213621 DOI: 10.1007/s00134-017-4716-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
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Monitorage hémodynamique par échocardiographie des patients en état de choc. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hwang GS. Transthoracic echocardiography probe in an anesthesiologist’s hand: utility in the operating room. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.4.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Critical care ultrasonography in acute respiratory failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:228. [PMID: 27524204 PMCID: PMC4983787 DOI: 10.1186/s13054-016-1400-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/01/2016] [Indexed: 12/12/2022]
Abstract
Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript.
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