Echocardiographic Hemodynamic Monitoring in the Critically Ill Patient

Romero-Bermejo, Francisco José; Ruiz-Bailén, Manuel; Guerrero-De-Mier, Manuel; Lopez-Alvaro, Julian

doi:10.2174/157340311798220485

Cited by 38 publications

(30 citation statements)

References 39 publications

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“…It is readily available, non-invasive and can be performed after a reasonable period of training. [19][20][21] However, expert advice should be available around the clock, as examination conditions in cardiovascular patients can be challenging (e.g. substernal air, dressings, chest tubes) and the underlying pathologies difficult to detect (e.g.…”

Section: Echocardiographymentioning

confidence: 99%

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe¹,

Krüger²,

Béttex³

et al. 2015

Cardiac Failure Review

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Shock in cardio-surgical intensive care unit (ICU) patients is a serious condition with a high morbidity and mortality.1,2 Prompt identification of the underlying conditions and correct management of the lifethreatening physiological deteriorations are crucial to save the patient's life. In daily practice, however, focusing on the main goal -to provide adequate oxygen delivery thereby preventing further organ damage -is often difficult due to multiple influences, distractions, and pending results. Hence, the setting up of priorities is necessary.In addition, many questions arise on how to optimally treat patients in shock: What blood pressure should we target? What fluid should we use and how much? Which vasoactive drug is best and which inotrope? While discussions about these issues can be very fruitful for experts, they risk confusing younger colleagues and nurses at the bedside. Disputes about controversial therapy opinions might consequently delay adequate resuscitation, putting the patient at risk of an adverse outcome. This review aims to give recommendations for the management during the early phase of shock of cardio-surgical patients hospitalised in the ICU. The focus is on the first 6 hours, which are also called 'the golden hours'. Methods Clinical SettingThe cardio-surgical ICU at the University Hospital Zurich is a 12-bed, high-intensity unit that cares for more than 1,100 patients every year.The majority of these critically ill patients undergo cardiac and/or major vascular surgery, most of them being mechanically ventilated and on inotrope/vasopressor support. The unit is part of a successful heart failure programme that includes extracorporeal life support, ventricular assist devices and a heart transplantation service. In order to optimise the initial resuscitation of patients and to avoid adverse effects of inadequate treatment, the consultants of the unit have agreed on treatment recommendations, which are presented here.They are based on current evidence and complemented by clinical experience in areas of uncertainty. Data ExtractionFor this narrative review, a search of the PubMed database and a review of bibliographies from selected articles were performed to identify original data relating to this topic. Key words used for the search were 'shock', 'cardiac surgery', 'critical care', 'inotropes', 'inotropic therapy', 'circulatory support', 'cardiogenic shock' and 'sepsis'. National and international guidelines were reviewed and integrated, e.g. The 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation, 3 The 2014 ESC/ EACTS guidelines on myocardial revascularization 4 and The Surviving Sepsis Campaign guidelines 5 . Articles were scrutinised regarding their study design, population evaluated, interventions, outcomes, and limitations. Finally, personal recommendations were included and highlighted as such to give a comprehensive overview on this topic. Rationale for an Early Management of ShockShock in patients under...

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Section: Echocardiographymentioning

confidence: 99%

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe¹,

Krüger²,

Béttex³

et al. 2015

Cardiac Failure Review

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show abstract

“…Esta aproximación nos sirve para determinar un choque cardiogénico y guiarnos en el uso de inotrópicos/vasopresores o líqui-dos intravenosos 44 . La evaluación cuantitativa estándar es el cálculo de la fracción de eyección por método de Simpson, sin embargo, este requiere 2 planos (apical 4 cámaras y 2 cámaras) y un cálculo avanzado del que no siempre se dispone en estos escenarios 45 …”

Section: Función Sistólica Ventricular Izquierdaunclassified

“…4)43 . Debe considerarse que este método no es apropiado en alteraciones de la contractilidad segmentaria45 . El modo M también evalúa la función sistólica con la excursión sistólica del anillo mitral (MAPSE) en apical 4 cámaras (normal: > 15 mm) (fig.…”

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Utilidad de la ecografía en reanimación

Pérez-Coronado

Franco-Gruntorad

2015

Revista Colombiana de Anestesiología

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información del artículo Historia del artículo: Recibido el 10 de septiembre de 2014 Aceptado el 2 de marzo de 2015 On-line el xxx Palabras clave: Ecografía Resucitación cardiopulmonar Taponamiento Cardíaco Volumen Sistólico Disfunción ventricular Derecha r e s u m e nLa ecografía se ha convertido en una herramienta diagnóstica y terapéutica en situaciones críticas. Este artículo revisa la evolución de la ecografía en eventos críticos y su impacto a través de la disminución de morbimortalidad en trauma abdominal y torácico, en el reconocimiento de causas reversibles en actividad eléctrica sin pulso, en la toma de decisiones en falla ventilatoria aguda, en predicción de supervivencia y en la disminución de complicaciones en procedimientos invasivos. Se revisa cómo la ecografía realizada por no expertos con mínimo entrenamiento enfocado al reconocimiento de situaciones específicas tiene una adecuada correlación con el experto. Se revisan algunos protocolos de ecografía en reanimación descritos en la literatura y se hace una descripción de las variables más relevantes en situaciones críticas como la función ventricular izquierda, respuesta a volumen, taponamiento cardíaco, dilatación del ventrículo derecho y la evaluación pulmonar. a b s t r a c tUltrasound has become a diagnostic and therapeutic tool for critical situations. This article reviews the development of ultrasound with respect to critical events and its impact on reducing morbidity and mortality from abdominal and chest trauma, on the recognition of reversible causes of pulseless electrical activity, on decision-making in acute respiratory failure, and on predicting survival and reducing complications associated with invasive procedures. We revised how ultrasounds performed by non-experts with a minimum of training and focused on recognizing specific situations have a good degree of correlation with expert * Autor para correspondencia: Calle 163a Número 13B -60. Segundo Piso Torre A. Fundación

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“…Cardiovascular dynamics are assessed by vascular pressure measurement in a peripheral artery, central vein, or pulmonary artery, or with echocardiography and other recent devices, and electrocardiography (ECG). [1][2][3] While advanced monitoring devices have improved acute care, measurements from these devices do not necessarily indicate intravascular volume status and/or contractility. For example, arterial pressure is influenced by both contractility of the left ventricle and afterload.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Monitoring of Cardiac Preload and Contractility by Heart Beat-Derived Mechanical Vibration on the Chest Wall in Guinea Pigs

Adachi¹,

Ohba²,

Fujisawa³

et al. 2016

J.ATAMIS

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Background: Myocardial motion produces compression waves that are transmitted to the surface of the chest and vibrate the chest wall. Piezoelectric transducers, which detect mechanical vibrations, may be useful for evaluating cardiac and/or breathing movements when the sensor is placed under an animal’s body.Methods: We assessed heartbeat-related chest vibration signals (CVS) detected with a piezoelectric transducer in anesthetized guinea pigs while simultaneously monitoring the electrocardiogram, heart sounds, aortic pressure, and central venous pressure.Results: CVS displayed characteristic features as the ventricle and/or atrium contracted and relaxed during cardiac cycles. A transient positive wave, which occurred approximately at the onset of the R wave on the electrocardiogram, was followed by a profound negative wave during systole. The negative wave peaked early in systole and then gradually returned. A small notch was observed at the second heart sound. A dome-shaped positive wave was observed during diastole that connected to the transient positive wave of the next cardiac cycle. In response to phlebotomy (blood volume, 15 ml/kg), the size of the dome-shaped positive wave decreased, whereas saline transfusion (20 ml/kg) increased the positive wave during diastole. Administration of isoproterenol markedly increased the transient positive wave at the onset of systole, whereas phenylephrine affected the transient positive wave only slightly.Conclusions: Our findings suggest that CVS may be useful to identify cardiac cycles and to evaluate cardiovascular dynamics during changes in blood volume and/or cardiac contractility.

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Echocardiographic Hemodynamic Monitoring in the Critically Ill Patient

Cited by 38 publications

References 39 publications

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Utilidad de la ecografía en reanimación

Noninvasive Monitoring of Cardiac Preload and Contractility by Heart Beat-Derived Mechanical Vibration on the Chest Wall in Guinea Pigs

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