Monitoring

Jozwiak, Mathieu; Monnet, Xavier; Teboul, Jean‐Louis

doi:10.1097/mcc.0000000000000236

Cited by 25 publications

(19 citation statements)

References 49 publications

(38 reference statements)

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“…Assessing CO is performed by invasive, minimally invasive, and non-invasive methods [3]. More recently, surviving sepsis campaign recommended the routine use of echocardiography during initial assessment of patients with septic shock [4].…”

Section: Cardiac Output As a Determinant Of Tissue Perfusionmentioning

confidence: 99%

Perfusion indices revisited

2017

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Monitoring of tissue perfusion is an essential step in the management of acute circulatory failure. The presence of cellular dysfunction has been a basic component of shock definition even in the absence of hypotension. Monitoring of tissue perfusion includes biomarkers of global tissue perfusion and measures for assessment of perfusion in non-vital organs.The presence of poor tissue perfusion in a shocked patient is usually associated with worse outcome. Persistently impaired perfusion despite adequate resuscitation is also associated with worse outcome. Thus, normalization of some perfusion indices has become one of the resuscitation targets in patients with septic shock.Although the collective evidence shows the clear relation between impaired peripheral perfusion and mortality, the use of different perfusion indices as a resuscitation target needs more research.

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Section: Cardiac Output As a Determinant Of Tissue Perfusionmentioning

confidence: 99%

Perfusion indices revisited

2017

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“…The most frequently recommended method involves measuring the blood flow velocity (using a Doppler technique) at the left ventricular outflow tract (LVOT) and thus obtaining the stroke volume (SV). Echocardiography is now recommended as the first evaluation of the patient in circulatory failure [1–3]. It is therefore very important to determine the reliability of TTE for the measurement of CO and variations in CO (ΔCO).…”

Section: Introductionmentioning

confidence: 99%

Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient

et al. 2017

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BackgroundCardiac output (CO) monitoring is a valuable tool for the diagnosis and management of critically ill patients. In the critical care setting, few studies have evaluated the level of agreement between CO estimated by transthoracic echocardiography (CO-TTE) and that measured by the reference method, pulmonary artery catheter (CO-PAC). The objective of the present study was to evaluate the precision and accuracy of CO-TTE relative to CO-PAC and the ability of transthoracic echocardiography to track variations in CO, in critically ill mechanically ventilated patients.MethodsThirty-eight mechanically ventilated patients fitted with a PAC were included in a prospective observational study performed in a 16-bed university hospital ICU. CO-PAC was measured via intermittent thermodilution. Simultaneously, a second investigator used standard-view TTE to estimate CO-TTE as the product of stroke volume and the heart rate obtained during the measurement of the subaortic velocity time integral.ResultsSixty-four pairs of CO-PAC and CO-TTE measurements were compared. The two measurements were significantly correlated (r = 0.95; p < 0.0001). The median bias was 0.2 L/min, the limits of agreement (LOAs) were –1.3 and 1.8 L/min, and the percentage error was 25%. The precision was 8% for CO-PAC and 9% for CO-TTE. Twenty-six pairs of ΔCO measurements were compared. There was a significant correlation between ΔCO-PAC and ΔCO-TTE (r = 0.92; p < 0.0001). The median bias was –0.1 L/min and the LOAs were –1.3 and +1.2 L/min. With a 15% exclusion zone, the four-quadrant plot had a concordance rate of 94%. With a 0.5 L/min exclusion zone, the polar plot had a mean polar angle of 1.0° and a percentage error LOAs of –26.8 to 28.8°. The concordance rate was 100% between 30 and –30°. When using CO-TTE to detect an increase in ΔCO-PAC of more than 10%, the area under the receiving operating characteristic curve (95% CI) was 0.82 (0.62–0.94) (p < 0.001). A ΔCO-TTE of more than 8% yielded a sensitivity of 88% and specificity of 66% for detecting a ΔCO-PAC of more than 10%.ConclusionIn critically ill mechanically ventilated patients, CO-TTE is an accurate and precise method for estimating CO. Furthermore, CO-TTE can accurately track variations in CO.

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“…These devices can provide real-time, beat-by-beat arterial blood pressure and SV (and CO ) monitoring, and provide parameters that have been validated for the assessment of preload responiseveness such as the pulse pressure variation (PPV) and SV variation (SVV) [21▪]. …”

Section: Hemodynamic Monitoringmentioning

confidence: 99%

“…Despite its vilification after several studies concluding no improvement in outcomes [24–26], the PAC continues to have a place in the management of patients with complex hemodynamic pictures, and is recommended in the context of refractory shock, severe acute respiratory distress syndrome, pulmonary artery hypertension or right ventricular dysfunction [7▪,21▪,27]. …”

Section: Hemodynamic Monitoringmentioning

confidence: 99%

“…Dynamic parameters such as SVV, PPV, collapsibility of the inferior vena cava in mechanically ventilated patients and the change in CO with passive leg rasing, outperform static parameters and thus, are recommended for the assessment of preload responsiveness [21▪,33], which is defined as the likelihood that the infusion of a bolus of 500 ml will increase CO by 10–15%. This assessment is based on the concept of functional hemodynamic monitoring [34] and supported on the physiologic principle described by the Frank–Starling curve of the heart.…”

Section: Hemodynamic Monitoringmentioning

confidence: 99%

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The crashing patient: hemodynamic collapse

Gidwani

Gómez²

2017

Current Opinion in Critical Care

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Purpose of review Rapid restoration of tissue perfusion and oxygenation are the main goals in the resuscitation of a patient with circulatory collapse. This review will focus on providing an evidence based framework of the technological and conceptual advances in the evaluation and management of the patient with cardiovascular collapse. Recent findings The initial approach to the patient in cardiovascular collapse continues to be based on the Ventilate–Infuse–Pump rule. Point of care ultrasound is the preferred modality for the initial evaluation of undifferentiated shock, providing information to narrow the differential diagnosis, to assess fluid responsiveness and to evaluate the response to therapy. After the initial phase of resuscitative fluid administration, which focuses on re-establishing a mean arterial pressure to 65mmHg, the use of dynamic parameters to assess preload responsiveness such as the passive leg raise test, stroke volume variation, pulse pressure variation and collapsibility of the inferior vena cava in mechanically ventilated patients is recommended. Summary The crashing patient remains a clinical challenge. Using an integrated approach with bedside ultrasound, dynamic parameters for the evaluation of fluid responsiveness and surrogates of evaluation of tissue perfusion have made the assessment of the patient in shock faster, safer and more physiologic.

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Monitoring

Abstract: The use of echocardiography should be encouraged at the initial period of shock to identify main involved mechanisms and to select the appropriate therapy. The use of more invasive monitoring systems should be discussed on an individualized basis.

Cited by 25 publications

References 49 publications

Perfusion indices revisited

Perfusion indices revisited

Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient

The crashing patient: hemodynamic collapse

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