Ultrasonic evaluation of the heart

Backer, Daniel De

doi:10.1097/mcc.0000000000000094

Cited by 18 publications

(12 citation statements)

References 53 publications

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“…A valid tool to access diastolic and systolic function and hemodynamics in septic and critically ill patients is provided by echocardiography [48]. Echocardiographic evaluation of septic mice was obtained.…”

Section: Discussionmentioning

confidence: 99%

Complement Destabilizes Cardiomyocyte Function In Vivo after Polymicrobial Sepsis and In Vitro

Kalbitz

Fattahi

Herron

et al. 2016

The Journal of Immunology

105

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There is accumulating evidence during sepsis that cardiomyocyte (CM) homeostasis is compromised, resulting in cardiac dysfunction. An important role for complement in these outcomes is now demonstrated. Addition of C5a to electrically-paced CMs caused prolonged elevations of [Ca2+]i during diastole, together with appearance of spontaneous Ca2+ transients. In polymicrobial sepsis in mice, we found that three key homeostasis-regulating proteins in CMs were reduced in amounts: Na+/K+ ATPase, which is vital for effective action potentials in CMs; and two [Ca2+]i regulatory proteins; SERCA2 and the Na+/Ca2+ exchanger (NCX). Sepsis caused reduced mRNA levels and reductions in protein concentrations in CMs for all three proteins. The absence of either C5a receptor mitigated sepsis-induced reductions in the three regulatory proteins. Absence of either C5a receptor (C5aR1, C5aR2) diminished development of defective systolic and diastolic ECHO/Doppler parameters developing in the heart (cardiac output, LV stroke volume, isovolumic relaxation, E’sa, E/E’sa, LV diastolic volume). We also found in CMs from septic mice the presence of defective current densities for Ik1, L-type calcium channel and NCX. These defects were accentuated in the co-presence of C5a. These data suggest complement-related mechanisms responsible for development of cardiac dysfunction during sepsis.

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Section: Discussionmentioning

confidence: 99%

Complement Destabilizes Cardiomyocyte Function In Vivo after Polymicrobial Sepsis and In Vitro

Kalbitz

Fattahi

Herron

et al. 2016

The Journal of Immunology

105

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“…In parallel, improvement in monitoring has allowed for a better adjustment of the therapy, minimizing the hazards of both over and under-treatment. Methods of non-invasive cardiac output monitoring, such as echocardiography and ultrasonic cardiac output monitor (USCOM) are available bedside and have their use incorporated in many intensive care units worldwide (17,18). Improvement in microcirculatory monitoring has revealed that profound derangements may be present in septic patients; timely reversal of these abnormalities impacts positively on the outcomes (19).…”

Section: Adequate Hemodynamic Resuscitation Is Not Enough For Survivalmentioning

confidence: 99%

Metabolic resuscitation in sepsis: a necessary step beyond the hemodynamic?

Leite¹,

Lima²

2016

J. Thorac. Dis.

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Despite the advances made in monitoring and treatment of sepsis and septic shock, many septic patients ultimately develop multiple organ dysfunction (MODS) and die, suggesting that other players are involved in the pathophysiology of this syndrome. Mitochondrial dysfunction occurs early in sepsis and has a central role in MODS development. MODS severity and recovery of mitochondrial function have been associated with survival. In recent clinical and experimental investigations, mitochondrion-target therapy for sepsis and septic shock has been suggested to reduce MODS severity and mortality. This intervention, which might be named "metabolic resuscitation", would lead to improved mitochondrial activity afforded by pharmacological and nutritional agents. Of particular interest in this therapeutic strategy is thiamine, a water-soluble vitamin that plays an essential role in cellular energy metabolism. Critical illness associated with hypermetabolic states may predispose susceptible individuals to the development of thiamine deficiency, which is not usually identified by clinicians as a source of lactic acidosis. The protective effects of thiamine on mitochondrial function may justify supplementation in septic patients at risk of deficiency. Perspectives of supplementation with other micronutrients (ascorbic acid, tocopherol, selenium and zinc) and potential metabolic resuscitators [coenzyme Q10 (CoQ10), cytochrome oxidase (CytOx), L-carnitine, melatonin] to target sepsis-induced mitochondrial dysfunction are also emerging. Metabolic resuscitation may probably be a safe and effective strategy in the treatment of septic shock in the future. However, until then, preliminary investigations should be replicated in further researches for confirmation. Better identification of groups of patients presumed to benefit clinically by a certain intervention directed to "mitochondrial resuscitation" are expected to increase driven by genomics and metabolomics.

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“…In patients, the intention is to obtain these images transesophageally or transthoracally, which are established methods in humans (Poelaert et al. ; De Backer ).…”

Section: Discussionmentioning

confidence: 99%

“…Doppler signals from the ascending aorta were in this study obtained by placing the GE 6T probe directly on the apex of the heart, as we had difficulties obtaining satisfactory images from a transesophageal position in the pigs. In patients, the intention is to obtain these images transesophageally or transthoracally, which are established methods in humans (Poelaert et al 1999;De Backer 2014).…”

Section: Limitations Of the Studymentioning

confidence: 99%

Minimally invasive beat-by-beat monitoring of cardiac power in normal hearts and during acute ventricular dysfunction

et al. 2016

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Cardiac power, the product of aortic flow and blood pressure, appears to be a fundamental cardiovascular parameter. The simplified version named cardiac power output (CPO), calculated as the product of cardiac output (CO) in L/min and mean arterial pressure (MAP) in mmHg divided by 451, has shown great ability to predict outcome in a broad spectrum of cardiac disease. Beat‐by‐beat evaluation of cardiac power (PWR) therefore appears to be a possibly valuable addition when monitoring circulatory unstable patients, providing parameters of overall cardiovascular function. We have developed a minimally invasive system for cardiac power measurement, and aimed in this study to compare this system to an invasive method (ttPWR). Seven male anesthetized farm pigs were included. A laptop with in‐house software gathered audio from Doppler signals of aortic flow and blood pressure from the patient monitor to continuously calculate and display a minimally invasive cardiac power trace (uPWR). The time integral per cardiac cycle (uPWR‐integral) represents cardiac work, and was compared to the invasive counterpart (ttPWR‐integral). Signals were obtained at baseline, during mechanically manipulated preload and afterload, before and after induced global ischemic left ventricular dysfunction. We found that the uPWR‐integral overestimated compared to the ttPWR‐integral by about 10% (P < 0.001) in both normal hearts and during ventricular dysfunction. Bland–Altman limits of agreement were at +0.060 and −0.054 J, without increasing spread over the range. In conclusion we find that the minimally invasive system follows its invasive counterpart, and is ready for clinical research of cardiac power parameters.

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Ultrasonic evaluation of the heart

Abstract: Echocardiography has now become an important tool for hemodynamic evaluation of the critically ill patient. Echocardiography should be performed in most patients with circulatory and respiratory failure.

Cited by 18 publications

References 53 publications

Complement Destabilizes Cardiomyocyte Function In Vivo after Polymicrobial Sepsis and In Vitro

Complement Destabilizes Cardiomyocyte Function In Vivo after Polymicrobial Sepsis and In Vitro

Metabolic resuscitation in sepsis: a necessary step beyond the hemodynamic?

Minimally invasive beat-by-beat monitoring of cardiac power in normal hearts and during acute ventricular dysfunction

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