Hemodynamic Assessment in the Contemporary Intensive Care Unit

2014 ◽  
Vol 30 (3) ◽  
pp. 413-445 ◽  
Author(s):  
Mohamad Kenaan ◽  
Mithil Gajera ◽  
Sascha N. Goonewardena
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hemodynamic Assessment

scholarly journals Correlation of stroke Volume Measurement between sonosite portable Echocardiogram and Edwards Flotrac sensor-Vigileo Monitor in an Intensive care Unit

2013 ◽  
Vol 7 ◽  
pp. CCRPM.S12498 ◽  
Author(s):  
Mehrdad Behnia ◽  
Sherry Powell ◽  
Linda Fallen ◽  
Houman Tamaddon ◽  
Masud Behnia
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Stroke Volume ◽  
Critically Ill ◽  
Arterial Line ◽  
Critical Care Echocardiography ◽  
Systolic Volume ◽  
Clinical Scenarios ◽  
Hemodynamic Assessment

Purpose Stroke volume (SV) is a parameter that is being recognized as an endpoint in fluid resuscitation algorithms. Its role is now being realized as an important variable in hemodynamic assessment in various clinical scenarios such as septic and cardiogenic shocks. Direct measurement of stroke volume (SV) and its novel corollary, stroke volume variation (SVV) derived by proprietary software, are preferred over mean cardiac output (CO) measurements because they render a more accurate reflection of hemodynamic status independent of heart rate. Flotrac-Vigileo monitor (FTV) (Edwards Lifesciences, Irvine, CA, USA) is a system that uses a complex algorithm analyzing arterial waveform to calculate SV, SVV, and CO. We assessed the feasibility of obtaining SV measurements with a portable echocardiogram and validated its accuracy with the FTV system in mechanically ventilated patients in our intensive care unit (ICU). Furthermore, we emphasized the importance of hemodynamic measurements and familiarity with critical care echocardiography for the intensivists. Methods Ten patients who were on mechanical ventilation were studied. A femoral arterial line was connected to the FTV system monitoring SV and CO. A portable echocardiogram (M-Turbo; Sonosite, Bothell, WA) was used to measure SV. CO was calculated by multiplying SV by heart rate. No patient had arrhythmia. We used biplane Simpson's method of discs to calculate SV in which subtraction of end-systolic volume from end-diastolic volume yields the SV Results The comparison of simultaneous SV and CO measurements by echocardiography with FTV showed a strong correlation between the 2. (For SV, y = 0.9545x + 3.3, R2 = 0.98 and for CO, y = 0.9104x + 7.7074, R2 = 0.97). Conclusions In our small cohort, the SV and CO measured by a portable echocardiogram (Sonosite M-Turbo) appears to be closely correlated with their respective values measured by FTV. Portable echocardiography is a reliable noninvasive tool for the hemodynamic assessment of the critically ill. Its results need further validation with gold standard measures in a larger cohort of patients. However, our results suggest portable echocardiography could be an attractive tool in assessment of different hemodynamic scenarios in the critically ill.

scholarly journals Utility of transthoracic echocardiography (TTE) in assessing fluid responsiveness in critically ill patients – a challenge for the bedside sonographer.

2016 ◽  
Vol 18 (4) ◽  
pp. 508 ◽  
Author(s):  
Wojciech Mielnicki ◽  
Agnieszka Dyla ◽  
Tomasz Zawada
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Transthoracic Echocardiography ◽  
Diagnostic Tools ◽  
Dynamic Parameters ◽  
Hemodynamic Assessment ◽  
Life Threatening

Transthoracic echocardiography (TTE) has become one of the most important diagnostic tools in the treatment of critically ill patients. It allows clinicians to recognise potentially reversible life-threatening situations and is also very effective in the monitoring of the fluid status of patients, slowly substituting invasive methods in the intensive care unit. Hemodynamic assessment is based on a few static and dynamic parameters. Dynamic parameters change during the respiratory cycle in mechanical ventilation and the level of this change directly corresponds to fluid responsiveness. Most of the parameters cannot be used in spontaneously breathing patients. For these patients the most important test is passive leg raising, which is a good substitute for fluid bolus. Although TTE is very useful in the critical care setting, we should not forget the important limitations, not only technical ones but also caused by the critical illness itself. Unfortunately, this method does not allow continuous monitoring and every change in the patient’s condition requires repeated examination.Keywords: hypovolaemia; non-invasive monitoring; intensive care unit; transthoracic echocardiography

scholarly journals PERSONALIZED INTENSIVE CARE OF CARDIOVASCULAR DISORDERS IN CHILDREN WITH RESPIRATORY FAILURE

2020 ◽  
Vol 117 (3) ◽  
pp. 46-57
Author(s):  
Olha Filyk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Stroke Index ◽  
Cardiovascular Dysfunction ◽  
Non Invasive ◽  
Group I ◽  
Hemodynamic Assessment ◽  
Group Ii

This article presents data on the frequency of incidence and duration of cardiovascular dysfunction in children with acute respiratory failure. The information on expediency of carrying out of personalized hemodynamic management in case of its insufficiency with use of multiparametric approach to estimate haemodynamic data are presented. The aim of the study was to compare the effectiveness of the standard approach and proposed by us additions to treatment of haemodynamic disorders in children with respiratory failure. It was summarized from the literature reviews that the presence and maintenance of patient`s spontaneous breathing pattern with use of non-invasive estimated cardiovascular monitoring, evaluation of preload with ultrasonography and reassessment of rate and volume of fluid replacement with taking into account solution`s composition might improve treatment results in children with acute respiratory failure. We conducted a prospective single-center non-interventional cohort study in children with acute respiratory failure 1 month - 18 years old. Patients were randomly divided into I and II groups. The data analysis included 43 patients of group I, who received conventional for this intensive care unit monitoring and treatment and 53 patients of group II, in whom we took into account the results of multiparametric monitoring during the correction of hemodynamics.Monitoring of hemodynamics included heart rate, non-invasive systolic, diastolic and mean blood pressure capillary refill time and presence of peripheral arteries pulsation with clinical verification of "warm" or "cold" shock, ScvO2 and lactate levels in the central venous blood; non-invasive estimated monitoring of stroke volume, cardiac output, cardiac index, stroke index using the esCCO technology, NIHON COHDEN (Japan) and the ratio of inferior vena cava diameter at inspiration and exhalation. Hemodynamic support in groups I and II included early goal-directad therapy, individualized and personalized treatment. In II group of patients there were taken into account the dynamics of changes of non-invasive esCCO data about stroke volume, cardiac output, cardiac index and stroke index, cumulative hydrobalance and the ratio of the of inferior vena cava diameter at inspiration and exhalation. Early goal-directed therapy was aimed to (supra) normalize of blood flow and was based on normal hemodynamic data for population, according to percentiles for specific age groups of patients. Individualized hemodynamic therapy included functional hemodynamic monitoring with assessment of to volemic therapy answer, individualization of target points and maximization of blood flow. Personalized hemodynamic management consisted of applying an adaptive multiparametric approach to hemodynamic assessment. Spontaneous diaphragmatic activity was maintained along all time of mechanical ventilation. The primary endpoint was 28-day mortality rate; secondary endpoints were the duration of cardiovascular dysfunction and the duration of intensive care unit stay. To assess age-dependent data, patients were divided into age subgroups: 1st subgroup - children 1 month - 1 year old; 2nd subgroup - children 1 - 3 years old; 3rd subgroup - children 3 - 6 years old; 4th subgroup - children 6 - 12 years old; 5th subgroup - children 12 - 18 years old. It was determined that the level of 28-day mortality was: in 1st age subgroup - 18.2% in group I and 3.1% in group II (p = 0.02), in the 2nd age subgroup - 11.1% and 0%, respectively (p = 0.11); in the 4th age subgroup - 10% and 0%, respectively (p = 0.28); in the 3rd and 5th age subgroups - was 0% in I and II groups. The prevalence of hemodynamic disorders was: in 1st age subgroup in patients of group I - 100%, while in group II - 62.5% (p = 0.001); in 2nd age subgroup - 55.6% in patients from group I and 42.9% in patients from group II (p = 0.05); in 3rd age subgroup in 100% of patients of group II and only in 75% of patients of group I (p = 0.02). In the 4th age subgroup no significant differences were found between I (30% of patients) and II groups (25% of patients), p = 0.28; in 5th age subgroup the frequency of cardiovascular dysfunction was 40% in group I, compared with 75% in group II (p = 0.008). It was found that duration of hemodynamic insufficiency was longer in patients of 1st and 4th age subgroups, and relatively shorter in patients of 5th age subgroup: in the 1st age subgroup it was 7.6 ± 0.5 days in group I and 8.8 ± 0.9 days in group II (p> 0.05); in 4th age subgroup - 6.7 ± 0.4 days in group I and 10.1 ± 1.2 days in group II (p> 0.05), while in 5th age subgroup - 4.1 ± 0.3 days in group I and 4.7 ± 0.5 days in group II (p> 0.05). We found that there were significant differences in the duration of stay in intensive care unit among patients of the 1st and 5th age subgroups. Specifically, in 1st age subgroup this indicator was in 1.3 times less in group II, compared with group I (p <0.05); in 5th age subgroup the situation was the opposite- the duration of intensive care unit stay in group II was in 1.4 times more in group I (p <0.05). Thus, obtained data demonstrated the results of the use of personalized management of hemodynamic disorders in children with acute respiratory failure. The use of a multiparametric approach to hemodynamic assessment in clinical practice may allow more differentiated use of volume replacement therapy as loop diuretics and will have a beneficial effect on the final clinical outcomes in patients with acute respiratory failure.

scholarly journals Point-of-care ultrasound for COVID-19 pneumonia patients in the ICU

2020 ◽  
Author(s):  
zouheir bitar ◽  
Mohammed Shamsah ◽  
Omar Bamasood ◽  
Ossama Maadrani ◽  
Huda Al foudri
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Left Ventricular ◽  
Circulatory Failure ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Point Of Care Ultrasound ◽  
Rt Pcr ◽  
Ventricular Ejection Fraction ◽  
Hemodynamic Assessment

Abstract BackgroundPoint-of-care ultrasound (POCUS) has a major role in the management of patients with acute hypoxic respiratory and circulatory failure and guides hemodynamic management. There is scarce literature on POCUS assessment characteristics in COVID-19 pneumonia with hypoxic respiratory failure.MethodsThe study is an observational, prospective, single‐center study conducted in the intensive care unit of Adan General Hospital from May 1st, 2020, to June 25, 2020. The study included adults suspected to have COVID-19 transferred to the intensive care unit (ICU) with fever or suspected respiratory infection. Patients were transferred to the ICU directly from the ED or general medical wards after reverse transcriptase-polymerase chain reaction (RT-PCR) testing. A certified intensivist in critical care ultrasound who was blinded to the RT-PCR results, if available at the time of examination, performed the lung ultrasound and echocardiology within 12 hours of the patient’s admission to the ICU. We calculated the E/e’, E/A ratio, left ventricular ejection fraction EF, IVC diameter, RV size and systolic function. We performed ultrasound in 12 chest areas.ResultsOf 92 patients with suspected COVID-19 pneumonia, 77 (84%) cases were confirmed. The median age of the patients was 53 (82-36) years, and 71 (77%) were men.In the group of patients with confirmed COVID-19 pneumonia, echocardiographic findings showed normal E/e’, deceleration time (DT), and transmittal E/A ratio in comparison to the non-COVID19 patients (P .001 for both). The IVC diameter was <2 cm with > 50% collapsibility in 62 (81%) patients with COVID-19 pneumonia; a diameter of > 2 cm and < 50% collapsibility in all patients, with a P value of 0.001, was detected among those with non-COVID-19 pneumonia. There were 3 cases of myocarditis with poor EF (5.5%), severe RV dysfunction was seen in 9 cases (11.6%), and 3 cases showed RV thrombus.Chest US revealed four signs suggestive of COVID-19 pneumonia in 77 patients (98.6%) (sensitivity 96.9%, CI 85%‐99.5%) when compared with RT-PCR results.ConclusionPOCUS plays an important role in bedside diagnosis, hemodynamic assessment and management of patients with acute hypoxic respiratory and circulatory failure in patients with COVID-19 pneumonia.

Hemodynamic Assessment in the Cardiac Intensive Care Unit

2021 ◽  
Vol 14 (6) ◽  
pp. 1288-1289
Author(s):  
Federico Fortuni ◽  
Alessandro Vairo ◽  
Gianluca Alunni ◽  
Gaetano M. De Ferrari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Hemodynamic Assessment ◽  
Cardiac Intensive Care

scholarly journals Transesophageal Echocardiography in the Intensive Care Unit

2013 ◽  
Vol 1 (1) ◽  
pp. 4-15
Author(s):  
Sundar Krishnan ◽  
Dallen Mill
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Transesophageal Echocardiography ◽  
Diagnostic Technique ◽  
Ventricular Outflow Tract ◽  
Hemodynamic Instability ◽  
Pericardial Tamponade ◽  
Left Ventricular ◽  
Hemodynamic Assessment ◽  
Left Ventricular Outflow

ABSTRACT Management of shock in the intensive care unit involves advanced hemodynamic monitoring. Invasive monitoring with central venous lines and pulmonary artery catheters may be inadequate in guiding therapy and improving outcomes. Echocardiography is a reasonably-safe, minimally-invasive diagnostic technique that provides rapid bedside evaluation of ventricular filling and function. While transthoracic echocardiography is the method of choice initially, images can be suboptimal in up to a third of intensive care patients. Transesophageal echocardiography is then required to better evaluate the cause of hemodynamic instability. In addition, transesophageal echocardiography can be used to diagnose other causes of hemodynamic failure (for e.g., pericardial tamponade, pulmonary embolism and left ventricular outflow tract obstruction) and to diagnose intracardiac shunt. Echocardiography is also vital in diagnosing the cause and guiding management in patients with cardiac arrest. Specific training is required for physicians in order to achieve competence in probe insertion, completion of a comprehensive examination and interpretation of the images. In this article, we provide an overview of the indications and complications of the technique and training pathways for the intensivist, followed by transesophageal echocardiography-guided hemodynamic assessment and diagnosis of specific cardiac disorders commonly encountered in the intensive care unit. How to cite this article Krishnan S, Mill D. Transesophageal Echocardiography in the Intensive Care Unit. J Perioper Echocardiogr 2013;1(1):4-15.

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