scholarly journals Hemodynamic Characteristics of Mechanically Ventilated COVID-19 Patients: A Cohort Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
E. Christiaan Boerma ◽  
Carina Bethlehem ◽  
Franciena Stellingwerf ◽  
Fellery de Lange ◽  
Koen W. Streng ◽  
...  
Keyword(s):  
Critically Ill ◽  
Extravascular Lung Water ◽  
Antihypertensive Drugs ◽  
Cohort Analysis ◽  
Left Ventricular ◽  
Contour Analysis ◽  
Lung Water ◽  
Mechanically Ventilated ◽  
Hemodynamic Characteristics ◽  
Over Time

Background. Solid data on cardiovascular derangements in critically ill COVID-19 patients remain scarce. The aim of this study is to describe hemodynamic characteristics in a cohort of COVID-19-related critically ill patients. Methods. A retrospective observational cohort study in twenty-eight consecutive mechanically ventilated COVID-19 patients. Pulse contour analysis-derived data were obtained from all patients, using the PiCCO® system. Results. The mean arterial pressure increased from 77 ± 10 mmHg on day 1 to 84 ± 9 mmHg on day 21 ( p = 0.04 ), in combination with the rapid tapering and cessation of norepinephrine and the gradual use of antihypertensive drugs in the vast majority of patients. The cardiac index increased significantly from 2.8 ± 0.7 L/min/m2 on day 1 to 4.0 ± 0.8 L/min/m2 on day 21 ( p < 0.001 ). Dobutamine was administered in only two patients. Mean markers of left ventricular contractility and peripheral perfusion, as well as lactate levels, remained within the normal range. Despite a constant fluid balance, extravascular lung water index decreased significantly from 17 ± 7 mL/kg on day 1 to 11 ± 4 mL/kg on day 21 ( p < 0.001 ). Simultaneously, intrapulmonary right-to-left shunt fraction (Qs/Qt) decreased significantly from 27 ± 10% in week 1 to 15 ± 9% in week 3 ( p = 0.007 ). PaO2/FiO2 ratio improved from 159 ± 53 mmHg to 319 ± 53 mmHg ( p < 0.001 ), but static lung compliance remained unchanged. Conclusions. In general, this cohort of patients with COVID-19 respiratory failure showed a marked rise in blood pressure over time, not accompanied by distinctive markers of circulatory failure. Characteristically, increased extravascular lung water, vascular permeability, and intrapulmonary shunt diminished over time, concomitant with an improvement in gas exchange.

scholarly journals Preliminary Exploration of Epidemiologic and Hemodynamic Characteristics of Restrictive Filling Diastolic Dysfunction Based on Echocardiography in Critically Ill Patients: A Retrospective Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Yi Li ◽  
Wanhong Yin ◽  
Yao Qin ◽  
Xueying Zeng ◽  
Tongjuan Zou ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Diastolic Dysfunction ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Extravascular Lung Water ◽  
Volume Status ◽  
Lower Percentage ◽  
Lung Water ◽  
Filling Pattern ◽  
Hemodynamic Characteristics

Objective. To preliminarily describe the epidemiologic and hemodynamic characteristics of critically ill patients with restrictive filling diastolic dysfunction based on echocardiography. Setting. A retrospective study. Methods. Epidemiologic characteristics of patients with restrictive filling diastolic dysfunction in ICU were described; clinical and hemodynamic data were preliminarily summarized and compared between patients with and without restrictive filling diastolic dysfunction; most of the data were based on echocardiography. Results. More than half of the patients in ICU had diastolic dysfunction and about 16% of them had restrictive filling pattern. The patients who had restrictive filling diastolic dysfunction were more likely to have wider diameter of IVC (2.18±0.50 versus 1.92±0.43, P=0.037), higher extravascular lung water score (15.9±9.2 versus 13.2±9.1, P=0.014), lower left ventricular ejection fraction (EF-S: 53.0±16.3 versus 59.3±12.5, P=0.014), and lower percentage of normal LAP that was estimated by E/e′ (8.9% versus 90.0%, P=0.001) when compared with those of patients without restrictive filling diastolic dysfunction. Conclusion. Our results suggest that critically ill patients with restrictive filling diastolic dysfunction may experience rising volume status, increasing extravascular lung water ultrasonic score, reducing long-axis systolic dysfunction, and less possibility of normal left atrial pressure. Intensivists are advised to pay more attention to patients with diastolic dysfunction, especially the exquisite fluid management of patients with restrictive filling pattern due to the close relationship of restrictive filling diastolic dysfunction with volume status and extravascular lung water in our study.

Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bedside alternatives to the pulmonary artery catheter

2006 ◽  
Vol 291 (6) ◽  
pp. L1118-L1131 ◽  
Author(s):  
Warren Isakow ◽  
Daniel P. Schuster
Keyword(s):  
Cardiac Output ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Critically Ill ◽  
Extravascular Lung Water ◽  
Ejection Time ◽  
Lung Water ◽  
Descending Aorta ◽  
Hemodynamic Management ◽  
Flow Through

The recently completed Fluid and Catheter Treatment Trial conducted by the National Institutes of Health ARDSNetwork casts doubt on the value of routine pulmonary artery catheterization for hemodynamic management of the critically ill. Several alternatives are available, and, in this review, we evaluate the theoretical, validation, and empirical databases for two of these: transpulmonary thermodilution measurements (yielding estimates of cardiac output, intrathoracic blood volume, and extravascular lung water) that do not require a pulmonary artery catheter, and hemodynamic measurements (including estimates of cardiac output and ejection time, a variable sensitive to intravascular volume) obtained by esophageal Doppler analysis of blood flow through the descending aorta. We conclude that both deserve serious consideration as a means of acquiring useful hemodynamic data for managing shock and fluid resuscitation in the critically ill, especially in those with acute lung injury and pulmonary edema, but that additional study, including carefully performed, prospective clinical trials demonstrating outcome benefit, is needed.

Evaluation of the Portable Chest Roentgenogram for Quantitating Extravascular Lung Water in Critically Ill Adults

CHEST Journal ◽  
1985 ◽  
Vol 88 (5) ◽  
pp. 649-652 ◽  
Author(s):  
Bruce D. Halperin ◽  
Thomas W. Feeley ◽  
Frederick G. Mihm ◽  
Caroline Chiles ◽  
Diana F. Guthaner ◽  
...  
Keyword(s):  
Critically Ill ◽  
Extravascular Lung Water ◽  
Chest Roentgenogram ◽  
Lung Water ◽  
Portable Chest ◽  
Critically Ill Adults ◽  
Ill Adults

scholarly journals Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance

2012 ◽  
Vol 2 (Suppl 1) ◽  
pp. S1 ◽  
Author(s):  
Colin Cordemans ◽  
Inneke De laet ◽  
Niels Van Regenmortel ◽  
Karen Schoonheydt ◽  
Hilde Dits ◽  
...  
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Extravascular Lung Water ◽  
Fluid Management ◽  
Capillary Leak ◽  
Lung Water ◽  
Abdominal Hypertension

Lung Ultrasound Predicts Well Extravascular Lung Water but Is of Limited Usefulness in the Prediction of Wedge Pressure

2014 ◽  
Vol 121 (2) ◽  
pp. 320-327 ◽  
Author(s):  
Giovanni Volpicelli ◽  
Stefano Skurzak ◽  
Enrico Boero ◽  
Giuseppe Carpinteri ◽  
Marco Tengattini ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Congestion ◽  
Lung Water ◽  
Ventricular Ejection Fraction ◽  
B Lines ◽  
Limited Usefulness

Abstract Background: Pulmonary congestion is indicated at lung ultrasound by detection of B-lines, but correlation of these ultrasound signs with pulmonary artery occlusion pressure (PAOP) and extravascular lung water (EVLW) still remains to be further explored. The aim of the study was to assess whether B-lines, and eventually a combination with left ventricular ejection fraction (LVEF) assessment, are useful to differentiate low/high PAOP and EVLW in critically ill patients. Methods: The authors enrolled 73 patients requiring invasive monitoring from the intensive care unit of four university-affiliated hospitals. Forty-one patients underwent PAOP measurement by pulmonary artery catheterization and 32 patients had EVLW measured by transpulmonary thermodilution method. Lung and cardiac ultrasound examinations focused to the evaluation of B-lines and gross estimation of LVEF were performed. The absence of diffuse B-lines (A-pattern) versus the pattern showing prevalent B-lines (B-pattern) and the combination with normal or impaired LVEF were correlated with cutoff levels of PAOP and EVLW. Results: PAOP of 18 mmHg or less was predicted by the A-pattern with 85.7% sensitivity (95% CI, 70.5 to 94.1%) and 40.0% specificity (CI, 25.4 to 56.4%), whereas EVLW 10 ml/kg or less with 81.0% sensitivity (CI, 62.6 to 91.9%) and 90.9% specificity (CI, 74.2 to 97.7%). The combination of A-pattern with normal LVEF increased sensitivity to 100% (CI, 84.5 to 100%) and specificity to 72.7% (CI, 52.0 to 87.2%) for the prediction of PAOP 18 mmHg or less. Conclusions: B-lines allow good prediction of pulmonary congestion indicated by EVLW, whereas are of limited usefulness for the prediction of hemodynamic congestion indicated by PAOP. Combining B-lines with estimation of LVEF at transthoracic ultrasound may improve the prediction of PAOP.

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