Muscle PO2 Measurement in Critically Ill Patients and Its Correlation to Cardiac Output and Arterial PO2

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624

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Current use of inotropes in circulatory shock

Annals of Intensive Care ◽

10.1186/s13613-021-00806-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Thomas W. L. Scheeren ◽

Jan Bakker ◽

Thomas Kaufmann ◽

Djillali Annane ◽

Pierre Asfar ◽

...

Keyword(s):

Cardiac Output ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Signs ◽

Left Ventricular ◽

Additional Treatment ◽

Circulatory Shock ◽

Left Ventricular Ejection ◽

First Line ◽

Ventricular Ejection Fraction

Abstract Background Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock. Methods From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions. Results A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81–90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement). Conclusion Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.

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NICOM vs LiDCO™ plus during changes in cardiac output in critically ill patients

Critical Care ◽

10.1186/cc8332 ◽

2010 ◽

Vol 14 (Suppl 1) ◽

pp. P100

Author(s):

M Cecconi ◽

G Monti ◽

S Vesconi ◽

M Hamilton ◽

M Grounds ◽

...

Keyword(s):

Cardiac Output ◽

Critically Ill ◽

Critically Ill Patients

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Cardiac output measurements using the bioreactance technique in critically ill patients

Critical Care ◽

10.1186/cc11481 ◽

2012 ◽

Vol 16 (6) ◽

Cited By ~ 21

Author(s):

David Fagnoul ◽

Jean-Louis Vincent ◽

DeDaniel Backer

Keyword(s):

Cardiac Output ◽

Critically Ill ◽

Critically Ill Patients ◽

Cardiac Output Measurements

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Cardiovascular System in the Critically Ill Patient

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0004 ◽

2019 ◽

pp. 26-34

Author(s):

Juan G. Ripoll Sanz ◽

Norlalak Jiramethee ◽

Jose L. Diaz-Gomez

Keyword(s):

Cardiac Output ◽

Cardiovascular System ◽

Critically Ill ◽

Fluid Responsiveness ◽

Critically Ill Patients ◽

Integrated System ◽

Critically Ill Patient ◽

Cardiovascular Disorders ◽

Output Control ◽

System 2

This chapter provides an overview of fundamental pathophysiologic concepts for the diagnosis and management of cardiovascular disorders in critically ill patients. Three major topics are presented: 1) the importance of vascular–cardiac pump coupling as an integrated system, 2) practical considerations of ventricular dysfunction, and 3) systemic vessels as a crucial factor for cardiac output control and fluid responsiveness.

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The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study

American Journal of Critical Care ◽

10.4037/ajcc1994.3.5.382 ◽

1994 ◽

Vol 3 (5) ◽

pp. 382-386 ◽

Cited By ~ 15

Author(s):

CL Ostrow ◽

E Hupp ◽

D Topjian

Keyword(s):

Blood Pressure ◽

Cardiac Output ◽

Critically Ill ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Critically Ill Patients ◽

Hemodynamic Parameters ◽

Trendelenburg Position ◽

Dependent Variables ◽

Preliminary Study

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.

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