Diagnostic and prognostic evaluation of soluble CD14 subtype for sepsis in critically ill patients: a 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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21 Three-dimensional transesophageal echocardiography for cardiac output in intensive critically ill patients: a preliminary study ultrasound versus thermodilution method

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(15)30259-7 ◽

2015 ◽

Vol 7 (3) ◽

pp. 242

Author(s):

Florent Laveau ◽

Guillaume Hékimian ◽

Marc Achkar ◽

Alain Combes ◽

Richard Isnard ◽

...

Keyword(s):

Cardiac Output ◽

Transesophageal Echocardiography ◽

Critically Ill ◽

Critically Ill Patients ◽

Three Dimensional ◽

Thermodilution Method ◽

Preliminary Study

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A New Monitor to Measure Dermal Blood Flow in Critically Ill Patients: A Preliminary Study

ISRN Critical Care ◽

10.5402/2013/578316 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Jonathan Cohen ◽

Ilya Skoletsky ◽

Rina Chen ◽

Daniel Weiss ◽

Pierre Singer

Keyword(s):

Blood Flow ◽

Critically Ill ◽

Critically Ill Patients ◽

Anterior Chest Wall ◽

Stable States ◽

Preliminary Study ◽

The Difference ◽

Finger Plethysmography ◽

Dermal Blood Flow ◽

Better Than

Background. Conditions of reduced perfusion are characterized by redistribution of blood flow away from the skin to more vital organs. Objectives. To assess the efficacy of a noninvasive, dermal blood flow (DBF) monitor in detecting changes in perfusion in critically ill patients. Methods. Eleven adult, critically ill patients in a general ICU were studied. DBF, finger plethysmography, and invasive mean arterial pressure (MAP) were recorded over an 8-hour period. DBF was measured using the DermaFlow DBF monitor via a skin probe placed on the anterior chest wall. Sensitivity was evaluated by visual inspection during active states, either induced, for example, fluid administration, or spontaneous, for example, altered hemodynamics, while specificity was evaluated during stable states. Data are expressed in terms of standard deviation of the difference (SDD) between the MAP and each of the tested methods. Results. The DBF detected all true changes detected by MAP while plethysmography detected fewer of these events. Based on SDD, the specificity of the DBF was found to be better than that of plethysmography and close in value to the MAP. Conclusions. This preliminary study suggests that the DBF monitor may be a useful noninvasive method for detecting changes in perfusion in critically ill patients.

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Accuracy of a Bedside Swallow Test After Extubation in ICU: A Prospective Validation of a Clinical Test Compared to a Fiberoptic Endoscopy.

10.21203/rs.3.rs-58683/v1 ◽

2020 ◽

Author(s):

Adel Maamar ◽

Valentine Parent ◽

Emmanuel Guérot ◽

Pauline Berneau ◽

Aurélien Frérou ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Validation Cohort ◽

Clinical Test ◽

Exclusion Criteria ◽

Predictive Values ◽

Swallowing Evaluation ◽

Independent Risk Factors ◽

Preliminary Study

Abstract Background: Swallowing disorders (SDs) are frequent after extubation in intensive care unit (ICU) exposing patients to aspiration pneumonia. There is no validated bedside swallowing evaluation (BSE) after extubation. We aimed to evaluate the accuracy of our BSE in comparison with fiberoptic endoscopic evaluation of swallowing (FEES) in critically ill patients after extubation, and to identify the incidence and risk factors of SD.Methods: After a preliminary study in a first center, we conducted a 1-year prospective study as a validation cohort in a second center. Patients intubated for longer than 48 hours were included. Exclusion criteria were a known laryngeal pathology, a preexisting SD and an admission for stroke. FEES of the larynx and BSE were assessed within 24 hours after extubation to compare the accuracy of the BSE to the FEES procedure.Results: One hundred and twenty eight patients were included, respectively 69 and 79 in the preliminary study and the validation cohort. Thirteen of 69 (19%) and 33/79 (42%) had SD assessed by FEES. The area under curve (AUC) reached respectively 0.86 (95% CI 0.73-0.98) and 0.83 (95% CI 0.74-0.92). Sensitivities were 77% (95% CI 0.54-0.99) and 85% (95% CI 0.73-0.94), specificities 94% (95% CI 0.87-0.98) and 80% (95% CI 0.7-0.91), and negative predictive values (NPV) were 95% and 90% in respectively preliminary study and validation cohort. Independent risk factors for SD were duration of intubation (OR=1.08; 95% CI 1.02-1.17, p=0.03) and hemodynamic failure (OR=4.46; 95% CI 1.27-21, p=0.03).Conclusion: Our BSE is accurate to detect SDs after extubation in critically ill patients and can easily be implemented in an ICU setting.

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