scholarly journals Bedside echocardiography in critically ill patients

2015 ◽  
Vol 13 (4) ◽  
pp. 644-646 ◽  
Author(s):  
Eduardo Casaroto ◽  
Tatiana Mohovic ◽  
Lilian Moreira Pinto ◽  
Tais Rodrigues de Lara
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Basic Training ◽  
Common Procedure ◽  
Left Ventricle Function ◽  
Non Invasive ◽  
Bedside Echocardiography ◽  
Cardiovascular Assessment ◽  
Ventricle Function

ABSTRACT The echocardiography has become a vital tool in the diagnosis of critically ill patients. The use of echocardiography by intensivists has been increasing since the 1990’s. This tool has become a common procedure for the cardiovascular assessment of critically ill patients, especially because it is non-invasive and can be applied in fast and guided manner at the bedside. Physicians with basic training in echocardiography, both from intensive care unit or emergency department, can assess the left ventricle function properly with good accuracy compared with assessment made by cardiologists. The change of treatment approach based on echocardiographic findings is commonly seen after examination of unstable patient. This brief review focuses on growing importance of echocardiography as an useful tool for management of critically ill patients in the intensive care setting along with the cardiac output assessment using this resource.

scholarly journals Impact of non-invasive respiratory support in severe patients with COVID-19

ANALES RANM ◽  
2020 ◽  
Vol 137 (137(02)) ◽  
pp. 154-160
Author(s):  
Ester Zamarrón ◽  
Carlos Carpio ◽  
Ana Santiago ◽  
Sergio Alcolea ◽  
Juan Carlos Figueira ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Respiratory Therapy ◽  
Respiratory Support ◽  
Intensive Care Patients ◽  
Non Invasive ◽  
Discharged Patients ◽  
Respiratory Treatment ◽  
The Impact

Objectives: to assess the impact of non-invasive respiratory therapies in critically ill patients diagnosed with COVID-19. Methods: retrospective cohort study of COVID-19 hospitalized patients who required non-invasive respiratory support. The impact of these treatments was evaluated in three groups of patients: pre-intensive care patients, discharged patients from critical care unit (CCU) and non-CCU admitted patients. The impact was assessed 30 days after completing respiratory therapy and was categorized as hospital discharge, transfer to a rehabilitation center, admission to the UCC and deceased. Results: a total of 80 patients were included (average age: 65.9 ± 11.9; men = 45 [56.3%]). 29 (36.3%) patients received BIPAP, 35 (43.8%) CPAP and 27 (33.4%) high-oxygen nasal cannula. Regarding the groups for the indication of respiratory treatment, 37 (46.3%) patients corresponded to the pre-intensive care patients, 24 (30%) were discharged patients from the CCU and 19 (23.8%) to the non-CCU admitted group. In the pre-intensive care, admission to a CCU was avoided in 19 (52.8%) patients and, on the other hand, 14 (38.9%) patients finally were admitted in a CCU. In the group of discharged patients from the UCC 19 (82.6%) patients showed a favorable course of disease. Only 3 (13%) patients were admitted in a UCC or died. Finally, in the group of non-CCU admitted, 6 (31.3%) improved after the use of respiratory therapy and 13 (68.4%) were deceased. Conclusions: respiratory therapies have a favorable impact on critically ill patients affected by COVID-19, both in patients with an indication for admission in the CCU, in those who are discharged from the CCUs and in those who do not have criteria for admission in these units.

scholarly journals Craniocerebral hypothermia as a therapeutic treatment option for thermal balance disturbances in post-comatose patients

2020 ◽  
Vol 2 (1) ◽  
pp. 11-19
Author(s):  
O. A. Shevelev ◽  
Sh. Kh. Saidov ◽  
M. V. Petrova ◽  
M. A. Chubarova ◽  
E. Sh. Usmanov
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Algorithm ◽  
Traumatic Injuries ◽  
Non Invasive ◽  
Medical Institutions ◽  
Disability Rate ◽  
Level Of Consciousness ◽  
Chronically Critically Ill

Background. Functional outcome in patients after cardiovascular, cerebral or traumatic injuries often remains unfavorable, what needs long rehabilitation and care. Aims. Optimization of chronically critically ill patients treatment using selective craniocerebral hypothermia added to a standard intensive care. Methods. Use of craniocerebral therapeutic hypothermia device ATG-01 has greater clinical efficacy in mortality rate, CRS-R rate and modified Rankin scale rate, as well as decrease in disability rate. Treatment algorithm with the use of craniocerebral hypothermia device ATG-01 has greater efficacy in cost- effectiveness analysis. Results. Methods of multipositional SHF- radiothermometry and thermomonitoring, as well as non-invasive craniocerebral hypothermia used in chronically critically ill patients for the first time. Results of our research have showed high efficacy of these methods and let us optimistically estimate the perspective to involve CCH in rehabilitation interventions of such patients. Conclusion. Our results can be used in Intensive Care Units of different medical institutions that provide healthcare to patients with brain damage and common central nervous system diseases that outcome to low level of consciousness.

scholarly journals Non-invasive detection of a femoral-to-radial arterial pressure gradient in intensive care patients with vasoactive agents

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Matthias Jacquet-Lagrèze ◽  
David Claveau ◽  
Julie Cousineau ◽  
Kun Peng Liu ◽  
Jean-Gilles Guimond ◽  
...  
Keyword(s):  
Intensive Care ◽  
Arterial Pressure ◽  
Pressure Gradient ◽  
Critically Ill ◽  
Radial Artery ◽  
Brachial Artery ◽  
Critically Ill Patients ◽  
Vasoactive Agents ◽  
Non Invasive ◽  
Radial Artery Pressure

Abstract Background In patient requiring vasopressors, the radial artery pressure may underestimate the true central aortic pressure leading to unnecessary interventions. When using a femoral and a radial arterial line, this femoral-to-radial arterial pressure gradient (FR-APG) can be detected. Our main objective was to assess the accuracy of non-invasive blood pressure (NIBP) measures; specifically, measuring the gradient between the NIBP obtained at the brachial artery and the radial artery pressure and calculating the non-invasive brachial-to-radial arterial pressure gradient (NIBR-APG) to detect an FR-APG. The secondary objective was to assess the prevalence of the FR-APG in a targeted sample of critically ill patients. Methods Adult patients in an intensive care unit requiring vasopressors and instrumented with a femoral and a radial artery line were selected. We recorded invasive radial and femoral arterial pressure, and brachial NIBP. Measurements were repeated each hour for 2 h. A significant FR-APG (our reference standard) was defined by either a mean arterial pressure (MAP) difference of more than 10 mmHg or a systolic arterial pressure (SAP) difference of more than 25 mmHg. The diagnostic accuracy of the NIBR-APG (our index test) to detect a significant FR-APG was estimated and the prevalence of an FR-APG was measured and correlated with the NIBR-APG. Results Eighty-one patients aged 68 [IQR 58–75] years and an SAPS2 score of 35 (SD 7) were included from which 228 measurements were obtained. A significant FR-APG occurred in 15 patients with a prevalence of 18.5% [95%CI 10.8–28.7%]. Diabetes was significantly associated with a significant FR-APG. The use of a 11 mmHg difference in MAP between the NIBP at the brachial artery and the MAP of the radial artery led to a specificity of 92% [67; 100], a sensitivity of 100% [95%CI 83; 100] and an AUC ROC of 0.93 [95%CI 0.81–0.99] to detect a significant FR-APG. SAP and MAP FR-APG correlated with SAP (r2 = 0.36; p < 0.001) and MAP (r2 = 0.34; p < 0.001) NIBR-APG. Conclusion NIBR-APG assessment can be used to detect a significant FR-APG which occur in one in every five critically ill patients requiring vasoactive agents.

scholarly journals Non-invasive Oscillometry-Based Estimation of Cardiac Output – Can We Use It in Clinical Practice?

2021 ◽  
Vol 12 ◽  
Author(s):  
Alexander Reshetnik ◽  
Jonida Gjolli ◽  
Markus van der Giet ◽  
Friederike Compton
Keyword(s):  
Cardiac Output ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pulse Wave ◽  
Estimation Method ◽  
Fluid Challenge ◽  
Pulse Wave Analysis ◽  
Wave Analysis ◽  
Non Invasive

While invasive thermodilution techniques remain the reference methods for cardiac output (CO) measurement, there is a currently unmet need for non-invasive techniques to simplify CO determination, reduce complications related to invasive procedures required for indicator dilution CO measurement, and expand the application field toward emergency room, non-intensive care, or outpatient settings. We evaluated the performance of a non-invasive oscillometry-based CO estimation method compared to transpulmonary thermodilution. To assess agreement between the devices, we used Bland–Altman analysis. Four-quadrant plot analysis was used to visualize the ability of Mobil-O-Graph (MG) to track CO changes after a fluid challenge. Trending analysis of CO trajectories was used to compare MG and PiCCO® calibrated pulse wave analysis over time (6 h). We included 40 patients from the medical intensive care unit at the Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin between November 2019 and June 2020. The median age was 73 years. Forty percent of the study population was male; 98% was ventilator-dependent and 75% vasopressor-dependent at study entry. The mean of the observed differences for the cardiac output index (COI) was 0.7 l∗min–1*m–2 and the lower, and upper 95% limits of agreement (LOA) were -1.9 and 3.3 l∗min–1*m–2, respectively. The 95% confidence interval for the LOA was ± 0.26 l∗min–1*m–2, the percentage error 83.6%. We observed concordant changes in CO with MG and PiCCO® in 50% of the measurements after a fluid challenge and over the course of 6 h. Cardiac output calculation with a novel oscillometry-based pulse wave analysis method is feasible and replicable in critically ill patients. However, we did not find clinically applicable agreement between MG and thermodilution or calibrated pulse wave analysis, respectively, assessed with established evaluation routine using the Bland–Altman approach and with trending analysis methods. In summary, we do not recommend the use of this method in critically ill patients at this time. As the basic approach is promising and the CO determination with MG very simple to perform, further studies should be undertaken both in hemodynamically stable patients, and in the critical care setting to allow additional adjustments of the underlying algorithm for CO estimation with MG.

Circulation and circulatory support in the critically ill

2020 ◽  
pp. 3881-3891
Author(s):  
Michael R. Pinsky
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Assessment ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Haemodynamic Monitoring ◽  
Vast Array ◽  
Bedside Echocardiography ◽  
Diagnostic Approaches

Cardiovascular dysfunction is common in critically ill patients and is the primary cause of death in a vast array of illnesses. The prompt identification and diagnosis of its probable cause, coupled to appropriate resuscitation and (when possible) specific treatments, are cornerstones of intensive care medicine. Cardiovascular performance can be assessed clinically at the bedside and through haemodynamic monitoring, and with therapeutic or other proactive interventions. Rapid assessment of shocked patients by bedside echocardiography is increasingly used in those institutions where equipment and expertise are available. Diagnostic approaches or therapies based on data derived from invasive haemodynamic monitoring in the critically ill patient assume that specific patterns of derangement reflect specific disease processes, which will respond to appropriate intervention.

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

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